Monday, August 25, 2014

Fueled by patient demand? No way.

I frankly expected better from HealthLeaders Media, which usually has well researched and thoughtful stories.  This one, though, reads like a press release from the investment bankers and law firms that make a bundle from proton beam projects.

Here's the most troubling statement:

As more American patients have become aware of the less invasive technology, they are emerging as a key driver of proton beam center growth in the United States, Caron says.

Who's Mr. Caron?

A partner at Chicago-based law firm McDermott, Will and Emery, who has worked on proton beam therapy center projects for more than eight years.

Aided and abetted by Leonard Arzt, executive director of the National Association for Proton Therapy, who says:

[C]onsumer demand for the treatment has created a marketing opportunity for the top cancer centers in the country. "If you're in the radiation oncology business, you want the latest and greatest tool."

Only at the bottom of the story do we get a truly thoughtful comment:

But Cigna, which also works with Bluffton, SC-based CareCore National LLC to manage proton beam therapy coverage, reimburses the therapy for only three conditions, citing a lack of clinical evidence showing the treatment is superior to more conventional radiation therapy for most cancers. "While PBT has been used in patients in the United States since the mid-1950s, and although it has been shown to be effective in some malignancies, there is no published data clearly demonstrating superiority over conventional forms of radiation therapy," state the Bloomfield, CT-based carrier's guidelines for radiation therapy.

If you want to know what's really driving consumer demand, it is the growing supply of these machines, supported by ill-conceived Medicare funding--a true product of the medical-industrial complex.  Gary Schwitzer and I have been writing about this debacle for several years.  In one, Gary quotes a Bloomberg report:

“Proton-beam therapy is like the death star of American medical technology; nothing so big and complicated has ever been confronted by the system,” said Amitabh Chandra, a health economist at Harvard University’s John F. Kennedy School of Government. “It’s a metaphor for all the problems we have in American medicine.”


nonlocal MD said...

If ever there were a poster child for re-instituting Certificates of Need, this is it.

akhan13 said...

We are a CON state here in MD and we are still getting them in every major AMC- they have too much political clout to implement the CONs effectively.

Barry Carol said...

As a patient, what I would really like to have access to in making medical choices is objective, independent information that covers the pros and cons of various approaches to surgical procedures and other expensive care and that can evaluate conflicting claims. The sponsor of such information should be paid on a subscription basis or by a foundation grant and should not accept advertising. Access to actual contract reimbursement rates and quality data would also be extremely useful. It would be a cross between Consumer Reports and Angie’s List.

Paul Levy said...

Barry, what I have come to understand is that your desire--which is so sensible--is contrary to powerful business interests in the medical-industrial community and is there for opposed by action or lack of action when it is proposed. I include many academic medical centers in that group.

Also, the CMS process has clearly become corrupted by those same influences. Witness the fact that the premium paid for proton beam treatment has been increased over the past several years, in the absence of scientifically based conclusions about efficacy for many types of cancer.

Barry Carol said...

Thanks Paul. I wonder how prevalent these high technology surgical systems are in other developed countries and, to the extent they exist, how much acceptance they have among patients. My perception, which may well be wrong, is that Americans are especially enamored with high technology out of a desire for the latest and greatest whether it is actually better than older technologies or not.

Just as many U.S. patients equate lots of testing with thorough treatment and many others want the heroic full court press at the end of life even when it’s futile either because family members can’t let go or for other reasons, my sense is that often unreasonable patient expectations make our healthcare system considerably more expensive than it needs to be or should be. Doctors, for their part, can then argue that they are just trying to satisfy their patients’ expectations while they happen to get paid more to do more in the process.