Originally published at: https://boingboing.net/2019/05/19/barbaric-and-immoral-industry.html
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I’m sympathetic to cancer patients suffering through the horrors of for-profit medicine. But proton beam therapy does indeed sound experimental. It’s unclear if it’s any better than conventional x-ray therapy, despite being many times more expensive. From Wikipedia:
The issue of when, whether, and how best to apply this technology is controversial.[36][37][38] As of 2012 there have been no controlled trials to demonstrate that proton therapy yields improved survival or other clinical outcomes (including impotence in prostate cancer) compared to other types of radiation therapy, although a five-year study of prostate cancer is underway at Massachusetts General Hospital.
Proton therapy is far more expensive than conventional therapy.[37][43]
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Having watched people close to me endure X-ray and another receive proton beam therapy, yes, PBT is better.
That’s great, but sympathy isn’t going to help anyone. What’s direly needed is comprehensive reform of the entire system.
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Once a critical mass of affluent white males over age 55 start joining Judge Scola in publicly denouncing the system and the industry that benefits from it, it’s over. It’s only a matter of time, because cancer cells don’t care about their victims’ race or gender or net worth and because young people are lucky if they can get even bare-bones health insurance after age 25.
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It seems to me that there are a few demographic groups whose blind allegiance to their narrow field of vision are doing the most to create the kind of world they most fear; anti-vaxxers precipitating mandatory vaccinations, health care greed and avarice driving the only substantive dialogue around healthcare reform that we’ve ever had and gun nuts edging themselves closer and closer to regulation (well, we can hope, anyway).
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On the contrary, his views sound fair and impartial to me.
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Indeed. A part of me is disappointed that he had to recuse himself, though I understand why it was the right thing to do from an ethical standpoint.
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And from a legal standpoint there’s no point in handing the healthcare company a basis for an appeal if they lose.
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Yes. Pushing things to extremes is the killer. If only they were merely, say, 75% as extreme as they are and had retained a veneer of reasonableness, they could have perpetuated their positions (and perpetrated their fuckwitteries) for ever and most of the rubes would have gone along or put up with it - certainly in the case of health insurance, and probably put up with gun nuts up to a point. Anti-vaxers though - they are beyond the pale.
(Quibble: they are not demographic groups. Vested interest groups, yes, but they consist of members of many demographic groups, although over 50 WASP males do predominate in health insurance and gun nonsense - but at the same time many of the same demographic are as adamantly opposed to what these fuckers get up to. Anti-vaxers are different though - seems high preponderance of 30-something mummies with insufficent education/IQ anf too much time on their hands spent reading internet fuckwittery.)
/sweepinggeneralisations
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The biggest lump of undiluted irony I’ve seen for a very long time. As if they’d recognise an ethic if it jumped up and bit them on the arse (which I hope it will). But yeah, what @Brainspore said - best not to give them an open goal with a higher/appeal court.
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♫ Soon come, soon come the day this tinderbox
Is gonna blow in your face
I don’t have the gift of the prophesy,
Telling everybody how it’s going to be
You go passing wrong for right
And right for wrong
People only stand for that for just so long ♬
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Which is absurd because an unethical person who would rule in favor of unethical companies would be just as likely to unethically stay silent about their bias, which may not be highly detectable except through self-disclosure.
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I agree, which is one of the reasons I said a part of me. From a purely pragmatic standpoint a failure to recuse himself would backfire. I also believe it was the right thing to do, but I don’t like it. That the health insurance mafia doesn’t care about ethics is self-evident. They see that as a strength, but in the end throwing out ethics becomes a weakness.
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May 19
zenkat:
It’s unclear if it’s any better than conventional x-ray therapy, despite being many times more expensive.
Having watched people close to me endure X-ray and another receive proton beam therapy, yes, PBT is better.
I’m sympathetic to cancer patients suffering through the horrors of for-profit medicine.
That’s great, but sympathy isn’t going to help anyone. What’s direly needed is comprehensive reform of the entire system.
