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Proton Beam Clinics: Boondoggle Or Boon?

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Mayo Clinic is building two new proton beam treatment facilities, one in Minnesota and one in Arizona. They exemplify either “what is wrong with American health care today” or an “investment to ensure that [Mayo’s] patients have access to proven, effective, safe treatment for serious illnesses.”

Or maybe both. Or neither.

The “what’s wrong” assessment comes from Ezekiel J. Emanuel, MD, PhD, and Steven D. Pearson, MD, in an op-ed piece last week in the New York Times. Dr. Emanuel, a bioethicist and former White House adviser (Rahm Emanuel, mayor of Chicago and former chief of staff for President Obama, is his brother), is a vice provost and professor at the University of Pennsylvania. Dr. Pearson is president of the Institute for Clinical and Economic Review at the Massachusetts General Hospital’s Institute for Technology Assessment.

Proton beam radiation therapy for cancer can be focused more precisely than other types of radiotherapy, minimizing damage to healthy tissue. However, proton beam machines are tremendously expensive, making the therapy rare and costly.

And, according to Drs. Emanuel and Pearson, unnecessary. They wrote:

The higher price would be worth it if proton beam therapy cured more people or significantly reduced side effects. But there is no evidence showing that this is true, except for a handful of rare pediatric cancers, like brain and spinal cord cancer.

John Noseworthy, M.D., Mayo’s president and CEO, took “serious issue” with Dr. Emanuel and Pearson a couple of days later in a notably calm op-ed piece of his own, this one in the Star Tribune of Minneapolis-St. Paul.

Mayo decided to build the proton beam facilities, he said, only after six years of researching the therapy:

The evidence shows proton beam therapy improves the effectiveness of cancer treatment while sparing surrounding key organs and tissue. The medical effectiveness of proton therapy and its benefit to our patients was the critical factor in our decision to establish these programs.

Dr. Noseworthy summed up the case for such admittedly expensive experiments in a single succinct paragraph: “Mayo Clinic always does what’s best for patients. We will use the proton beam only if it is the best treatment for the right patients. Our program will help to establish this therapy’s appropriate role in medical practice. If there is no benefit to a particular proton therapy for a particular illness, we will discontinue its use, just as Mayo Clinic has for the past 150 years with other technologies and programs too numerous to list.”

That process is one of the ways medical science advances. It also can be really expensive. Drs. Emanuel and Pearson, among others, may contend that we can’t afford it.

But can we afford not to explore what may be significant advances in treatment just because of initially high financial cost?

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One Response to “Proton Beam Clinics: Boondoggle Or Boon?”

  1. william on January 13th, 2012 at 11:40 am

    Interesting that Rahman does not mention his institution Penn, just opened proton beam therapy. Hmmmmm.