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No reasonable person believes reasonable people believe healthcare is a free market. I think he or she is just trolling.
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3.14% profit margin though for UHC. Lower than hospital systems, which are usually around 5-6%. Lower than (hopefully for the owners) that of private practice groups.
The revenue numbers are impressive but the profit margins are not.
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Analogous to the visa/MasterCard model
Maybe in order to understand mankind we have to look at the word itself... "mankind." Basically it's made up of two separate words, "mank" and "ind." What do these words mean? It's a mystery. And that's why so is mankind.
lol never change Wallnerus!
12 years ago???
More toxic? No hint of benefit? Costs 4x as much? Much poorer access for patients?
Conclusion: Feasible and acceptable.
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Patient: "Why is my skin all red and peeling? I thought protons had less side effects??"
MD Anderson: "Oh no, the skin reaction just means the protons are working!"
Patient <smiles> and proceeds to take a picture of her skin for Instagram
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This was actual concluding paragraph of the trial:
In other words, protons caused demonstrably worse skin toxicity in a manner that was highly statistically significant. However, you should still consider protons for breasts due to the "expected dosimetric benefits."
If you are going to go through the trouble of creating, enrolling patients on, and publishing a randomized trial that is negative, and you still reach this conclusion . . . what, pray tell, was the purpose of the trial in the first place?
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Heard a proton therapist say it was almost one in two of their proton breast patients … I have never witnessed with my own eyes proton breast RT effects. So solipsistically speaking I should maybe still be skeptical protons are worse than photons.
Everyone is right to bash on the conclusion of the trial and the way things are written, but I will say the proton centers I'm familiar with specifically contour and modulate the dose to the skin. I'm not sure if that was done on this trial and I can imagine that making a difference on this particular finding.
The broader conclusion to me is that photons have gotten so good we're not really finding clinically significant differences despite the dosimetric differences
The broader conclusion to me is that photons have gotten so good we're not really finding clinically significant differences despite the dosimetric differences
You mean, they treat the skin like an OAR...
But I thought protons have "dosimetric advantages, particularly the reduced dose to OAR"
Ok, I'm just trolling now...
At a fraction of the price. Sounds like photons should be the standard of care
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I mean yes, it's done now, after we learned that people's skin really lit up (especially during the old PS days). The point is that we're treating patients with protons for breast/prostate just to get to the point where we can say they're "another possible option," not that they're actually better. Yes, you can argue that learning/developing these technologies is useful work, but if that were the primary motivation, I imagine I'd see fewer claims about "lower side effects."
How did it work out?
They had that conclusion written long before the trial started enrolling
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Not well for anyone.
Some thing just happened at one of our centers in a non-CON state
Or when Britney Spears is involved
Whenever protons have a bad effect, someone points out that nowadays they are being delivered differently. Pencil beam, robustness, etc. I have never heard of a rib fracture from photons in breast cancer.
has anyone at a proton center pulled a Nicole Hannah jones and had themselves or a family member treated with protons?
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Here is John Oliver, ranting about everyone's favorite pinata United Healthcare. Fast forward to 12:45 and you will find an interesting case where a woman had recurrent cervical cancer that her doctors at Harvard wanted to treat with proton beam. This was back in 2018.
From what I could gather from the article she initially had locally advanced disease, was treated with chemorads and had a recurrence in the PA lymph nodes. MGH wanted protons to treat it and UHC refused. She ultimately scrounged $95,000 to pay for it out of pocket (~$126,000 in todays USD value adjusted for inflation).
DIscuss.
I wouldn't have paid for protons there either, unless the PA nodes were covered as a part of the initial treatment, which I doubt they were.
I treat recurrent disease (usually prostate, but not always) along the PALNs all the time without protons with zero issues. MGH having the family pay cash rather than going with a perfectly-acceptable SBRT plan is morally bankrupt behavior, and they should be ashamed.
I think we talked about this back in 2018, maybe even in this thread. I know nothing about the specifics of this case, but I’d feel awful telling the patient they needed to pay 100k for protons for a pa nodal recurrence, barring other factors.
That being said, it's still tough for me to side with United against a physician.
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You know a wild thing about this story that no one will really ever know and you won’t hear in the news. This decision came down to one low level board certified radiation oncologist working for UHC looking at a computer screen and deciding “no.” There’s really no great UHC conspiracy or anything like that. The one person could have decided yes with no repercussions whatsoever.
This reminds me of the OJ Simpson trial. OJ (like United) was guilty of horrific crimes IMO, regarding which the evidence is incontrovertible.
As the lawyers say...never frame a guilty man (thinking Mark Fuhrman in the OJ case, MGH protons in this one).
Somehow protons (our most dubious and expensive intervention) seem to get disproportionate media play regarding the practice of predatory denials...probably because it's a rich person thing.
My favorite theory about the OJ Simpson trial is that his son did it and OJ covered for him. His son had known issues and, given the more primitive DNA testing then, he and his son would have been a DNA match...but the glove would not have fit.
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I am not sure why protons would be better for re-irradiation or pediatrics. I think the logic is that they must have some redemmeing utility and somehow can’t suck for everything. There is no reason they can’t be inferior in every scenario.
Where I used to work at the city academic proton center patients just showed up demanding protons all the time, and if I didn’t give it to them they went elsewhere and got the protons instead. I gave up quickly trying to be rational about it given that I was being paid $/RVU.
Low dose radiation for sarcoidosis?
Therapeutic Petct?
