Friday, September 06, 2013

I wasn't cynical enough about the proton beam industry

I've posted a number of stories about the manner in which the medical-financial complex has pushed through the construction of very high cost proton beam machines, creating a market for a service that has limited clinical support.  It turns out I wasn't cynical enough.

Here's a report from The Advisory Board Company entitled, "Achieving financial success in proton therapy in 2013." Here's the imperative laid out in the report:

This turns the scientific method on its head. Instead of conducting research to determine if proton beam therapy is clinically more efficacious that traditional radiotherapy, we are told to conduct trials designed to substantiate the superiority of this technology. Here's the advice:

Facing heavy payer scrutiny and patient recruitment challenges for large-scale randomized controlled clinical trials, proton centers will need to augment clinical trials while refining strategies for engaging private payers. For tumor sites facing scrutiny, proper patient selection, recent data, and messaging will be very important.

In other words, pick the patient sample to support the desired conclusions.

Meanwhile, another report sets forth marketing advice. Here it is:

As proton centers enter the market in 2013, administrators will need to adapt referral strategy to a new environment.   Changing market forces, including the proliferation of centers,  an expansion in clinical eligibility, trends in physician-hospital relationships, and healthcare reform create new marketing imperatives. 

Now, centers will focus not on a largely exclusive, trans-regional marketplace, but focus much more intensely on finding patients within their own backyards, raising the need to convert exploratory self-referrals.

Let's think about the meaning of: "Convert exploratory self-referrals."  We're going to take ordinary people suffering from cancer and persuade them that this technology is the answer to their problems.  So direct-to-consumer marketing will be applied to this patient population.

Well, it's worked before, e.g., with the da Vinci surgical robot.  Who can blame these guys for taking a leaf out of that book?


akhan13 said...

I agree with you on the premature use of proton beam therapy at higher rates. But why is this your crusade? You are uniquely positioned to criticize healthcare inefficiencies and you pick a more expensive radiation oncology modality that happens to be unproven in trials (and given the evidence will probably be marginally better if we test with appropriate power). There are bigger issues with publicly funded healthcare than PBT vs IMRT.

Paul Levy said...

This is actually one of the biggest, when you add up the billions being spent.

Paul Levy said...

Gary Schwitzer offers more here:

"This is such an important story – demonstrating the hodge-podge decision-making about technology proliferation and cost control in the US healthcare non-system."

Neville Sarkari MD, FACP said...

It's not so much about PBT itself, but about the way new technology, new drugs, and new procedures are marketed. It ends up being an incredibly powerful driver of un-needed health care cost increases.

And that is worth pointing out again and again.

Linda Galindo said...

I would be fascinated to know how the process for Board approval to take on this "revenue" center is accomplished. Isn't that an opportunity for accountability before the fact? Or, are these proton beam machines only going in stand alone clinics at the peril of venture investors?

Keith said...

The ever increasing proportion of financing of medical research by commercial interests has created great skepticism in the medical community. Indeed, studies are designed so they will more likely show the desired results, or the data are cherry picked to provide the preferred answer to the question being considered. What elso would one expect when we are dealing with enormous amounts of profit that can hinge on what these studies show?! The finaciers of these studies are those with the most to gain from the desired result, so not too suprisng to see the Advisry Board Company reccommending studies that will convince us of Proton Beams superiority.

First item I always look at when reading a journal article is who funded the study.

Anonymous said...

Keith, to my way of seeing it, the commercial interests are simply doing what they do: going where the money is. What I object to is all the M.D.'s who sell their souls to be on the payrolls of the commercial interests and help further their commercial goals.
There is only 'great skepticism in the medical community' among the increasingly small portion of that community which holds to its ethics and remains apart from those commercial interests.

nonlocal MD