Whenever a new medical technology comes out in the U.S., a few things happen. Doctors, hospitals, the media, and, of course, the drug and device makers cheer. Newer technology must always be better, right? Never mind if it costs a little extra. We’re talking about a patient’s life and well-being, after all.
But when we ignore the higher cost of the new technology, or don’t consider cost in a broad contextual view of the standard of care, we allow perverse market incentives to take root. We end up as a society directing people to the new and expensive treatment option, regardless of the evidence.
This kind of attitude has helped create a dysfunctional market with runaway health spending, as Time magazine recently described in a devastating cover story. The piece resonated for me, because as a journalist, I see plenty of new medical technologies come along that don’t have solid evidence that they provide benefits that outweigh their added cost.
The latest advance I’ve seen follow this familiar pattern is happening in my community of Seattle. I toured the region’s new proton therapy center run by a private company called ProCure and the Seattle Cancer Care Alliance—a collaboration of three renowned institutions—the University of Washington, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital.
This facility, the 11th of its kind in the U.S., is a scientific marvel. Instead of using standard radiation beams to zap tumors, the $152 million facility covers two-thirds of a football field, and houses a 220-ton cyclotron that forms proton beams to precisely whack tumors. Although standard radiation beams can be shaped and conformed to tumors with pinpoint precision to minimize damage to healthy surrounding tissues on the way in and out of the body, proton therapy is thought to be even a more precise way to hit the tumor and reduce side effects, says George Laramore, the chair of the Department of Radiation Oncology at the University of Washington, and the medical director of the new Procure/Seattle Cancer Care Alliance facility.
Cutting-edge as it sounds, proton therapy isn’t new. It’s been around since the 1950s, but because of the size and cost of the capital equipment required, it’s been limited mostly over the years to patients willing to travel to just a few sites in the U.S., including ones in Southern California and Boston. About 84,000 patients have been treated worldwide with proton therapy, and many have lived long and healthy lives afterward, Laramore says.
Even after all those years and that many patients, the medical evidence to support use of proton therapy has its limits. It does appear to have value for medulloblastoma, a dangerous type of brain tumor more common in children than adults. Laramore says data shows that kids with medulloblastoma who were followed
