|Year : 2018 | Volume
| Issue : 3 | Page : 204-206
Review of the book entitled “Cancer, Radiation Therapy, and the Market” by Ms. Barbara Bridgman
Deepak Dattatray Deshpande
Department of Medical Physics, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||26-Sep-2018|
Dr. Deepak Dattatray Deshpande
Prof. Medical Physics, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Deshpande DD. Review of the book entitled “Cancer, Radiation Therapy, and the Market” by Ms. Barbara Bridgman. J Med Phys 2018;43:204-6
|How to cite this URL:|
Deshpande DD. Review of the book entitled “Cancer, Radiation Therapy, and the Market” by Ms. Barbara Bridgman. J Med Phys [serial online] 2018 [cited 2018 Dec 15];43:204-6. Available from: http://www.jmp.org.in/text.asp?2018/43/3/204/242275
Author: Barbara Bridgman Perkins
Title: Cancer, Radiation Therapy, and the Market
Publisher: Routledge-Taylor and Francis Group, New York
Total number of pages: 243
ISBN No: 978-1-138-282524-8
The book makes interesting reading. It is an account of the close link of marketing by the companies/manufactures and medical care, especially in the USA. Since 19th century, there has been a medical business system. In the 20th century, there was a lot of capital investment by wealthy investors in medical business who encouraged the selective growth of more profitable services and technologies.
The book emphasizes more on Radiology and Radiotherapy industry from the days of powerful new form of energy in 1890's to proton therapy with skyrocketing cost 1940's onwards. The author discussed the aura of scientific inventions of complex technologies over the medicine and at the same time need to have evidence-based medicine. She observes that in US billions of dollars were spent, those days yearly on medical over /under treatment.
Part I: In early 20th century, A. Carnegies and business magnets funded institutions like Massachusetts and California Institutes with mission of linking technological inventions to industrial production.
Chapter 2 describes the Medical Radium Industry. Soon after Madam Curie and Pierre Curie discovered Radium in 1898, the industrialist, Emile Armet de Lisle built a refinery to provide more Radium and many surgeons started using it for treatment. Medical journals advertised the radiation treatments along with physician offering there. Processing Radium was a status symbol. The book describes with details how Radium industry was a flourishing industry in the US those days. It also described the politics involved in controlling Radium industry. From 1930's onward, the Radium use was reduced due to new X-ray tube in the market which was more effective.
Chapter 3 gives details of how General Electric company became the most dominant X-ray industry. General Electric company played a dynamic role in developing X-ray therapy soon after the discovery of X-ray by Roentgen in 1895. In 1913, William Coolidge an engineer with GE developed X-ray tube which was much better than existing. They later developed 200 KV therapy tube which revolutionized the X-ray business. They escalated to million volt tube in Chicago hospital. In 1934, GE announced a now resonance transformer which was used in New York Memorial hospital for supervoltage therapy.
Chapter 4 discusses the role of competing research universities. The California Institute of Technology (Caltech), University of California (UC), and Massachusetts Institute of Technology (MIT) led the way to build the high-voltage technology. They attracted donors by emphasizing medical as well as industrial use of their new machines and also offered the machine to physician for sending patients for treatment in their laboratories. The book describes the competitive research and development of these universities for megavoltage treatment.
The result of this had been the development of neutron treatment by Lawrence and megavoltage X-rays by Van de Graaff. Simultaneously, many medical literature started reviewing the results of radiation treatment also. The reports and claims began to appear in medical literature far too early to evaluate clinical effectiveness! It was felt then that the growth of the field owned more to professional, institutional, and industrial aspirations than did to improved cancer control.
Part II: It investigates the impact of wartime and postwar economics. There was a massive industrial growth for World War II. Military research contributed to medical technology as high-powered radiotherapy devices were made based on microwaves developed for radar. Furthermore, artificial radioactive elements were made in reactors for the atom bomb. Private companies augmented the growth. FORD Foundation hospital's Grants Program distributed $200 million to 3000 US firms manufacturing hospital equipment.
Health insurance also grew very rapidly and helped medical industry and hospitals. In 1950, there was 6th International Congress of Radiology where companies showcased their products to radiologists and radiation physicists.
Chapter 5 outlines how academia and industrial engineers worked with radiologists to attract funding to build new devices and collaborated with established companies to manufacture them.
The book described competition in academia and industry in the development of radiation technology. Massachusetts Institute of Technology (MIT) and University of California (UC), remained dominant institutes in research and General Electric (GE) the dominant industry in development of technology. The book also narrates the journey of one of the engineers in GE, John Trump (uncle of President Trump) who has started with Van de Graaf and later owned a competing High Voltage Engineering Corporation and collaborated with Lahey laboratory for clinical treatments. Trump remained in news for many years due to wide publicity he did for Van de Graff generator X-ray and his claims about their superiority. The author has given details about professional war between MIT-Lahey and Robert Stone of UC.
