"My chance of surviving prostate cancerand thank God I was cured of itin the United States? Eighty-two percent," says Rudy Giuliani in a new radio ad. "My chances of surviving prostate cancer in England? Only 44%, under socialized medicine."
Critics have attacked his numbers, which he drew from an essay that I wrote for City Journal.
In the New York Times, Paul Krugman declared the stats "bogus numbers wrapped in an invalid comparison embedded in a smear," and added that the 44% figure was wrong, citing a British government stat of 74%. The Washington Post's Eugene Robinson wrote that "the tough-talking former mayor is growing estranged from empirical fact." Bloggers used harsher words.
Let me respond: The mayor is right.
According to data that the Organisation for Economic Co-operation and Development published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57% of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43% survived.
Consider some more numbers from various sources:
The American Cancer Society has released data from the 1990s suggesting five-year survival rates of 95% for the U.S. and 60% for Britain.
Lancet Oncology, drawing on data from the Eurocare database for this decade, published five-year survival stats this August showing survival rates of 99% for the U.S. and 71% for the U.K. (without England because of incomplete data).
And data from the U.S. National Cancer Institute and the U.K.'s Office of National Statistics, much quoted by the media, show rates of 98% and 74%, respectively.
Krugman and others have compared statistical apples to oranges. My 44% figure, replicated by economist John Goodman and others, looks at a snapshot in time, based on decade-old OECD data; Krugman's 74% is a five-year relative survival rate from government sources today.
Because Giuliani was describing his experience with cancer from years past, referring to older data makes perfect sense. Even if you prefer the American Cancer Society's 95% and 60% statisticsalso from the 1990sthat would mean that Giuliani slightly understated British effectiveness but also American effectiveness.
Though the various sources' different approaches have yielded, naturally, different results, their uniform conclusion is that Americans do better with prostate cancer than people across the Atlanticmuch better.
As Giuliani noted: "Even if you want to quibble about the statistics, you find me the person who leaves the U.S. and goes to Britain for prostate care treatment."
Some critics, however, have argued that statistics comparing American survival rates with British ones are meaningless. They point to two facts: that screening for prostate cancer is far more common in the U.S. than in the U.K., and that prostate cancers are often slow-growing.
What this means, they continue, is that in America, many people who have slow-growing prostate cancer and will never succumb to the disease are nevertheless diagnosed with it, yielding an artificially high survival rate.
But why is it that Britons (and other Europeans) aren't screening more for cancer? Remember the cardinal rule of cancer care: Early detection is critical to treating the disease successfully.
In public health care systems, oncologists are scarce, PET scanners are rare, and novel cancer drugs aren't covered. That may not prove deadly for some patients with slow-growing prostate cancers. But it is a disastrous approach with, say, melanoma.
The Lancet Oncology datawhich I consider the best of the four sets listed aboveshow a gap between five-year survival rates in the U.S. and Europe for more than a dozen different types of cancer.
On average, American men have a 66% chance of living at least five years after a cancer diagnosis, compared with only 47% for European men; American women have a 63% five-year survival rate, compared with 56% for European women.
People like Krugman have long glorified public health care. Even in the face of the cancer outcome data, he writes that "there's very little evidence that Americans get better health care than the British."
But on this there should be no debate: Public health care systems ration care. The results are long waiting lists for tests and specialist consults, limited access to new drugs, and poorer standards.
This is the reason that Americans do better with cancer careand other types of health care. And it's the reason that when he fell ill, Rudy Giuliani was lucky to be living in New York, and not in York.
Original Source: http://www.ibdeditorials.com/IBDArticles.aspx?id=279237711504195