How Proton Beams Are a Metaphor for Our Broken Health Care System

Via Austin Frakt, here's a lovely little chart from a Brookings report that helps explain why health care costs in the United States are so stubbornly hard to control. It shows the growth in proton beam facilities, which Kaiser Health News describes as an "arms race" between hospitals. These facilities are the size of a football field and cost hundreds of millions of dollars to construct.

Which might be OK if PRT were truly an advance in treating cancer. Unfortunately, there's not much evidence that it is, even though it costs far more than old-school IMRT radiotherapy. Here's the conclusion from a recent study of prostate cancer cases:

Although PRT is substantially more costly than IMRT, there was no difference in toxicity in a comprehensive cohort of Medicare beneficiaries with prostate cancer at 12 months post-treatment.

In other words, the supposed advantage of PRT—that it targets cancers more precisely and has fewer toxic side effects—doesn't seem to be true. It might be better in certain very specialized cases, but not for garden variety prostate cancer.

And yet, new facilities are being constructed at a breakneck pace. Why? Because if they build them, patients will come. "They're simply done to generate profits," says health care advisor Ezekiel Emanuel. Roger that.