Good contrast of the US marketing-based approach and the Canadian public healthcare one, and how Canadian decisions are influenced by the US. Quote:
Think of it, over a billion dollars has now been spent on these machines in the United States; Medicare is paying more for the treatment than for conventional radiotherapy; and we are only now asking the question of whether they offer treatment that is better. In a rational environment, the study would have taken place using the small number of the first generation machines that were funded with federal support. Then, if the results were positive, we could have made a rational decision as to how many installations would make sense and where to place them geographically. But now, the horse is out of the barn. ….
Meanwhile, north of the border, Canadians are debating whether and where to build a full-scale proton beam treatment center. (My Google search reveals only a small one thus far, for melanoma of the eye, in British Columbia.) Because of its cost, a large machine would have to be federally authorized; but the organization of health care in Canada is by province, raising the prospect of an interesting competition. When you consider the size (and thus space needs), technical staffing requirements, and financial condition of the various provincial governments, there are only a few candidate cities. Toronto would seem a logical spot, for example, but there is not enough space near the major medical center, and the Ontario finances are weak. Oddly enough (given the small population of the province), Saskatoon might end up as a top candidate. It has physical space, expert staff, and a surplus in current provincial accounts.
But does Canada need one at all? The issue appears to have been decided. As an expert said to me recently, “If we don’t build one, there will be a huge outflow of patients to the US for treatment, and we will be forced to pay US prices for something that would be less expensive if we owned it. Canada cannot afford to export millions of dollars to the States to treat our patients.”
The medical arms race has now gone international. In the words of nuclear arms policy, this is mutually assured destruction.