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Selling Proton Therapy

by MARTHA ROSENBERG

eventeen years after direct-to-consumer (DTC) drug advertising was instituted in the US, 70 percent of adults and 25 percent of children are on at least one prescription drug. Topping the adult pill category is–surprise!–antidepressants which are used by an astounding one in four women between 50 and 64. Topping the child pill category is–another surprise!–ADHD meds, though kids increasingly take blood pressure, diabetes and insomnia meds too. (Babies are actually given GERD medicine for spitting up.) Twenty percent of the population is now on five or more prescription medications. Ka-ching.

DTC advertising has done two pernicious things. It has created a nation of hypochondriacs with depression, bipolar disorder, GERD, Restless Legs, insomnia, seasonal allergies and assorted pain, mood and “risk” conditions and it has reduced doctors to order takers and gate keepers. Thanks to TV drug ads, patients tell doctors what is wrong with them and what pill they need, coupon in hand. Drug company-funded web sites even give patients talking points to use when they see the doctor, lest they don’t ring up a sale.

Selling prescription drugs like soap makes a mockery of a medical school education. It has created the need to train doctors in “refusal” skills said Richard Pinckney, MD, Professor at the University of Vermont College of Medicine at a 2010 Chicago conference attended by medical boards, accrediting agencies and representatives from the AMA, FDA, VA and 23 medical centers. Now the same technique is at play with
radiation therapy.

For at least two years, direct-to-consumer radiation ads have aggressively promoted “proton therapy” to patients, an expensive new kind of radiation treatment for people with prostate and other cancer that is said to limit radiation exposure to surrounding organs. While proton therapy sounds like a “scientific marvel,” writes biotech reporter Luke Timmerman, the evidence of its value is limited so far to brain
tumors called medulloblastomas and not other cancers for which it is marketed. There is also a “real problem” with the business model, writes Timmerman. Because a proton center costs $152 million to build and operate, it “creates an incentive for doctors within a network to steer their patients to proton therapy,” including cancer patients who may not be appropriate and who may “benefit just as much from an existing, lower-cost alternative.”

How much more expensive is proton therapy? The average Medicare reimbursement for proton treatment for prostate cancer is about $32,428 versus $18,575 for standard radiation. Other estimates place proton therapy at $50,000 for prostate cancer, twice as much as intensity-modulated radiation therapy (IMRT) which is also employed to limit radiation exposure to surrounding organs.

Is it proton therapy better? Not according to comparative effectiveness studies in the Journal of the American Medical Association (JAMA). Patients on the cheaper IMRT therapy had a 34 percent lower risk of gastrointestinal side effects compared to proton therapy. (IMRT was also associated with  22 percent fewer hip fractures and a 19 percent reduced need for further cancer treatment than traditional radiation though there was a greater risk of erectile dysfunction.)

Will “Ask Your Doctor” radiation ads sell proton therapy the way they have Lipitor, Nexium, Claritin and Prozac? If patients can be experts on diseases and medication, why can’t they be experts on oncology? Or will the medical establishment realize if proton therapy were really superior, ads and patients would not be required to sell it–and pay for the machine.

Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

 

Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

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