I agree we desperately need systematic reform in the US. The entire system is a mess. I personally favor a single-payer system, like nearly every civilized country has.
But that won’t magically make proton-beam therapy available. Check out the Wikipedia article I cited, especially the quote from England’s NHS (a single-payer public health provider):
“We cannot say with any conviction that proton beam therapy is “better” overall than radiotherapy. (…) Some overseas clinics providing proton beam therapy heavily market their services to parents who are understandably desperate to get treatment for their children. Proton beam therapy can be very costly and it is not clear whether all children treated privately abroad are treated appropriately.”
Health-care for patients with terminal illnesses will always involve difficult choices, no matter who is footing the bill. Don’t fool yourself that those hard choices will magically disappear when we finally replace our broken system with a (hopefully) better one.
PS – My cousin and my mother-in-law are both cancer survivors. Stage 4 melanoma for one of them. Cancer sucks.
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From the first paragraph:
The chief advantage of proton therapy over other types of external beam radiotherapy is that as a charged particle the dose is deposited over a narrow range of depth, and there is minimal entry, exit, or scattered radiation dose.
My feeling is that the choice of x-rays vs. proton beam should be based on where the tumor is, depth, size, etc. as well as the type of tumor. There’s no one size fits all. It should be a purely medical decision, not a self-serving financial decision by an insurance company. Indeed, the only way to make informed medical decisions is to have as much experience with the machine as possible (both as individual physicians, and by the medical community as information from studies are published in the literature). This can only come about as more and more procedures are done, which is being limited by the insurance companies.
I think this judge is the perfect person to handle the case. But as others have said, it would be used against the patients.
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The issue is really “who do you want deciding what is the best medical management of your individual medical case”? Do you want execs and staff at an insurance company deciding this, or do you want a dedicated team of medical professionals that are familiar with the details of your individual case?
As a former CEO of the company I now work for once said “there’s a price to insure a million dollar house that you know is going to burn down the next day”… There’s also a price for a policy that covers proton therapy etc… The issue is the $$$, not whether the recommended care is “experimental” or not (except in the financial/legal world of an insurance contract).
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Quite the 1-2 punch from the judge.
- I despise the defendant.
- And here’s why…
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May 19The issue is really “who do you want deciding what is the best medical management of your individual medical case”? Do you want execs and staff at an insurance company deciding this, or do you want a dedicated team of medical professionals that are familiar with the details of your individual case?
I’m not a big fan of health insurance companies making these decisions. As you rightly note, the incentives are all screwed up. That’s why I support single-payer.
But remember that in a public health system, decisions like this will not (solely) be made by a “dedicated team of medical professionals that are familiar with the details of your individual case”. Most decisions on what treatments are supported will be made at a national level based on the currently available evidence on efficacy vs cost. (And that’s a good thing!)
As a former CEO of the company I now work for once said “there’s a price to insure a million dollar house that you know is going to burn down the next day”… There’s also a price for a policy that covers proton therapy etc… The issue is the $$$, not whether the recommended care is “experimental” or not (except in the financial/legal world of an insurance contract).
In a world of privatized health-care, insurance agencies aren’t the only bad guys. Doctors and hospitals are also incentivized to push the most costly, complicated treatments that they can possibly justify.
A writer of Cory’s stature could just as easily turn this story on its head, and craft a tale of greedy huckster doctors trying to make a buck off desperate cancer patients by pushing a hugely expensive unproven treatment. Much like this one:
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As a cancer survivor and physician, I find myself utterly incapable of being totally objective in this sort of case. Insurance companies suck, and make money by maximizing premiums and minimizing benefits. And they are phenomenally profitable. The conclusion I draw from that is that they are very good at minimizing benefit. As a physician, I see daily insurance deny what is clearly the most effective treatment for patients, while weaseling out of responsibility by claiming that “they are not making treatment decisions, only advising coverage decisions.” In other words, if the patient decides to use the best therapy, they are very welcome to, so long as they pay for it themselves. Which, of course, is far beyond the means of most normal people. Single payer is the really the only way out that I see.
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