You Can Now Treat Prostate Cancer with the Most Expensive Medical Device in the History of the World If you've heard that proton therapy is the magic bullet for prostate cancer, be warned: There's a lot of money tied up in this therapy, but not a lot of research. That's a scary combination for any health treatment. Let's look at the facts. . . Continued below. . .
This treatment definitely has some advantages Proton therapy isn't even a new breakthrough, although the public didn't get interested till recently. The therapy was initially prompted by Dr. James Slater of Massachusetts General, who first started harvesting protons from a Harvard cyclotron in the early 1960s. Dr. Slater had been disheartened by the side effects of radiation treatment (using X-rays) and has since devoted most of his professional life to bringing proton-based treatments to medical facilities.Proton therapy itself is fairly simple. It uses a beam of protons to inject a tumor with radiation. Protons are one of the three main particles that make up atoms (the other two are electrons and neutrons). Protons have a positive charge while electrons have a negative charge. Like X-rays, protons wreck the genetic makeup of a tumor. More importantly, proton therapy is much more precise than other radiation therapies, but without the side effects. For example, when a patient undergoes X-ray treatment, tissues surrounding the tumor site are easily destroyed. The side-effects and resulting sickness can be overwhelming. But in proton therapy, the stream of charged particles can be tailored to the contours of the tumor, without affecting any tissues except the tumor. Unfortunately (and like too many things in the medical industry), proton therapy suffers from a money bias. Construction costs for a proton-beam generator can top $200 million, making it the most expensive medical device ever invented. One of the reasons the treatment is so expensive is that protons aren't exactly easy to harvest. For proton therapy, protons must be stripped from hydrogen atoms and then moved into a stream that is nearly as fast as the speed of light. The device that makes this possible weighs around 220 tons and must be housed in a structure at least the size of a football field. So, beyond the cost of the machine itself come considerable construction expenses for any hospital toying with the idea of offering this treatment. But here's the worst problem of all. . . Proton therapy involves spending a stupefying amount of money on something that doesn't necessarily work better than other prostate cancer treatments. Anthony Zietman, MD, of Massachusetts General Hospital in Boston and past president of the American Society for Radiation Oncology, has gone on record saying proton therapy is a very good treatment for prostates, but "It just doesn't appear to be superior treatment." In the world of peer-reviewed journals, they won't be able to say whether proton therapy deserves all the rave reviews it's gotten until somebody puts together a decade-long, randomized trial to see which treatments have the best outcome overall.In the meantime, the Internet has become a serious hindrance to spreading accurate information about this treatment. Loads of blogs and websites run by men who had success with their own proton treatment laud the benefits of proton therapy. I don't deny that they have good intentions. Many of these enthusiastic Internet writers feel proton therapy was the best and only cure for their prostate cancers. Plus, men love the fact that's it's non-invasive. Who wouldn't? After all, few things shake a man's pride like the idea of losing bladder function or becoming impotent. A man's well-being after conventional radiation or surgery can be very poor indeed. But the buzz reminds me of prime-time commercials from the pharmaceutical industry (although more honest, I hope). When you see a commercial for the latest and greatest pill, featuring happy people evangelizing a drug, it's hard not to wonder if it might work for you. Just remember, the bloggers are comparing proton therapy to conventional radiation and surgery. To be fair, it IS an improvement — a very expensive one. But why go there at all? The problem in this case is that too many websites are written by guys who aren't aware of the costs-versus-benefits of this treatment, much less the benefits of alternative cancer treatments. They're excited by the high-level technology — the ultimate power tool for guys — and they give false hope to millions of men searching the Internet for legitimate answers. The bias for proton therapy technology continues to grow with time, making it hard to put together any kind of a reliable study on outcomes. Researchers are finding that men who went in thinking proton treatment was superior, who then have unexpected and unnecessary side effects, still advocate proton therapy as the best choice they could have made. Marketers call it "post-purchase dissonance." When people have made an important choice, they have to convince themselves they did the right thing. If the purchase is a let-down, some people go into denial and still insist they made a good choice. And remember, as with most medical therapies these days, the advice you get from doctors is subject to a ton of bias. Dr. Zietman, while being interviewed for an article in Men's Health last year, said, "In the absence of knowledge, anything goes. Surgeons recommend their favorite surgery. Radiation oncologists recommend their favorite form of radiation." It follows that oncologists smitten with cool technology — and with making money — recommend proton therapy. Money-driven healthcare, the vampire that's sucking the life out of our country What's obvious here is that the least expensive option for treating early-stage prostate cancer rarely gets lip service from the experts. Officially, it's called "active surveillance." You may know it as "watchful waiting." Watchful waiting boils down to closely monitoring a patient and watching for any signs of growth in his cancer. If there's no growth, there's no treatment. If there is growth, the patient gets treated. Most prostate tumors are slow-growing. There's no pressing need to take action. And there are dozens of safe nutrients, foods and herbal remedies a man can use to control or eliminate prostate tumors without resorting to radiation, chemotherapy and surgery at all. I gave readers my take on all this in my Special Report, Don't Touch My Prostate.Proton treatment sounds to me like technology-driven medicine gone crazy. Frightened people with cancer are willing to buy into any kind of nonsense recommended by the men in white coats, and of course we all get handed the bill. Medical care is the single biggest expense driving the country into bankruptcy and potential social and political collapse. Meanwhile, to the doctors and industrialists meting out the treatments, there are massive profits to be had treating prostate cancer with protons. Proton therapy isn't worthless. Far from it. It actually shows more reliable promise for treating brain, eye, and spinal cord tumors, as well as certain kinds of tumors in children. But treating something like childhood cancers requires multiple, lengthy sessions and insurance companies are loath to cover it. Prostate patients, on the other hand, are in and out in 20 minutes and need fewer total treatments. Medicare and most insurance companies cover the cost without hassle. And there are a lot of prostate cancer cases to funnel through the system. It's healthcare dictated by money, which is the worst kind. I should point out that even with the heavy emphasis on proton therapy as a miracle cure, it's hard to come by. Only 1% of radiation oncologists in the U.S. have experience in proton therapy. And right now, there are only nine proton centers in operation (though eight more are in development, which shows how the medical industry is responding to demand). Sometimes the best healthcare means bucking the trends Conclusive studies are a long way off. But for now, the best information we can find is that proton treatment is not much better than standard radiation treatment — just more expensive and more techno-fancy. I admit, it's hard to beat claims like those made by Loma Linda Medical Center on their website's "Proton Therapy for Prostate Cancer" page: "More accurate, non-invasive, painless, provided in an outpatient setting, little impact on energy level, and requires no recovery."But don't be so sure it's a good choice. There are many, many easy alternative treatments I'd try first. |
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