What kind of feeling or impression would these words and phrases give you about a business—any business: balk, big bets, uncertain, dogged, lack of evidence, closed, losses, ridiculously expensive, behemoth, decline, taken a toll, money-losing, no guarantee, dispute, concerned, unproven, pricey, problem, bankruptcy? Let me guess: not so hot, right?
All of these words are used by Melinda Beck of the Wall Street Journal in her May 25, 2015 editorial-disguised-as-news article about proton beam therapy for cancer treatment. I’m not sure whether her spin on proton was intentionally negative—I have no reason to question her motives—but regardless of her intent or lack thereof, the article needs to be fixed.
I have no reason to doubt her facts. What I will do is reverse spin it 180 degrees the other way …
So I’m going to fix it by rewriting it. Let’s give Ms. Beck the benefit of a doubt and stipulate that her actual data—the facts, as presented by her—is correct. I’m not going to fact-check the article because that’s not the point, and I have no reason to doubt her facts. What I will do is reverse spin it 180 degrees the other way using no information other than what was included in her article.
The Positive Spin
My counter-spin rewrite is intentionally in much the same style as Ms. Beck’s original article. For an accurate A-B comparison I’ve kept my article about the same length as hers, included most of the relevant facts she presented, and added no new factual information beyond what she included.
This is not a rebuttal; it is a rewrite. First read her article (click here), and then read my rewrite (minus the copyrighted photos) in the box below. If you’re short on time, just read the heading and first few paragraphs of each. After reading both, ask yourself how each leaves you feeling about proton therapy.
Cutting-Edge Proton Therapy Blasts Into a Bright Future
Falling costs, smaller machines, and private support give insurers fewer excuses
By Ron Nelson
June 8, 2015
Six new treatment centers are expected to begin providing state-of-the-art proton radiation to cancer patients around the country this year. Ten more are anticipated by 2018, bringing the total to 30 centers in the U.S. This explosion of proton centers, each at between $100 million and $200 million to build, indicates growing confidence in the value of this cutting-edge therapy for many types of cancer.
Proton-beam therapy, a highly precise form of radiation, is believed by many to have advantages over traditional photon (x-ray) radiation, but some insurers including UnitedHealth Group Inc. and Aetna Inc. have stopped covering it for prostate cancer, making it difficult for some men to afford this state-of-the-art treatment, regardless of their preference. Nevertheless, proton proponents are undeterred in their quest to make this therapy available to those who need it, and are pursuing new business models despite a lack of support from insurers.
Mevion Medical Systems Inc. is helping the cause. The Littleton, Mass. company makes proton systems with single treatment rooms instead of the four or five offered by larger facilities, and they do this for an investment of only $30 million—possibly even less. Other proton manufacturers, including Ion Beam Applications SA, Hitachi Ltd., and Varian Medical Systems Inc., have also entered the growing market by building their own compact proton systems in the U.S., Europe, Asia and the Mideast.
Regarding the cost of proton therapy, Joseph Jachinowski, chief executive of Mevion, said “there had to be a way to make it more accessible.” Just last month, a Mevion-equipped cancer center in Jacksonville, Fla., became the first proton therapy facility owned by a private physicians group. In addition, five of the six proton centers opening in 2015 are compact centers constructed and operating at only a fraction of the size and cost of larger multi-room facilities.
Officials at many centers say they are using proton radiation not only to treat prostate patients, but also to effectively treat breast, lung and other cancers. To make proton as affordable for patients as traditional photon/x-ray radiation commonly known as IMRT (intensity-modulated radiation therapy), they are experimenting with alternative payment models. For example, The University of Pennsylvania Health System is accepting the same rate for proton therapy that it does for IMRT from two insurers while it tracks patient outcomes. “It’s very important that providers have skin in the game as well as payers,” said radiation oncologist Justin Bekelman.
Private funding has also become part of the evolving proton picture, and some hospitals have turned to private donations, rather than private equity, to finance proton operations. Next month, the Mayo Clinic in Rochester, Minn., plans to start treating patients at its new proton center, one of two built with the help of a $100 million gift. With no investors to repay, they are able to charge the same rates for proton therapy as for IMRT, according to Mayo officials.
“We’re basically telling the insurance companies and our critics—we’re not in this for the money. We think this is the best thing for our patients,” said Sameer Keole, medical director of proton-beam therapy at the Mayo Clinic in Phoenix, scheduled to open next year.
Health systems of all sizes now see proton therapy as not only an attractive option for patients, but also an enticement to obtain top clinicians who are excited about providing cutting-edge care. “All of the top 10 cancer centers in the U.S. have proton therapy or are developing a center, which shows they believe in it,” said Scott Warwick, chair of the National Association for Proton Therapy.
