I agree with Dr. Yu as to our focus on small improvements with
PRT as compared to IMRT.  Not unlike Neutron therapy of the 1980s
we are focused on a cancer that is already treated reasonably
well with IMRT.  

Protons have some very interesting characteristics and should be
studied and examined carefully.  These centers are not
inexpensive and if we do not try our best to justify their
existence and use at these high reimbursement levels they will be
some of the first big cuts when Obamacare is fully enacted. We
either police ourselves or the Government will do it for us. 
These centers could be easily dealt a death blow with legislation
as far sweeping as the Stark Law.  

Let's face it when you speak with someone planning a PRT center
they speak of the potential improvements in care and in revenue
production almost hand-in-hand.  This is a recipe for disaster in
a time when reimbursement and the quality/effectiveness of the
clinical service will be closely scrutinized by non clinicians
employed by the Government.

It is a terrible injustice how one group of potentially biased
researchers can publish findings on a therapy that they are not
even proficient at by selecting to focus on a fraction of one
single measurement parameter and then reporting it out like it is
meaningful, or even worse, like it is the ultimate verification
of the efficacy of that modality. Worse than that the potentially
biased media picks up the press-release of study then publishes
it without any further research; while often making up their own
biased head-lines in order to strike another unfair blow against
a modality that they too have a minimal understanding of. If
somebody wants to do a fair comparison of protons versus photons;
they would be best served by bringing out the entire therapeutic
picture, which includes but is not limited to; dose-escalation,
dose-response, control rates, immobilization techniques, control
rates, toxicity and survival. Quality of life measurements should
go beyond a year; reporting on anything less seems highly
suspicious.

Mr. Valencia,  I think your attack on this one article is
unfortunate.  I believe the facts are quite clear when speaking
to centers about how they make their decisions as to which
imaging modalities, surgical applications and in this case
radiation therapy offerings frequently they decide on early
science and high reimbursement.  

Proton Therapy is interesting but like most new technologies it
really isn't clear that it is much better than anything else.  If
you have statistics to prove Proton Therapy is so much better
that it is worthy of reimbursement that is 2X or more than
standard photon therapy then please publish them please.  

I'm not against Proton Therapy and its installation in the US and
elsewhere.  But when you read the articles that support any new
modality the authors are almost always twisting the statistics to
demonstrate how what they do is better than what is already done.
 I think we have to think about the entire population and
determine if there is enough of an improvement to justify the
cost.  If we don't start thinking this way for ourselves then
maybe the payers will take it upon themselves to do it for us.