Ethically Financing Proton Therapy

This post is one in a series by students in “Emerging Technologies and the Future of the World,” a new interdisciplinary course on how political, legal and social factors influence technological change.

Kimia Ahmadi is a senior from Staten Island, NY in Penn’s College of Arts & Sciences majoring in Political Science with a minor in French Language. After graduation she will be heading back to New York to work in Citigroup’s Sales & Trading division.

This past summer, I had the opportunity to learn about nanotechnology from a credit investment standpoint while working in Citigroup’s Municipal Bond trading division. After having spent a full summer at the Johns Hopkins Nanotechnology lab during the summer after my sophomore year in high school, the promising impact of nanotechnology in the medical world was familiar to me. However, learning how to assess the creditworthiness of an investment in this line of science opened my eyes to the financial and ethical aspects of nanomedicine.

My summer project required that I compare the creditworthiness of two different proton therapy centers and ultimately decide which one to invest in. Proton therapy is a subfield of nanotechnology that is aimed to refine the use of generalized radiation therapy in cancer treatment. Using a proton, rather than the traditional photon (which is significantly larger in surface area), proton therapy can deliver powerful doses of radiation to specific treatment areas rather than transmitting radiation throughout the entire body — allowing for more accurate treatment with less adverse effects. Although the technology dates back to the 1920s, the first medical proton therapy center in the US opened in 2010. The reason for this large gap between discovery and medical implementation is largely due to a lack of private sector funding, resulting in public uncertainty and lack of awareness. By 2014, private sector investments into nanotechnology came in at an estimated $9.8 billion, nearly tripling that from the the public sector. Since then, investment from the private sector has continued to rise, but not without hesitation. After having interviewed countless investors, I found that most hesitation stemmed from uncertainty about healthcare policy and the future of medical technology innovation.

Nearly 60 per cent of proton therapy recipients in the US are covered by public sector insurance (Medicare and Medicaid). Both healthcare insurance programs currently deem proton therapy a “medically necessary” procedure and will cover patient treatments. Private insurers, however, have the ability to scrutinize over the definition of “medically necessary” which leads to an ethical quagmire. Prostate cancer treatment is the most controversial in this dilemma. Prostate cancer has the highest success rate with general radiation therapy but can cause irreversible side effects in the male reproductive system — most often impotence. Proton therapy’s targeted approach significantly lowers the possibility of this side effect occurring, but at nearly five times the cost of traditional radiation therapy. As a result, most private insurers reject claims to cover proton therapy for prostate cancer treatment and will reserve reimbursement for patients suffering from more complex cancers with a lower success-rate under general radiation therapy, such as cancers of the nervous system.

Continue reading on the course’s Technology, Innovation, and Society blog.