TIROG
`000
`TUMOR INSTITUTE RADBATION ONCOLOGY GROUP, LLP
`
`*‘
`
`MEDICAL DIRECTOR
`TODD A. BARNETT M.D.
`
`ROBERT M. DOUGLAS, M.D.
`
`SFEPHEN M. EULAU, M.D.
`
`_
`
`DANIEL M. LANDIS, M.D., PHD
`
`BRIAN LEE, M.D., PHD
`
`SKYLER LINDSLEY, M.D.
`
`CHRIFFOPHER LOISELLE, M.D.
`
`TIMOTHY P. MATE, M.D.
`
`VIVEK K. MEHTA, M.D.
`
`ROBERT M. MEIER, M.D.
`
`Asmio 0. MORRIS,M.D.
`
`JAMES F. SPIEGEL, M.D.
`
`ROBERT M. TAKAMIYA, M.D.
`
`JOHN J. TRAVAGLINI, M.D.
`
`SANDRA S. VERMEULEN, M.D.
`
`JAMES R. DINGELS, MBA, MPH, CPA
`ADMINISTRATOR
`
`swenrsn CANCER1|-isrrrin-E ATFIRSF HILL
`1221 Madison Street First Floor
`Seatfle, WA 98104
`P: 206-386-2323
`F: 206-2156150
`
`swsnrsu RADIQSURGERYcan-rm
`James Tower, Life Sciences Building
`550 17"‘ Ave., Suite A-10
`.
`Seattle, WA98122
`P: 206-320-7130
`F: 206-320-7137
`
`SWEDISHmnczn msrrrurs ATEDMONDS
`21605 75"‘ Avenue W
`Edmonds, WA98166
`P: 425-640-4300
`F: 425-640-4440
`
`SWEDISH CANCER INSTITUTE AT HIGHLINE
`16251 Sylvester Road SW
`Burlen, WA 98166
`P: 206-386-2626
`F: 206-246-7344
`
`SWEDISHcnncsn msrrnrrz ATISSAQUAH
`751 NE Blakely Drive, Suite 1090
`Issaquah, WA 98029
`~
`P: 206-386-2626
`F: 206-246-7344
`
`UW VALLEYMEDIFALcement
`400 S 43"’ Street
`Renton, WA 98055
`P: 425-251-5121
`F: 425-6564072
`
`December 14, 2016
`
`The Honorable Irving Williamson, Chairman
`U.S. International Trade Commission
`500 E Street SW
`Washington, DC 20436
`
`Re:
`
`Certain Radiotherapy Systemsand Treatment Planning Software,
`and Components Thereofi Inv. No. 337-TA-968
`
`Dear Chairman Williamson:
`
`_
`
`I write in response to the Commission’s Request for Submissions on Public
`Interest, issued October 30, 2016, in the above-captioned investigation. I
`understand that Complainants have asked the Commission to stop the
`importation and sale in the United States of Elekta’s linear accelerator products
`(“linacs”) and Monaco treatment planning software. I am writing to advise you
`of the very real detrimental impacts such action would have on my hospital and
`other similarly situated entities.
`'
`
`'
`
`Elekta is the only substantial competitor to Varian in the market for
`radiotherapy equipment such as linacs. Although there are a few other much
`smaller market participants, such as Accuray, Elekta provides the only real
`alternative to purchasing a Varian linac. If Elekta’s products are eiccluded,
`Varian would have unchecked dominance over the U.S. market and could price
`its products accordinglywithout any competitive pressure. -This is very likely
`to drive prices for new and upgraded linac equipment very high, straining the
`budgets of American’s already burdened public health system. Moreover, the
`market barriers for any new competitors, including smaller players like
`Accuray, is extremely high and would not provide any real check to Varian’s
`market power.
`_
`
`Another important consideration is the long order cycle for new linacs.
`Hospitals and clinics frequently put many months, and sometimes years, of
`planning into purchasing a linac and the related software and equipment. The
`decision often involves a detailed look at the specific hospital and patient
`needs, the capabilities and relative strengths of the various linac products, and
`the experience and training of the staff on the different brands of linac
`~
`products. Many orders.alsoirequire specialconstruction of vaults before linacs
`can be delivered.
`~
`. A
`1
`;
`'
`
`1221 Madison Street Q Seattle, WA Q 98104 O Phone: 206-386_-2323 O Fax: 206-215-6150
`I
`-
`6%i'Zz%
`
`­
`

`
`Forcinga hospital with an existing linac order, awaiting final delivery or installation, to abandon
`those efforts order a Varian.linac would be harmful to the patients who must wait longer for treatment
`and for increased
`’ -
`~
`
`cost of healthcare. For this reason, even if the Commission decides to exclude Elekta linacs,
`customers should be permitted to receive linacs that are the subject of existing orders.
`
`Finally, the Commission should be aware that a linac is not a one-off purchase. Linac customers,
`including my hospital the Swedish Cancer Institute/Providence Health System, purchase multiple
`Elekta linacs knowing and relying on the ability to upgrade those linacsas needed over a periodof
`several years, if not a decade or more. An upgrade to, for example, a more sophisticated multi-leaf
`collimator allows a hospital or clinic to expand the types of treatments it provides to patients along
`with increased speed and efficiency. Upgrades of Elekta equipment cost only a fraction of the
`amount of a new linac and are perfonned much’more quickly, allowing better treatment options for
`patients. Varian hardware is not compatible with Elekta equipment, so Varian cannot provide
`upgrades to Elekta equipment. If Elekta upgrades are not available, most facilities will have to go ‘
`without such improvements, because purchasing 'a new linae is a largeinvestment. For these reasons,
`even if the Commission decides to exclude Elekta‘linacs, Elekta should be allowed to not only repair
`and service existing products, but to offer upgrades to newer versions.
`'
`
`I recognize the importance of enforcing intellectual propertyirights. I believe, however, that
`excluding Elekta linacs and treatment planning software from the U.S. market would do a grave
`disservice to America’s public health system and the hospitals, clinics, physicians, and patients in that
`system. If the Commission ultimately decides to issue an exclusion order, however, that exclusion
`order should account for and attempt to mitigate the concems addressed above.
`
`Sincerely,
`
`.
`=
`Vivek Mehta, MD
`Director, Center for Advanced Targeted Radiotherapies
`Swedish Cancer Institute
`.
`1221 Madison St, First Floor
`Seattle, WA 98104
`_
`
`‘
`
`'
`
`I
`
`c_c: Counsel of Record
`Per Certificate of Service
`
`V