This is the time of year when bloggers make either resolutions or predictions. I’m not particularly good at either, so I will arbitrarily choose the latter and share my predictions for 2016. I actually have many, but I’ll keep the list short and limited to those relevant to The After Proton Blog. I also have a few un-predictions of what will not happen in 2016. Keep in mind that I have no track record whatsoever of making accurate or even sensible predictions, but it is fun to make them. Take some with a grain of salt, others with a pinch of pepper. Okay, let’s have some fun.
Only 1 in 10 men will be diagnosed with prostate cancer
I’m not saying they won’t have prostate cancer—they just won’t know it. After all, we seem to be doing our best as a society to keep men in the dark. Yes indeed, we are making great headway in our march toward ignorance. Less and less PSA testing, as recommended by our brilliant government medical gurus, is dragging us into the abyss of darkness. I predict that this year they will also recommend eliminating the DRE (digital rectal exam), and I further predict nobody will complain. That’s three predictions already!
With no PSA tests or DREs we’ll be waist-deep in that abyss with nary a clue about the early stages of prostate cancer. I recall that recently one in six men was diagnosed with prostate cancer, and gradually it became one in seven. Unless our attitude changes, the trend will continue and 2016 will enjoy a remarkable reduction of prostate cancer diagnoses—only one in ten men.
I predict that this year they will also recommend eliminating the DRE (digital rectal exam), and I further predict nobody will complain.
The ultimate result—and my early prediction for a future year—will be a total absence of early detection. Only when we show symptoms in the later stages of prostate cancer will we be diagnosed, and some will call that progress. But those who might have benefited from an early diagnosis might disagree—yet another prediction.
Balloons will become history
The beloved balloon-up-the-derriere to help stabilize the prostate and push it away from the rectum during proton radiation will, like the 5th Dimension’s beautiful balloon, be heading up, up, and away. This is because instead of the daily balloon, some facilities now offer injection of a gel between the prostate and rectum where it remains until dissolving after treatment is complete. Sure, a one-shot gel injection might work—maybe even better than a bunch of balloons—but this ignores the value of tradition.
… our brotherhood of men who had the pleasure of the balloon will gradually be relegated to cult status …
I predict that gel recipients will have no formalized organization or club like the one Bob Marckini founded for us balloon guys. But sadly, I must also predict that beginning in 2016 our brotherhood of men who had the pleasure of the balloon will gradually be relegated to cult status. We men of the balloon era may henceforth have to meet annually in dimly lit libraries with ten foot ceilings in southern mansions, sipping cognac while quietly reminiscing about the good old days, remembering the anaconda effect as the balloon was slowly withdrawn. We will certainly welcome with open arms any gel guys who wish to join us as honorary members, but they’ll never truly understand.
Beck will bash proton therapy (again)
If the Wall Street Journal’s health columnist Melinda Beck has read my earlier posts, she should by now be a proton advocate instead of antagonist. Or at least neutral. Or maybe even objective. I might be going out on a limb, but I’m guessing that will not be the case. I’m betting we’ll see at least three new negative references to proton therapy in her columns in 2016, if not an entire proton-bashing article. She has not been a friend to proton, but she has been predictably consistent.
Insurance companies will find new excuses to deny proton coverage
Insurance companies are nothing if not clever, cunning, and creative. So far, they have called proton therapy—effectively used for no less than a quarter century—experimental, or more euphemistically, investigational. They still claim it’s “not worth the cost,” ignoring opinions of thousands of proton therapy patients—including some who paid for the treatment out-of-pocket—who say otherwise. They claim it’s no better than cheaper therapies, despite proton being cited by many as the “Rolls Royce of Radiation Oncology.” Reality is not an obstacle to denial of coverage.
… the creative insurance geniuses charged with conjuring plausible sounding reasons to refuse payment for proton will need some fresh ideas …
Like the emperor’s new clothes, those lame excuses will become increasingly transparent. In 2016 the creative insurance geniuses charged with conjuring plausible sounding reasons to refuse payment for proton will need some fresh ideas. I predict they will begin replacing their golden oldies with one or more new tunes, perhaps similar to these examples, in which “they” are the insurance carriers:
- They would cover proton, but they are prudently saving up for the possibly even more expensive carbon ion beam therapy of the future.
- In an effort to simplify their policies for consumers, they are removing all references to the widely misunderstood “proton therapy” from their playbook and will simply pretend it doesn’t exist.
- Each carrier will point at a competitor, promising they will cover proton therapy for prostate cancer as soon as the other one does.
- They will promise to re-consider coverage for proton by immediately creating an impartial investigative committee to study the matter.
- They will claim that like the staged moon landing of the 1960s, there is really no such thing as a proton beam, and insurance claims to cover proton beam therapy are actually carefully orchestrated scams to bilk them out of billions of dollars and fool the public.
- They will end the proton coverage controversy and proudly begin automatically covering all claims for proton therapy—no questions asked—at ten cents on the dollar.
- They will do a study proving proton just doesn’t work, based on patients’ assertions of feeling nothing while under the beam. In a parallel study, surgery patients will assert you can actually feel it working (i.e., it hurts). Carriers will cite these studies when ruling out future coverage for proton, and surprisingly also (for a similar reason) IMRT.
Un-predictions: what we will NOT see in 2016
- Prostate transplants—we can barely get it out, let alone put one back in.
- Pediatric prostate cancer specialists—this market is still too small to attract physicians as a specialty.
- Prostate cancer for women—they already have most of the breast cancer, and men need some kind of cancer they can call their own.
- A dinner invitation from Melinda Beck (WSJ) to discuss proton therapy with me in depth—this is both a prediction and a dare.
- Total elimination of all cancer—government would never permit this because the global economy would collapse without a steady influx of new cancer patients.
- Bob Marckini as a prostate surgery lobbyist—read his book to learn why this is highly unlikely.
- A complete ban of proton therapy for prostate cancer—this would leave insurance companies nothing to complain about.
- Denial of insurance for prostatectomies—carriers would if they could, but they know they have to pay for something sometimes.
- HIFU as the new gold standard for prostate cancer treatment—most people think HIFU is a martial art, not cancer therapy.
- Legislation promoting prostate cancer awareness—promoting unawareness will remain our societal priority.
So those are my predictions. If you’re willing to share yours, I’d love to hear them (email me here).
And please have a happy, healthy year filled with fun and humor!