Losing the Waigul Valley

In the last century, American medicine has gone from a cottage industry to a technology-driven juggernaut. The machine at the heart of the new Roberts Proton Therapy Center, dubbed “the world’s most expensive and complex medical device,” provides a glimpse of what the coming years may hold.
By William Hanson


Mar|Apr 09 Contents
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My father was a physician whose career spanned the four decades from the early 1950s to the early 1990s, and many things changed during his lifetime. For example, in the 1950s, the RJ Reynolds Tobacco Company actually ran a campaign with the slogan “More doctors smoke Camels than any other cigarette,” and many of the pictures in my father’s medical school yearbook show him and classmates with cigarettes in hand. However, the really big changes occurred during the latter part of his career (when my own career was just beginning), during which medicine began to evolve from a mom-and-pop, cottage industry into the highly competitive, rapidly advancing, multinational business it is today.

In the late 1970s and early 1980s, I worked at the same medical center that I do now, in an office that was then called Data Processing—the hospital division that managed patient’s bills and accounts payable. There was exactly one computer in the entire hospital—in the basement—and it dined exclusively on IBM punch cards (those heavy, rectangular paper cards formerly used for census-taking, school examination registration, time cards and, perhaps most notoriously, for voting in Florida during the U.S. presidential election in 2000—the piece punched out of the card is, of course, a chad). Punch cards were used to keep track of the medical bills. Data entry clerks punch-typed charges onto the cards, which were then sorted into piles secured with a rubber band. Periodically, the computer would be fed a pile of punch cards upon which it would chew noisily for some time and eventually spit out a ream of data on a teletype machine.

Fewer than 10 people worked in hospital administration—the chief operating officer, the chief financial officer, the chief nursing officer and a few support people. Their job was keep the books, buy things that were needed and make sure the bills got paid—nothing more. The concept of engaging in overt competition to attract patients was inconceivable: The patients just came to us, and the hospital’s officers did pretty much what they were told by the doctors who sat on the hospital’s board.

As I drove to work in the early 1980s, I passed plenty of billboards, none of which advertised hospitals or doctors. In fact, the thought of self-promotion was abhorrent to the medical profession at that point. There were no signs on the city buses asking “Have you been misdiagnosed?” There were very few regulatory agencies, and magazines didn’t publish lists of the best doctors and hospitals. Medical benefits were a little employee perk in the same category as parking and free company business cards.

In short, medicine back then was a pretty sleepy, gentlemanly affair, and some hospitals were like the fat, slow-moving dodos from the island of Mauritius. Today, however, a mere 25 years later, we are in a medical evolutionary arms race. Computer chips are ubiquitous—there are probably 20 in my office alone, what with desktops, laptops, telephones, cell phones, a camera and other gadgets. Data analysts have found their own ecological niche; and 30 percent of health care workers are administrators. In fact, upwards of 30 percent of health care dollars go toward medical administration. Hospitals now have powerful CEOs, many of whom have advanced degrees in health care administration, an educational track that teaches how to control costs, grow product lines and capture market share.

The current landscape of medicine and its place in the larger society is, at best, very confusing when viewed from the ground. We are in what Clausewitz described as the fog of war. On the one hand we hear a steady stream of dire predictions about the all-engorging growth of health care in every modern country in the world, while on the other, there is a competing flow of information about tantalizing new therapies, such as proton beams, that can cure or extend life. Some of the latter will represent major breakthroughs while others will turn out to be no better than or even worse than their less costly predecessors.

Proton beam therapy is a perfect example of the technologies and treatments that are at the leading edge of medicine and that you’ll find in the hospital of the future. Developed by physicists, in their search for fundamental particles, this therapy is technologically sophisticated; even as a critical element of a treatment assembly line, it can be programmed to give treatments precisely calibrated to the specific needs of each individual patient.

Inside the Cancer-Cell Smasher By William Hanson
Illustration by Ryan Graber

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©2009 The Pennsylvania Gazette

Countdown to the
First Proton-Beam Patient

One year and one month after workers lowered the 220-ton proton cyclotron into the construction site of the Roberts Proton Therapy Center, the building above it has come into being. But it will be just a while longer before anyone can book an appointment. In addition to the parade of federal inspectors who have to sign off on it, the equipment is in the midst of tests and simulations that will occupy several months.

Those will run the gamut from one end to the other of an astoundingly complicated pipe. “First, you turn on the cyclotron to see if it makes protons,” says Susan Phillips, vice president for public affairs at Penn Medicine. “We know it does that, because that test has already happened. Then you test the magnets that shape the beam to various treatment rooms. Then you have to test what comes out of the patient gantry. It’s literally thousands of calculations. And on top of that, there’s a tremendous amount of software and computer programming.”

After that, it’s a case of rinse, wash, repeat. “Each treatment room comes online by itself,” adds Phillips. “So you have to do it five times.

If everything goes according to plan, protons will start zapping tumors this November.

The Oldest Tool in Medicine




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