Many radiation oncologists are also enthusiastic about proton technology, in which positively charged particles—protons—are accelerated to about two thirds of the speed of light, and then routed into a powerful beam that deposits most of its radiation energy directly onto the target tumor, minimizing exposure to surrounding healthy tissues. While several treatment options, including proton therapy, can effectively halt cancer, proponents of proton say this phenomenon, called the Bragg peak effect, sharply cuts side effects that can add substantial long-term costs.
There is little disagreement about the benefits of using proton to treat rare pediatric brain cancers, adult eye tumors and cancers at the base of the skull, which insurers generally cover. Some oncologists say proton therapy has a unique ability to reduce harmful side effects in many other localized cancers as well, including head and neck, central-nervous system, lung, prostate and breast, where some patients develop heart damage from spillover radiation provided the traditional non-proton way.
But some insurers are balking at paying for proton therapy for such common cancers without more evidence that it improves patient outcomes. Although there is already much supportive evidence available, these insurers insist they must wait for completion of additional trials now in progress. Because it will be years before those trials are complete, some patients are currently denied this option.
In notable contrast, most Medicare regions do cover proton therapy for prostate cancer. But several major insurers stopped after a 2012 study stated that it has no added long-term benefit. Men with prostate cancer had once accounted for as much as 70% of patients at some proton centers, but this has dropped to less than 50% nationwide, largely because of insurance denials.
At some point, insurers will likely be unable to continue using cost factors to justify denials of coverage. Proton proponents have high hopes that “hypofractionation,” or delivering higher doses of radiation in fewer treatment sessions, will help bring the cost of proton therapy in line with IMRT. Costs will drop even further because smaller proton centers with substantially lower operating costs can more easily remain profitable. Mr. Jachinowski said Mevion’s systems use just 5% of the energy and only 10% of the operating staff of larger facilities—“but the billing codes are the same,” he added.
In the meanwhile, insurance coverage denials have hurt both patients and some proton facilities. Indiana University was unable to compete and closed its facility in Bloomington. In 2013, ProCure Treatment Centers Inc., a private-equity backed operator of proton facilities, sold its share in one center near Chicago after missing a loan payment. Earlier this month, ProTom International Inc., another closely-held builder of compact systems, filed for bankruptcy protection because of a contract dispute over a center in Flint, Michigan.
These examples remind us that despite the promise of proton therapy in fighting many cancers, no facility is guaranteed success. They must each meet the challenges of the marketplace and the ever-evolving insurance industry. They must also fight a continuing public relations battle with critics who remain firm and vocal, calling this therapy pricey and unproven despite evidence to the contrary.
Critics recognize that lower startup costs will lead to a growing number of proton therapy centers, a trend they regard as undesirable because they still view proton as experimental and too expensive . One such critic, Amitabh Chandra, a professor of public policy at Harvard’s Kennedy School of Government, bluntly summarizes, “Now, we’ll have an even bigger problem on our hands.”
Despite the challenges, the promise of proton beam therapy has strong continuing support, and more centers are planned. By 2018, three are expected in the Washington, D.C., area; two in Oklahoma City; two near Dallas; four in Florida; three in New Jersey and one in Manhattan. All expect to become profitable within a few years of opening, and thousands of patients will benefit from easier access to this powerful tool for fighting cancer.
Let me be perfectly clear: my rewrite of Melinda Beck’s article is equally and intentionally slanted, but in the opposite direction. Same facts, reverse spin. Neither hers nor mine is unbiased, and neither should be regarded as objective news or presented as such. But when an article—her article—appears in the Business News section we expect objective, unbiased reporting.
Feeding the Falsehoods
All therapies—including proton—continue to push forward with refinements that are initially experimental, maybe costly, but possibly better. Surgery, chemotherapy, hormonal therapy, x-ray radiotherapy, and yes, proton therapy are legitimate options now, even as researchers and practitioners strive for improvement. All should be in our cancer treatment toolbox today, while we hope they become more effective and affordable tomorrow.
… misrepresentations make it easier for insurers to justify denials of coverage for patients in need …
Articles like Ms. Beck’s do the public a disservice by using a respected news platform to intentionally or maybe inadvertently feed the falsehoods that proton is a new and floundering therapy that is experimental, too costly, and without advantage. Such misrepresentations make it easier for insurers to justify denials of coverage for patients in need. Possibly even worse, proliferation of such negative notions can and sometimes does contribute to the complete omission of proton therapy from the list of options presented to patients who should at least be informed about it.
Ms. Beck had some good factual information in her article, but until she can find a way to report business news minus her subtle spin, she might be more comfortable and appropriately placed in the editorial department. News reporting carries a responsibility: many consumers of the news assume it to be reported objectively. When it’s not, it becomes a form of propaganda that influences the thinking of unsuspecting, trusting, and often vulnerable individuals.
You can let me know what you think by emailing me directly. I also urge you to follow the lead of my good friend Harold Mills and others by adding your comment after the original Wall Street Journal article (click here).See Ron's 2023 book!available now on Amazon Already read it?Review it now on Amazon