Rudy Was Right

Today’s Washington Post takes Rudy Giuliani to task for a radio ad in which he claims that the chances of surviving prostate cancer are roughly twice as high in the United states than under Britain’s system of socialized medicine. The Giuliani campaign cited as its source an article by Manhattan institute scholar David Gratzer, which the Post pointedly notes “provides no source for its assertion.” However five minutes of research might have shown the Post that the numbers actually come from a Commonwealth Fund study by Gerard Anderson and Peter Hussey.

Moreover, the Post’s own figures, using more recent numbers and a different methodology, show that the five year survival rate for prostate cancer to be 98 percent in the U.S. and 74 percent in Great Britain. Not quite as good as Rudy’s numbers, but still a clear advantage for the U.S.

The Post also suggests that the better U.S. outcome is a reflection of “different philosophies about how to treat the disease.” Indeed! I think that is Rudy’s point.

The one valid criticism of Rudy’s point is that prostate cancer might not be the best example of outcome disparities between the two systems. Because prostate cancer is a slow-growing cancer, the disparity may reflect more aggressive testing and screening procedures in the U.S. That is, we catch many cancers that would go undetected in other countries. As, Robert Ohsfeldt and John Schneider concede in their book, The Business of Health:

[Many] cancer survival rate estimates…do not adjust for cancer stage at diagnosis. This could result in survivor time bias – those with cancers detected at an earlier stage would exhibit longer post diagnosis survival times, even for cancers that are essentially untreatable.

Survivor time bias, however, should not be a significant concern for cancers that respond well to treatment if detected early. For such cancers, early detection makes a substantive contribution to survival time – the longer survival time associated with early detection thus is not a spurious effect of early detection. An example is thyroid cancer. In the United States, virtually all females with thyroid cancer survive for at least five years. The lower survival rates for thyroid cancer in European countries suggest some underperformance in either early detection or post diagnosis management in these countries. In contrast, the differences in survivor rates are less pronounced for cancers that are more difficult to treat, such as lung cancers.

U.S. outcomes beat the U.K not just for prostate cancer, but for a wide variety of cancers and other diseases, where survivor time bias is not at issue. According to a study published this year in the British medical journal, The Lancet, for all types of cancer, the U.S. ranks number one among industrialized nations: 62.9 percent of women with cancer survive for 5 years, 66.3 percent of men. Britain ranked 16th for women (52.7 percent) and 15th for men (just 44.8 percent).

Besides, one of the most common arguments for socialized medicine is that it would lead to more testing, screening, and preventive care. Proponents of government-run health care can’t have it both ways.

For this one, it looks like the Post deserves “four Pinocchio’s.”