Hospitals Look to a Nuclear Tool to Fight Cancer

The feed points us to a NYTimes article about hospitals using particle accelerators to treat cancer. While expensive, proponents say that the proton beams generated by the accelerators are more precise than conventional X-ray radiation therapy. This results in fewer side effects and reduced irradiation of surrounding tissue. The technology's critics say that the cost is not justified by a measurable increase in the level of care given to the patients. Nevertheless, this is an excellent example of "pure scientific research" leading to a useful, unrelated technique. From the NYTimes: "Tumors in or near the eye, for instance, can be eradicated by protons without destroying vision or irradiating the brain. Protons are also valuable for treating tumors in brains, necks and spines, and tumors in children, who are especially sensitive to the side effects of radiation."

Comments

As the husband of a survivor...

[_14k4]

Personally, who cares how expensive it is. I mean, we're not rich people and we are pretty close to that sarcastic "upper lower middle class" line.. but watching my wife go through chemo and surgery (no radiation, thank God) hurt me more than I can ever explain. If there was a way to make sure that radiation was a little "cleaner" and crisp around the edges, I'd say go for it. Chemo and surgery are hell enough.

Plus, x-rays are so last century. Everyone knows the new thing is protons.

Re:As the husband of a survivor...

[Rich0]

Personally, who cares how expensive it is.

The person paying for it. In the US that would probably be an insurance carrier (those who pay a higher premium might get access to it). In most of the rest of the world it would be your government (if you are lucky you might get access to it).

I have only sympathy with what you went though - I've had someone close to me go through life-threatening medical problems as well. I'm all for improving the level of technology available. However, economics always comes into play - it just isn't politically-correct to admit it.

No nation on earth fully meets their medical needs financially - everybody rations care at some level. Every nation also faces questions like "is it better to spend $500M on one machine in one hospital that will cure 10 extra people per year, or $500M on something else that might save more lives?". The cost of one of those machines would also pay for a lot of doctors and nurses as well - you might save more lives just by giving patients more time with caregivers.

The problem in medicine is that nobody is allowed to discuss the hard questions like this without being branded as insensitive or inhuman. The problem is that the hard decisions get made one way or another, and without genuine debate the decisions are probably made in a less-than-ideal way. Money spent on particle accelerators saves lives - but so does money for food/education/sanitation/law-enforcement/doctors/clean-air/etc. There is only so much money to go around - and economics are all about spending it where it will do the most good...

Bad guess

[hrvatska]

No, it's shorthand for prominent and respected radiation oncologists who don't see any difference in cure rates and side effects for advanced x-ray therapy and proton beam therapy for many cancers. They are concerned that medical centers and their financial backers, which are investing over 100,000,000 USD per facility, are pushing patients to the new therapy just to recoup their expenses, with no real benefit for the patient. The article offers this example.

Dr. Zietman said that while protons were vital in treating certain rare tumors, they were little better than the latest X-ray technology in dealing with prostate cancer, the common disease that many proton centers are counting on for business. "You can scarcely tell the difference between them except in price," he said. Medicare pays about $50,000 to treat prostate cancer with protons, almost twice as much as with X-rays.

Insurance companies frequently follow Medicare's lead, so we may find in a few years that we're paying gobs of money for proton beam treatments that do not offer better outcomes than alternatives. Once it gains acceptance as a standard treatment for cancers on which it offers no better outcome, we'll be paying a huge collective sum in taxes and insurance rates with no discernable benefit.

Re:critics... let me guess

[arivanov]

Aaa... The so called ~NHS logic. Treat 10 times more people regardless of the fact that the result is nil, but do not use the treatment that may actually save one of the 10 because it is expensive.

They do it for everything.

They consider it OK to treat Eczema by splating children with a bucket of hydrocortisone twice a day and drowning them in Claritine despite the fact that the result is nil and the treatment drags on for decades. After all it is cheaper per-day and per-dose than Pimercrolimus or Advantan. They miss a crucial difference - the latter can actually put eczema under control and reduce it to a point where treatment is unnecessary most of the time.

Same for allergies - there is practically no way in hell to get them to approve gammaglobulinisation therapy.

Same for vaccines - they use "all animals are equal, but some are more equal than the others

approach and vaccinate themselves against chickenpox and leave children who are in high risk groups like astma and eczema sufferers to fend for themselves (and die from secondary infections). After all, vaccination is expensive, isn't it.

Same for cancer. Treat 10 people without any one of them getting improved survival rates as long as "it improves their quality of life", but do not use treatment that will actually give one of out 10 a chance to survive because it is expensive. Do not pay for herceptine because it is expensive, use cheap stuff regardless of the fact that as a result UK has cancer survival rates of a 3rd world country (worse than the whole of the EU).

And so on.

Sorry. NHS treatment selection logic is flawed by design. It is based on fake happy commie concepts of fairness which are misplaced here. The main goal of medicine is to try to cure the patient. If you have the choice of using a medication that has a chance of curing even one more patient and medication that will cure even one less the "cost" option is simply no longer part of the equation. It is there only if the treatments are equivalent.