The Dark Side of U.S. Medicine
by Juli Mosoff
Since 1990, when the first hospital-based proton treatment facility was built by the Loma Linda University Medical Center, a new option has been available for cancer patients deciding on a treatment plan-proton therapy. Proton therapy uses a nuclear particle accelerator that shoots highly energized protons at the speed of light into tumors to treat cancer, and it has arguably become the most effective form of radiation available. It is also one of the most exact forms, as protons aimed directly at the cancer can be stopped directly at the tumor rather than depositing their energy all along the way to the tumor the way that typical radiation treatment sometimes does.
Proton therapy has been especially successful in the treatment of prostate cancer by helping to reduce many of the side effects, such as impotence, that are caused by radiation being exposed to organs surrounding the prostate. Extensive research has been performed ever since proton therapy became available, and scientists now hope that proton therapy will become just as useful for the treatment of breast cancer.
However, as useful as proton therapy might be, scientists are worried that hospitals are entering a new nuclear arms race where the competition to get the latest cancer-treating technology comes with a huge price tag. Although some experts say that an increase in proton treatment facilities is necessary for the treatment of cancer, according to The New York Times, others say that hospitals are merely looking for the prestige and profits that these machines will bring.
For ten years, the Loma Linda University Medical Center was the only cancer center that used proton treatment, but five more have been built since 2000 and dozens more are expected to be created in the near future. Most people underestimate the sheer size of the treatment centers, each of which must be the size of a football field with 18-foot thick walls surrounding the 222-ton proton accelerator. The cost of building a treatment center is also often underestimated—each center costs over $100 million.
Nuclear particle accelerators have been described as "the world's most expensive and complex medical device" by one of the equipment vendors that produce them. Because of the huge cost of installing the machine, some scientists worry that hospitals will push patients toward this much more expensive treatment rather than a less expensive one that may work as well.
Other scientists wonder if proton treatment is really that much better than typical radiation treatment, which has been recently developed to leave less radiation behind. Some doctors, such as Anthony L. Zietman, a radiation oncologist at Massachusetts General Hospital, say that "you can scarcely tell the difference between them except in price." Proton therapy regularly costs insurance companies about $50,000, twice the amount that radiation therapy costs.
Hospitals are ignoring this thought, rushing to get funding to build their own nuclear particle accelerator, and the projects are often funded by those who want to get the most possible profit from the facility. One proposed treatment center, ProCure Treatment Centers, is gaining funds from community hospitals and private practices, using incentives such as giving individual doctors partial ownership of the center and a part of the earnings once it opens.
Even the M. D. Anderson Cancer Center, which is part of the University of Texas, has done whatever it could to make as much money as possible. Although the newly built proton center is located on the university’s campus, it is not considered part of the university in order to protect the university's credit. It is instead considered a completely separate facility used for gaining profit, even though it is located within a cancer center that is part of the university.
Some doctors and scientists are speaking out against the "arms race" that is being held in hospitals. Timothy R. Williams, former co-chairman of the radiation oncology society's health policy committee, said that many hospitals are building centers for the wrong reason, and said that the health profession "was threatening to debase itself if doctors were building centers for the money or competitive advantage." Doctors say that the health profession is supposed to benefit the patient, not the hospital itself. Dr. Zietman said that he is "fascinated and horrified by the way it's developing... This is the dark side of American medicine."
