Giuliani Prostate Survival Statistics - Follow-up Part I

A liberal friend of mine kindly suggested that I read "The Fact Checker" column by the Washington Post's Michael Dobbs regarding the Giuliani statistics debate. Mr. Dobbs trys to substantiate the previous columns by Mr. Krugman of the New York Times and Eugene Robinson of the Washington Post that claimed Giuliani was basically pulling statistics out of thin air to support his position.

http://blog.washingtonpost.com/fact-checker/2007/10/rudy_miscalculates_cancer_surv.html

I read the Michael Dobbs article, I read the Commonwealth Fund paper from 2000, including the data used to calculate the 44% survival rate, I read the press release by the Commonwealth Fund stating their believe that their data is being misinterpreted., and I read Mr. Grazer’s rebuttal to the NY Times and Washington post, et.al.

Here is a summary of what I found:

• Rudy Giuliani made a statement in a speech that his survival from prostate cancer would have been 44% in England.
• The Commonwealth Fund paper shows that for every 49 people diagnosed with prostate cancer 28 die from it. That is a survival rate of 44%. The Commonwealth Fund paper’s data for this is from the Organization for Economic Cooperation and Development. This data is from the time relevant to Rudy Giuliani’s personal battle with the disease.
• Michael Dobbs states that the survival rate for prostate cancer is 98% and 74% for the U.S. and England respectively. But he also says that the mortality rates per 1,000 is roughly the same. Does that make sense?
• The International Agency for Research on Cancer number for 5 year prostate survival rate for England is 44%. This is from a study published in 2003 based on patients diagnosed from 1985 to 1989.
• Michael Dobbs cites (finally) data from the National Cancer Institute for the U.S. and the U.K.’s Office National of Statistics of a survival rate of 98% and 74% for the U.S. and the England respectively. These are apparently more recent numbers that some of the other citations.
• 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).

Here are my conclusions based on my analysis:

• It is not fair to accuse Giuliani of making statements that are not true; is it fair to call his a liar (I think that’s what 4 Pinocchio’s means). There is simply too much data from the period when Rudy had cancer that substantially validates his statement.
• No matter which methodology is used, and you would expect different study methodologies to have somewhat different results, it is undeniable that there is a much higher survival rate in the U.S. that in England for surviving prostate cancer. Nobody is traveling to England for its superior cancer diagnosis and treatment.
• Single payer, government health care relies on rationing and queuing for cost control . The OECD paper from 2000 showed that the wait time for the U.S. for non-emergency surgery was 0.9 months compared to 2.2 months for England.
• In single payer, government health care there is a shortage of oncologists, PET scanners are rare, innovative cancer drugs are not covered. For a slow growing cancer such as prostate this is not as serious a problem. For fast developing cancers such as melanoma this is a death sentence.
• The higher level of survival rates in the U.S. by study are: National Cancer Institute and U.K.’s Office of National Statistics (32%) American Cancer Society (58%) Lancet Oncology (39%), International Agency for Research on Cancer (86%), OECD (86%). So you can quibble with the statistics but the U.S. is head and shoulders above the U.K. by any methodology. I think I’ll just stay here thank you very much.
• It is interesting that the number for survival is England that is by far the highest comes from the U.K’s official government agency, who clearly has a vested interest in making the number as favorable as possible. I still find it implausible that the survival rate in England could shoot up that much in just a few years.
• It appears that Krugman, Robinson, Dobbs, et.al., are falling back on Ken’s standard liberal responses #1 and #3*: when presented with facts that do not support their liberal agenda (government single payer health care is the only solution) just ignore those facts and repeat your position as if they had not heard them, and, when in doubt, launch an Ad Hominem attack.
• The lower level screening as a way of invalidating the statistics for England are a red herring (or a McGuffin if you are a student of film). The health care system is what it is. Saying that the prostate statistics in England aren’t valid due to a lack of screening is like saying the U.S. high infant mortality rate is not valid because we don’t do enough prenatal care.

*Ken's standard liberal responses when presented facts that do not support their position:

1. Simply repeat the liberal position as if they had not heard the contradicting facts.
2. Present an emotional argument that does not respond to the contradicting facts or logic.
3. Launch an Ad Hominem attack.