Two days after the U.S. House of Representative's historic vote approving health care reform in the United States, OT spoke with William R. Harvey, DEd, President of Hampton University in Virginia, which coincidently was the same day that President Barak Obama signed the bill into law.
The timing was significant, since under Dr. Harvey's leadership the university had undertaken the funding and construction of what he called the largest proton beam radiation therapy (PBRT) facility in the world (at 98,000 square feet), with one of the world's largest price tags for such an enterprise—$225 million secured through bonds raised by a consortium of banks led by JP Morgan.
It had also been recently announced that President Obama would speak at the school's commencement, which he did on May 9, and Dr. Harvey said at the time of our interview that he hoped that time would allow Mr. Obama to tour the proton facility when he was visiting; that turned out, though, not to happen.
Dr. Harvey had also been appointed in early March by Mr. Obama to be Chairman of the President's Board of Advisors on Historically Black Colleges and Universities.
The Hampton University Proton Therapy Institute is scheduled to see its first patient in August and already has a waiting list of approximately three months for appointments, as well as $20 million raised to begin paying back its massive mortgage.
It was also getting ready to announce the recruitment of leaders from other proton centers to join its program.
No Cancer Center, Medical School, or Medical Center
But what was really interesting was that the university was entering the proton therapy business without benefit of a cancer center, medical school, or medical center.
And it planned to treat about 65% of its eventual estimated 2,000 patients a year for prostate cancer, an indication for the procedure that is currently controversial and had been stated to be scientifically unproven to be better than other therapies by a number of radiation oncology experts who spoke to OT for this series.
Dr. Harvey said that he first heard about proton therapy a number of years ago when a Hampton alumnus told him about a cousin who had been successfully treated for prostate cancer at Loma Linda University Medical Center's proton facility.
“I started researching it myself and spent a great deal of time on the Internet and talking to people. At that time there were only three centers in the country [Loma Linda, Massachusetts General Hospital, and Midwest Proton Radiotherapy Institute at Indiana University], and I talked to the heads of those units.”
He said that he found it wasn't necessary to have a medical school or a hospital, but that a proton center could exist as a freestanding clinic with medical doctors, medical physicists, dosimetrists, and technicians who were not associated with a hospital or medical school.
“So I thought with our history of doing very important work on very dreaded diseases we could do it. The first person I brought in was [medical physicist] Cynthia Keppel, PhD, as my partner to take the lead on the cancer research [as scientific and technical director]. We now have a center and equipment, are testing and calibrating it, and intend to see our first patient in the summer.”
The university has been involved in research for decades, Dr. Harvey explained.
“We've been doing a great deal of cancer research. Our group has about 14 patents for both breast and prostate cancer detection devices, and we've had a very keen interest in cancer, its prevention, and cure.
“Although Hampton is a relatively modest university we've a great deal of overall world-class research— for example, our school of pharmacy faculty is trying to identify the gene that causes Alzheimer's; another group is working on prosthesis devices and has about 14 patents as well; we've started a skin-of-color research center since there is a vast difference between black, white, yellow, red, brown, and tan skins, and other than pigmentation there are other challenges and diseases that affect people of color differently from others; and our atmospheric science group's last effort was launching a $140 million satellite.”
He said that the Hampton Roads community has several hospitals interested in partnering with the proton facility, as are the University of Virginia, Virginia Medical College, Eastern Virginia Medical School, Johns Hopkins—which has indicated it might like to send physicians through the proton center on rotations—and Duke, which would like to get involved in clinical trials. However, he added, so far discussions have been informal and there aren't any contractual agreements at this time.
“We intend to be very inclusive, not exclusive, and work with anyone who wishes to work with us in a very positive way.”
Hampton plans the proton center to be primarily a treatment facility, with some research as well.
The types of cancers treated are expected to be about 65% prostate cancer, with the remaining 35% pediatric, ocular, lung, breast, and other cancers.
Information from the university points out that African-American men are 59% more likely to get prostate cancer than white men are, and that CDC data show that Hampton Roads leads the nation in prostate cancer deaths.
When asked about the heavy emphasis on treating prostate cancer patients who were not on protocols and the lack of scientific evidence showing that proton therapy is more effective than other less costly and more readily available modalities, Dr. Harvey said he disagreed.
“I'm not so sure I would agree that there is no scientific evidence. I know that Loma Linda has been doing it since 1990, and if you look at what Loma Linda and Mass General have done at the established centers I am convinced that proton therapy is far superior to many others for many reasons including that there are little to no side effects; and if you use some common sense when you talk about IMRT, or seeds or surgery, all of them have potential side effects that protons don't have.
“We will work with all of the centers around Hampton Roads to try to see if we can combat that dreaded disease, and we're not going to be competitive with the other modalities but will be working together. With all the research I have done if I had prostate cancer that had not metastasized then I would get proton therapy.
“I agree there have been no clinical trials, but I'm not sure that clinical trials are the only way to determine if something is effective. Look at the evidence, from Loma Linda since 1990 and many men have greatly benefited. If those people at those sites didn't think this was a good thing, then why are they doing it?”
He added that he thought proton centers that didn't treat prostate cancer beg the question since if “they haven't done very much then how do they know?”
Dr. Harvey, who has been president of the university for 32 years, said he didn't have any concerns about paying off the large mortgage on the facility—that would be accomplished, he said, through reimbursement, individual gifts, and support from both the state and federal governments.
City Donated the Land
The city of Hampton donated 5.5 acres of land in an industrial park overlooking a lake for the freestanding proton center, and the university has ties with the nearby Thomas Jefferson National Accelerator Facility, and with the local cancer treatment community, said Dr. Harvey, who also noted the area boasts one of the largest military complexes in the world and said that he intends to reach out to the military, veterans, and their dependents.
He said that the institute received its certificate of medical need from the Commonwealth of Virginia in the record time of three months.
A future medical school was not the motivating factor in creating the proton center, “but it's not something we want to take off the table. A number of people have approached me about starting a medical school, but I've said it's very expensive. Though I might look at it,” he said, “if Bill Gates or Warren Buffett wanted to give me a billion dollars, or maybe $500 million or $100 million.”
So far the proton institute has recruited 14 medical doctors, all of whom must have at least six months of experience with proton therapy, and its medical director is Christopher Sinesi, MD, with Oncology Associates of Virginia. The university also eventually plans to establish training programs for proton therapy technicians.
When it opens, the center will be the only such facility between Philadelphia and Jacksonville, FL, and since it doesn't offer any other medical services it may serve somewhat as a safe haven for referring proton patients who can then return to their original medical practitioners.
Nonetheless there seems to be some concern among a number of radiation oncologists interviewed for this article, who preferred to speak off the record, that Hampton's limited experience in health care may affect quality of care. As one source put it, “we've been doing this for a long time and know how difficult and complicated it is.”
However, Dr. Harvey doesn't appear to be worrying about these issues: “I am an educator and a businessman,” he said. “I have been the 100% owner of a Pepsi Cola bottling plant in Michigan for 25 years, and I run Hampton like a business for educational objectives. We are establishing this for medical reasons, but it will be run like a business because I run everything as an educator and a businessman.”