Things I didn't know about Medicare

It uses private insurance companies for regional contractors

Go read The Evidence Gap in todays paper where a few other things pop up.

I'm botherd by things like using treatments that have been untested:

CyberKnife, made by Accuray of Sunnyvale, Calif., was allowed onto the market by the Food and Drug Administration in 1999 as a treatment for brain and spine tumors. Two years later the F.D.A. authorized it for use throughout the body. Accuray, as well as hospitals and clinics that operate the CyberKnife machines, which cost $3 million to $5 million, have been promoting their use on various cancers, including lung and pancreatic cancer — and, increasingly, prostate cancer.

According to Accuray, patients can get by on fewer treatments because the machines deliver highly focused beams of radiation at heavier doses than conventional systems. But some leading radiation oncologists worry that the cumulative radiation that CyberKnife delivers over a course of prostate treatments — ultimately lower than what patients would receive in standard therapy — is not adequate to treat the disease.

“They are basically pushing the envelope,” said Dr. William R. Lee, a radiation oncologist at Duke University. “If they’re right, it’s going to be an important advance. If they’re wrong, there’s a potential for a big downside.”

With about 80 patients studied under the regimen in published peer-reviewed research over five years, the results for CyberKnife are promising. Yet, because prostate cancer is frequently slow-growing, Dr. Lee argues that five-year data with so few patients may not be very meaningful. Others raise concerns that high daily doses may increase radiation side effects that can show up years after treatment.

The board of the radiation oncology society, the American Society for Therapeutic Radiology and Oncology, or Astro, has called CyberKnife promising, but raised questions this year about the evidence supporting its use in prostate cancer, saying “there is not sufficient or mature data to demonstrate equivalency to existing standard treatment modalities.”

Also I have a huge problem with selling a medical treatment to consumers directly:

Citing the variety of proven treatments for prostate cancer, one member of the Astro board, Dr. Louis Potters of North Shore-Long Island Jewish Health System, said that advertising CyberKnife directly to consumers could confuse patients, who have to choose the best treatment from an already bewildering array of options.

“Patients are becoming commodities and prostate cancer is the ultimate example,” Dr. Potters said.

They aren't exactly experts. And will often want more, wrong, or unproven treatments.