Chapter 6 deals with the development of cobalt machines. Another important fallout from nuclear reactors invented for war was Cobalt-60 isotope, which was called as “peace time bomb.” It was projected as Atoms for Peace. Canada was the first to produce teletherapy device using Co-60. Ontario Cancer Treatment and Research Foundation and Eldorado Company first used Co-60 for patient in 1951. Eldorado partnered with Atomic Energy of Canada (AECL) which became the largest seller of Co-60 sources in the world. In 1941, MD Anderson Hospital for Cancer Research of University of Texas was set up at Houston which was having America's first Cobalt machine and host of other advanced machines.
By 1959, there were 288 cobalt devices in the US and Canada, 137 in Europe, and 218 in Asia (200 of which were in Japan). Canadian AECL and US Picker companies supplied over 80% of cobalt machines. GE went in background as it could sale only 10 X-ray devices in decade! However, the boom of cobalt-60 proved to be due to economic and professional factors than any scientific advantage.
Chapter 7 narrates the success story of Standford University. The Stanford University always supported the technological entrepreneurship. It is here brothers Russell (Rus) and Sigurd (Sig) Varian invented Klystron in 1937. Stanford President Ray Lyman Wilber offered Varian a contract to allow them to use physics department equipment in exchange of patent rights and 50% of royalties. Later, Henry Kaplan and Edward Ginzton contributed in research of linear accelerators. In 1956, Varian Associates announced that they are the company in linear accelerator business. In 1959, they designed their first linear accelerator and named it Clinac. The Varian took capital from stock market and became the power of Wall Street. In 1972, they introduced Clinac 18 linear accelerator. The book gives a detailed account of Kaplan's aggressive treatment of Hodgkin's disease and how he put a picture of Varian's 6 MV on his cover textbook of Hodgkin's Disease.
Chapter 8 describes the politics in radiation therapy for the growth of the devices and test the clinical effectiveness. By 1970s, 5-year survival studies claimed that cure rates of cancer of cervix had rose from 25% to 75% due to megavoltage radiation. However, it was partly due to the increase of provincial cancer clinics and Pap smear More Details use. The author gave some studies from California where surgery and radiation treatment for cancer of the cervix and breast are discussed. It was found that combined treatment may be beneficial.
Although there was no clear benefit of supervoltage machines, they were preferred due to sophisticated technology and higher productivity. Despite the lack of evidence, the growth of linear accelerator was phenomenal in the US. Total installations rose to 1000 by 1980s, 2000 by 1990s, and 3000 in early 2000s! Linear accelerators were new thing and conferred greater institutional prestige. The author further elaborated the policies which expanded radiation therapy facilities. In 1965, Regional Medical Programme (RMP) and Blue-ribbon policy which strengthened elite centers for specialty services through RMP-established networks. The hospitals were applying to buy linear accelerators as they will improve hospital market positions and not because they will cure more!
Part III: This part describes the entrepreneurship and financial firms contributed to medical care during 1970s to 2010s. Chapter 9 described the advent of proton therapy. In 1980's, the investigators were reporting that photon has reached the peak of clinical performance and any further increase in energy will not help and other particles like neutron and proton therapies were being explored. Sweden's University of Upsala used proton for clinical purpose in 1957 and Massachusetts General Hospital in 1961. California's Loma Linda university announced the first hospital-based proton therapy center. Ion Beam Applications (IBA), Varian, and Hitachi were leading companies to enter the market for proton therapy. The author details about the growth of proton therapy, health policies, insurance challenges for proton therapy, and particle centers globally.
In chapter 10, the author discusses the professional standards, patterns of care studies, radiation treatment effectiveness, and various clinical trials. The author has raised the issue of Food and Drug Administration (FDA's) 510 (k) notification process. This process eliminates any testing or evaluation of equipment but just compares with earlier similar models and certifies it. The author claims that nearly half of FDA Advisory Committee members had ties with it in the form of stocks, research grants etc.!
Finally, in chapter 11, the author discusses the key market strategies such as monopolizing populations, disease and technologies, design high-cost technologies, compete for patients and doctors using technology, and integrate medical care into finance through insurance and debt, etc., The author concludes that there is a need to build more effective and efficient health-care system by winning over market strategies and choose health over wealth.
Overall, the book gives detailed account of market forces in medical, especially radiotherapy development. Reader gets surprised to know that right from Roentgen days market was shaping the radiotherapy treatment methods. It also highlights the close collaboration of industries with universities in the US, which helped in producing new inventions quickly at the large scale for the benefit of people. Every country, especially India should emulate this.