The Mayo Clinic has defended its multi-million dollar investment in two in-the-works proton therapy centers after a New York Times column dubbed the centers "exhibit A" in what's wrong with American health care.

Earlier this week, the Grey Lady published a column by two doctors, Ezekiel J. Emanuel and Steven D. Pearson, who said proton therapy was too expensive and not proven superior to cheaper treatments for most cancers. They also said the rush to build the centers was only done to tap into "generous" Medicare payments and compete with other top hospitals like M.D. Anderson Cancer Center in Houston and Massachusetts General Hospital in Boston (where Pearson works), which have the technology.

But in a letter to the Times and in a separate opinion piece in the Minneapolis Star Tribune, John Noseworthy, president and CEO of Mayo, said the non-profit health system would lose money (at least at first) in the centers and that it was investing in them only to offer its patients cutting-edge cancer treatments. Mayo has two $180 million proton centers under development, one in Rochester, Minn., another in Scottsdale, Ariz.

"Our intent is not profit, nor is it to contribute to the medical arms race. In fact, we chose not to build a proton beam center on our Florida campus. That area was served by another center," he said in his letter to the Times.

Proton therapy works by firing protons into cancerous tissue to destroy it. Because of the nature of protons, the radiation dose delivered in the treatment rapidly falls off away from the target. Theoretically, this means fewer side effects from treatment, as healthy tissue would receive less radiation.

But the centers are expensive to build, and there are only nine in operation nationwide.

Also, critics of the technology want to see more evidence. For instance, in their column, the two doctors said there was some evidence protons were better for rare pediatric brain and spine cancers, but there was no solid evidence - specifically, randomized, controlled trials - demonstrating its greater worth for prostate cancer, commonly treated at proton centers.

Because of this, Emanuel and Pearson argue Medicare should adopt a "dynamic" pricing model to pay for proton therapy. Currently, they say Medicare pays about twice as much for protons for prostate patients as it does for other types of radiation therapy (because proton centers are so expensive to set up and operate). Instead, they want Medicare to only pay more for protons in areas where it's clinically proven to be more effective; in other areas, they would pay as much as they did for other radiation therapy treatments, with patients paying out of pocket to make up the difference, if they still want that treatment.

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