A reader says I showed lack of objectivity in my post yesterday on whether Obama will slash reimbursements for proton beam therapy for prostate cancer. It’s true, I don’t want to see prostate cancer patients lose the option of proton beam therapy. If using proton beam therapy for prostate cancer actually helps subsidize proton beam use to treat pediatric cancer and rarer adult brain or eye cancers — where it’s said to be even more advantageous — this seems like a good overall arrangement.

The reader asks, has anyone seen a lot of data on the results of proton beam therapy? Not a lot, but results so far are on a par with current results for robotic prostatectomy compared with open prostate surgery. The problem is cost.

Yesterday we saw pressure to take proton beam therapy for prostate cancer off the table coming from a physician interviewed in business and biotech columns. This disturbs me. I’m not invested in proton beam or any other therapy, nor close to anyone who ever received proton beam. But I’ve seen closeup how even the next best thing in radiotherapy, sculpted and targeted IMRT, can cause a man rectal bleeding, loss of bowel control, and worse. If anyone can take a shot at something better, I say help him go for it.

It’s disappointing that incontrovertible evidence for superior long term survival after proton therapy isn’t here yet. But my feelings clarified when I came across this video from last year’s ASCO, 2008, featuring Harvard radiation oncologist Dr. Anthony Zeitman, a doctor who’s been talking up a storm with the business press. Dr. Zeitman can sound cool, calm and scientific. But sometimes he sounds like a weatherman in a hurricane.

In 1997 Dr. Zeitman identified with the American College of Physicians’ position that insufficient evidence existed to justify screening men for prostate cancer. He favored watchful waiting and emphasized that “even the newest forms of treatment have potential downsides.” He was equable and temperate about holding this opinion.

In recent sound bites about proton beam therapy, by contrast, he sounds agitated. His titles his latest article on prostate proton therapy after a poem by Thomas Hardy, “The Titanic and the Iceberg.” In the video he describes the excitement surrounding proton beam radiation as “an exuberant maelstrom” and a “proton avalanche.”

“I’m fascinated and horrified by the way it’s developing,” he says. His riveted gaze — “This is the dark side of American medicine” — perhaps fits a man educated at Oxford and University of London. Apparently, as a physician and medical scientist raised in a different system, US medicine appalls him, feel monstrous, alien and irrational. This contrasts with the calm, measured scientific view of proton beam therapy for prostate cancer in Dr. Zeitman’s piece this year in the prestigious journal Nature. His interviews about the economics and financing of new proton beam facilities are shot through with incredulity at such medical villainy. Patients ought not to be allowed to waste public money, he implies, on less than fully proven procedures.

Yet the UK health service can’t stop patients from going for their best shots too.

The BBC reported last November on how cancer patients “miss out on therapy” because the UK has only one (totally antiquated) proton therapy center.

The equipment is at Clatterbridge Center for Oncology near Liverpool, and “because it’s a low-energy machine whose protons travel a maximum of 31mm it can only be used to treat eye cancers.”

UK patients demand better.

“Ian Lawrence …. has just paid out Euros 47,000 (around £40,000) for a six week course of proton therapy treatment at a hospital near Paris, after a cancerous tumor was discovered on the optical nerve leading to his left eye.” ”

Alex Barnes from Leicestershire is just five….. he underwent surgery for brain cancer – for the second time in his short life – at a hospital in Jacksonville, Florida and has now started proton therapy treatment there. The cost: approaching £100,000, partly paid for by well-wishers.” The BBC report goes on:

The biggest hurdle facing enthusiasts for proton therapy centres in the UK is undoubtedly financial. In the US, with its private health system, that is less of an issue.

Hospitals like the one in Jacksonville build proton therapy machines and make most of their money treating hundreds of cases of common conditions like prostate cancer.

In the NHS, where money is much tighter, only a very few cancer sufferers would be likely to qualify for treatment – perhaps as few as 400 a year – to prevent the facilities being overwhelmed.