Protons and the IPAB

By Doug Magill

It starts in the basement of the hospital.

Hydrogen atoms are split and the protons are extracted and injected into a linear accelerator, and then into a synchrotron.  The heavy particles are then energized further before being magnetically guided to nozzles through which the proton beam is delivered to the patient.

Proton therapy is incredibly complex, but has the capability – unlike conventional radiation – of being able to precisely target cancers.  Originally proposed in 1946, the treatment of head and spinal cancers that were inoperable began less than 10 years later.  Today, there are 29 proton treatment centers throughout the world.

I received proton therapy for my prostate cancer at Loma Linda University.  Today, by all relevant medical criteria I am considered cured.

The main reason I chose to travel to Loma Linda for treatment was my fear of the side effects of other forms of treatment.  I spoke to a lot of men who had been treated locally, primarily via surgery, and the majority of them had problems subsequent to their treatment.  The words impotence and incontinence were heard regularly.  I was relatively young to have been diagnosed with cancer, and I was terrified of having to deal with those side effects.

My local urologist dismissed proton therapy as experimental.  Many other professionals didn’t know anything about it.  Several prominent surgeons were angry that it even existed, as it threatened their livelihood after having spent years learning to perform prostate surgery.

For me, the decision was primarily focused on the quality of life I would have post-treatment.  There was no going back.  And, if, like many men, I had the surgery and had problems afterward there was no solution available.

The probability of the recurrence of prostate cancer is roughly equal between the two kinds of treatment, and is based on the stage and aggressiveness of the cancer when first diagnosed.

I wasn’t surprised that my local physician recommended surgery; after all, that is what is primarily done in the large medical centers here in northeast Ohio.  Although the local medical experts have evaluated proton therapy, I suspect they have not pursued it because of the costs of setting up a center, and the fact that it would interfere with their current prostate cancer treatment business.

I was lucky.  I was able to evaluate a number of options and make a choice based upon what I perceived as my medical, and quality-of-life needs.

One of the poorly understood features of the ironically named Patient Protection and Affordable Care Act, or Obamacare, is the creation of the Independent Payment Advisor Board (IPAB).  There are a number of duplicitous and dishonest features of the bill, but the IPAB may be the most pernicious.

Obama recently mentioned this board in his disingenuous response to the budget plan proposed by Congressman Paul Ryan.  According to the president, rather than relying on competition to generate efficiencies and control costs, the IPAB will force control of prices, not costs.  And, because price controls never work, the absolutely predictable result will be shortages, rationing, and reductions in options,

One of the most outrageous aspects of this board is that it will be composed of 15 “experts” who will have the power to impose whatever price controls they see fit.  Until now, only Congress had the power to change Medicare reimbursement rates.  Under the new law, the board’s changes will take effect automatically unless Congress passes opposing legislation and it is signed into law by the president.

Presto: The control of the medical system has now been passed from representatives of the electorate to bureaucrats who are unelected and unaccountable.

According to Peter Orszag, the former director of Obama’s Office of Management and Budget, the IPAB has “an enormous amount of potential power.”  Yes it does, and the ideological makeup of those unelected solons will be a defining factor of whether they get appointed or not.  By the way, this board will first be appointed in 2014, halfway through the next term of whoever will be president.

The creation of a board with effectively dictatorial powers will also be coupled with the latest catchphrase in government, “comparative effectiveness.”  In theory, the idea is to compare various treatments and come up with the one that is most effective at the best price.

Sounds reasonable.

However, medical treatment deals with people, not averages, and there are an enormous number of factors that come into play.  Decision-making based upon a sample population in which the study questions are undoubtedly slanted to benefit certain practitioners will leave out consideration that medical care should be an individual choice.

We know that the current administration likes to reward friends and punish enemies, and the large medical chains will become friends quickly if they are certain to be included in those averages.  In particular, the local behemoths will surely find lots of data that show their prostate surgery protocols are the standard of comparative effectiveness.  And lesser-known treatments, such as proton therapy – no matter how much more effective or conducive to long-term quality of life – will not be included in the studies.  And will disappear.

In my case, I would not have the option of considering how I would want the rest of my life to be.  I would be forced to deal with surgery, and potentially have to live the rest of my days incontinent and impotent, as my quality of life would be of no consequence when considering how to keep the cost average down.

I remember having a discussion with a good friend after my treatment.  She said that proton therapy had a chance to become the new standard for treatment of localized tumors. Within my lifetime we would look back and marvel at how barbaric some surgical options had been.

Not if the IPAB has its way, and freezes choices to the cheapest currently available.  Marvelous technologies with the potential to lessen the terrible burdens of cancer will be ignored.  And we will deal with a future where, as Noah Boyd wrote, “…understanding the futility of our fate is the only form of happiness we’re allowed.”


Doug Magill is a prostate cancer survivor, freelance writer, and voice-over talent.  He can be reached at


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