Proton promotions


Journalists can set the agenda for public discussion on health care reform. Or they can simply be led by the nose by special interests down a path of the medical arms race.

The latter was the case with a Columbus Dispatch story last week. It was a shill of a story and it should have done so much more to inform readers.

The story was about one Ohio man having to go to Florida for proton beam therapy for prostate cancer. But the story seemed to promote the plans for two proton beam facilities of their own in the near future right there in central Ohio so no one would have to travel to Florida anymore.

Our review summarized:

"Cheerleading hometown story, perhaps meant to pave the way for two very expensive proton therapy centers in Central Ohio. No hard questions about whether two are needed, or about the therapy itself.”

Here's a website promotion for the Florida proton center the Ohio man visited.

UFL proton website.png

The story could have asked for evidence on the benefits the website promotes. And for evidence on the "harder on cancer, easier on you" claim.

Indeed, the Boston Globe this week looked for evidence and reported:

"...a study found that though proton beam therapy is at least five times as expensive as other forms of radiation, only a few small, brief studies have examined its effectiveness. There was no evidence that it was better at curing prostate cancer, and insufficient evidence that it was superior at preventing side effects."

The Columbus paper could have asked questions that appeared in a New York Times story about 14 months ago. Excerpt:

“Some experts say the push reflects the best and worst of the nation’s market-based health care system, which tends to pursue the latest, most expensive treatments — without much evidence of improved health — even as soaring costs add to the nation’s economic burden.”

“There are no solid clinical data that protons are better,” said Dr. Theodore S. Lawrence, the chairman of radiation oncology at the University of Michigan. “If you are going to spend a lot more money, you want to make sure the patient can detect an improvement, not just a theoretical improvement.”

Meantime, here’s an ad one medical center is running in local papers in advance of their acquisition of a proton beam facility.

Proton ad.png

Questions consumers might ask:

1. How can you know you’ll treat 2,000 patients a year when it hasn’t even opened yet? How can you know this will be their choice? Or that it will be the best option for 2,000 a year?

2. Why doesn’t the ad mention any evidence of benefits or harms?

3. Why doesn’t the ad mention cost?

The stimulus plan contains more than $1 billion in funding for "comparative effectiveness" research and guidelines. It is predictable that some in the medical arms race industry will scream "rationing" when questions about evidence and cost-effectiveness arise. Rather than "rationing" journalists could start talking about "rational" health policy decisions. And it starts on the local level, questioning whether any one area needs two - or even one - proton beam facility.


American Society for Therapeutic Radiology and Oncology's annual meeting, Sept 2008. Rad Oncology group at Harvard and Mass Gen. Hospital presented a study comparing proton beam and conventional photon radiation. Proton beam had 1/2 the rate of new cancers (i.e. rebound tumors) as the old way. I think this is a significant improvement. It was a fairly large study with about 1500 patients.


There clearly isn't unanimity in that Harvard/MGH group you cited. In that Boston Globe article I cited is this excerpt:

Anthony Zietman, a radiation oncologist at Massachusetts General Hospital, is part of a team that wants to compare two or three different kinds of radiation therapies for prostate cancer, including proton beam. Such work, he said, is urgently needed.

"We've got to help patients sort their way through this morass of options," he said. "If these new technologies are better - prove it. If it's worth the cost, we should pay the cost. If it's not worth it, we should dispense with them or not cover them."

About this Entry

This page contains a single entry by Gary Schwitzer published on March 3, 2009 7:38 AM.

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