The creation of new technology is a complicated, risky business regardless of the area of healthcare or industry. The cover story in this issue, “Proton Beam Centers Multiply Despite Economic Risks,” illustrates that the oncology field is no exception to those rules of the marketplace.
Proton therapy centers that cost at least tens of millions of dollars to build are under construction throughout the United States, even though experts remain divided over whether the technology is superior to conventional radiotherapy.
Intuitively, it would seem that radiation treatment that hits cancerous cells while sparing surrounding tissue would be far more tolerable and effective for patients. In practice, that theory has been difficult to prove in clinical trials. As a result, insurers are likely to approve proton therapy for patients with intracranial, ocular, or skull-based tumors but not for the prostate cancers that institutions were hoping would help pay for the facilities.
Unlike new drugs, medical technology can be introduced in the United States without evidence of superiority, one commentator noted. In a market-driven economy, cancer centers that build proton therapy facilities are taking an enormous financial risk.
How else can innovative technology advance? Undoubtedly, there are other economic models. However, patients and their families want the most advanced treatments that our best minds can serve up.
We cannot imagine being in the situation that parents of a 5-year-old boy in Great Britain faced when they decided to remove their son from a hospital without the doctor’s permission and travel to Prague for proton treatment. The therapy is not offered in the United Kingdom—but it probably will be by 2018 after the outcry over that incident. Two proton beam centers are now being planned.
Getting from here to there in healthcare quite often seems to be a messy business. We don’t pretend to have all the answers, but we certainly want to help raise the questions. Please let us know what you think about these matters and, as always, thank you for reading.