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Here is the fun part that most people don't know...universal healthcare systems wouldn't have paid for this either. However, the patient never would known abou

by refurb 3y ago

Here is the fun part that most people don't know...universal healthcare systems wouldn't have paid for this either. However, the patient never would known about it because it wouldn't have been on the list of "approved therapies", so the doctor never would have suggested it. The article dances around it, but for this particular cancer, proton beam therapy has little evidence supporting it. The current treatment guidelines like NCCN list a number of evidence-based therapies for first line, second line and subsequent line treatments. Proton beam thereapy is a "hail mary" and universal healthcare systems are less expensive than the US because they don't pay for "hail marys". So in places like Canada (whose patients, it's important to note, need to travel to the US because there are no proton beam centers) the doctor wouldn't have even considered it as a treatment option in this case.

toomuchtodo 3y ago
This is a valid point about gating of medical procedure access, but more an argument for exception processes and cost reductions to allow off label attempts at treatment. I see the price of proton therapy varies wildly between thousand and tens of thousands of dollars per treatment. Still too high. Perhaps if the cost were lower and some streamlined review process existed, it would be less of a lift to say “hop on the table while the accelerator spins up, won’t be expensive if this doesn’t work.” (in this example) Rationing human supply (labor) makes sense, making humans takes time and supply is constrained. Other costs can be ruthlessly driven down (with some combination of manufacturing learning, research, etc). Consider the costs of Western disease (obesity) and bariatric surgery with recent developments in semaglutide, for example.
- nradov 3y ago
  On what basis are you claiming that the cost of proton beam therapy is too high? How do we calculate the correct price? Newer medical devices will always be expensive due to the high costs of R&D plus obtaining FDA approval.
  - toomuchtodo 3y ago
    Proton therapy has existed for decades. I’m claiming the costs are too high based on today’s dollars, and is an opinion. Cyclotrons can cost anywhere from low 7 to mid 8 figures, but cyclotron time can be had as cheap as $1100/hr at certain labs. Offering someone experimental or unproven protocols is more palatable if treatment costs closer to $10k vs $100k. On what basis are you claiming that the cost of proton beam therapy is not too high? https://en.wikipedia.org/wiki/Proton_therapy https://en.wikipedia.org/wiki/Proton_therapy
cloudsec9 3y ago
Your comment doesn't seem consistent, so I'm not sure if it's just disorganized or actually false. You state that non-US healthcare "wouldn't have paid for this either", but later you mention "need to travel to the US because there are no [PB] centers" (which is true). But then you continue "the doctor wouldn't have even considered it as a treatment option". Now, I'm not an expert at PB treatment, but the fact that patients have to travel would suggest that at least some do that; I'm not sure if the treatment is partially or fully covered. But a quick Google seems to suggest that this option is known, and that there is lobbying to create such a center in Canada; and they acknowledge that the treatment, lasting 6-8 weeks in a distant city can be challenging. But if it isn't an option considered or offered, why bother to build something with no demand?
- refurb 3y ago
  > But if it isn't an option considered or offered, why bother to build something with no demand? I said "in the case of the patient in the article". Proton beam therapy is in the clinical guidelines, just not first line for throat cancer (or at least not right now, maybe future evidence will prove otherwise).
Kim_Bruning 3y ago
Are you sure? It seems like many countries in Europe have facilities for proton beam therapy, including countries with universal health care (which IIRC is all of them?). [1] Canada happens to not have one yet, but the question is under study. [2] What concerns me is "This rapid growth in the number of proton beam therapy centres, [...] is viewed with concern by advocates of evidence-based medicine. " [1] It seems like Proton beam therapy is still -as yet- somewhat controversial. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474264/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474264/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130814/#:~:text=As%20of%20the%20end%20of,private%20proton%20beam%20therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130814/#:~:tex...
unsupp0rted 3y ago
My urologist in Canada recommended a procedure that universal healthcare doesn’t cover. I paid out of pocket at the clinic where he does these procedures. I’m glad I got it.

by refurb 3y ago

toomuchtodo 3y ago

This is a valid point about gating of medical procedure access, but more an argument for exception processes and cost reductions to allow off label attempts at treatment. I see the price of proton therapy varies wildly between thousand and tens of thousands of dollars per treatment. Still too high. Perhaps if the cost were lower and some streamlined review process existed, it would be less of a lift to say “hop on the table while the accelerator spins up, won’t be expensive if this doesn’t work.” (in this example) Rationing human supply (labor) makes sense, making humans takes time and supply is constrained. Other costs can be ruthlessly driven down (with some combination of manufacturing learning, research, etc). Consider the costs of Western disease (obesity) and bariatric surgery with recent developments in semaglutide, for example.

nradov 3y ago
On what basis are you claiming that the cost of proton beam therapy is too high? How do we calculate the correct price? Newer medical devices will always be expensive due to the high costs of R&D plus obtaining FDA approval.
- toomuchtodo 3y ago
  Proton therapy has existed for decades. I’m claiming the costs are too high based on today’s dollars, and is an opinion. Cyclotrons can cost anywhere from low 7 to mid 8 figures, but cyclotron time can be had as cheap as $1100/hr at certain labs. Offering someone experimental or unproven protocols is more palatable if treatment costs closer to $10k vs $100k. On what basis are you claiming that the cost of proton beam therapy is not too high? https://en.wikipedia.org/wiki/Proton_therapy https://en.wikipedia.org/wiki/Proton_therapy

cloudsec9 3y ago

Your comment doesn't seem consistent, so I'm not sure if it's just disorganized or actually false. You state that non-US healthcare "wouldn't have paid for this either", but later you mention "need to travel to the US because there are no [PB] centers" (which is true). But then you continue "the doctor wouldn't have even considered it as a treatment option". Now, I'm not an expert at PB treatment, but the fact that patients have to travel would suggest that at least some do that; I'm not sure if the treatment is partially or fully covered. But a quick Google seems to suggest that this option is known, and that there is lobbying to create such a center in Canada; and they acknowledge that the treatment, lasting 6-8 weeks in a distant city can be challenging. But if it isn't an option considered or offered, why bother to build something with no demand?

refurb 3y ago
> But if it isn't an option considered or offered, why bother to build something with no demand? I said "in the case of the patient in the article". Proton beam therapy is in the clinical guidelines, just not first line for throat cancer (or at least not right now, maybe future evidence will prove otherwise).

Kim_Bruning 3y ago

Are you sure? It seems like many countries in Europe have facilities for proton beam therapy, including countries with universal health care (which IIRC is all of them?). [1] Canada happens to not have one yet, but the question is under study. [2] What concerns me is "This rapid growth in the number of proton beam therapy centres, [...] is viewed with concern by advocates of evidence-based medicine. " [1] It seems like Proton beam therapy is still -as yet- somewhat controversial. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474264/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474264/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130814/#:~:text=As%20of%20the%20end%20of,private%20proton%20beam%20therapy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130814/#:~:tex...

unsupp0rted 3y ago

My urologist in Canada recommended a procedure that universal healthcare doesn’t cover. I paid out of pocket at the clinic where he does these procedures. I’m glad I got it.