Whose Prostate Cancer Survival Statistics are Really Spurious?

Paul Krugman's recent op-ed column in the New York Times accused GOP presidential candidate Rudy Giuliani of picking statistics out of the air in order to support his position on opposing a government single payer system for health care. The subtitle of the piece is, "Rudy Giuliani has a habit of saying things that are demonstrably untrue. And the American people have a right to know that."

http://www.nytimes.com/2007/11/02/opinion/02krugman.html?_r=1&n=Top/Opinion/Editorials%20and%20Op-Ed/Op-Ed/Columnists/Paul%20Krugman&oref=slogin

Mr. Krugman says that Giuliani got his 44% number for prostate cancer survival in England from an article published by “the conservative Manhattan Institute”. It is implied that the number is automatically suspect because it was used in a conservative publication. He then criticizes the Manhattan Institute author for not citing his source.

Mr. Krugman then states that the real figure is 74.4%. But guess what? He doesn't cite a source! So it is unacceptable for Giuliani as a conservative to use a statistic and cite the author of the article but Mr. Krugman as a liberal can throw out his own number with no source and it is OK? That is really, really funny.

Because the Manhattan Institute is conservative it must be wrong. Because Mr. Krugman is a liberal his number must be correct? Are you truly telling me just to take Mr. Krugman, who has an unabashedly liberal agenda, on faith?

Eugene Robinson, op-ed columnist for the Washington Post piles on as well. He also assails Giuliani's 44% percentage. Mr. Robinson, states that the Manhattan Institute article is using a statistic from the Organization for Economic Cooperation and Development that are 7 years old. Mr. Robinson further states that more recent statistics show that the survival rate in the U.S. and England to be 98% and 74% respectively.

http://www.washingtonpost.com/wp-dyn/content/article/2007/11/01/AR2007110101991.html

It just so happens that one of the other books I am reading right now is The Business of Health by Robert Ohsfeldt and John Schneider.

Dr. Ohsfeldt is a professor with the Department of Health Policy and Management at the School of Rural Public Health, Texas A&M Health Science Center. He has received research grants on many subjects including cancer. He has been the peer reviewer on more than 30 articles for scientific journals. He is also on the editorial board of the Journal of Managed Care Pharmacy.

Dr. Schneider is a professor with the Department of Health Management and Policy at the University of Iowa College of Public Health. He holds a secondary appointments with the Department of Economics and the Iowa VA Center for Research in the Implementation of Innovative Strategies in Practice.

Chapter 1 is titled, U.S. Health Systems Performance: An International Perspective. TABLE 1-6 is titled: Five-Year Age-Adjusted Cancer Survival Rates, United States and Selected European Countries. The United States figures are cited from the U.S. National Cancer Institute (2003), year of diagnosis 1986-88. European Country statistics are cited from the International Agency for Research on Cancer (2003), year of diagnosis 1985-89.

The five-year prostate cancer survival rate for white males in the U.S.: 82.7% (blended U.S. survival rate is 81.2%). The survival rate for England: 44.3%.

The diagnosis dates for the European data in The Business of Health are 1985-89, which means the data is about 3 years old. (the last year of diagnosis is 1989 plus 5 years equals 2004).

To recap, 7 years ago the Organization for Economic Cooperation and Development has the survival rate for England at ~44%. 3 years ago the International Agency for Research on Cancer has the survival rate for England at ~44%. Mr. Robinson, and I guess Mr. Krugman, are claiming a “more recent”, and still un-cited, figure of a 74% survival rate for England.


Give this the plausibility test. Does it seem plausible that the survival rate could improve by 30 points between 2004 and 2007 after apparently remaining constant for a number of years before that from several different independent organizations? Of course it does not.

Just as Mr. Krugman, Mr. Robinson provides no source for his “more recent” data, or exactly how recent it is. Mr. Robinson’s lack of citations just extends the sloppiness of the argument.

Mr. Krugman concludes his piece with the following:

“The fact is that the prostate affair is part of a pattern: Mr. Giuliani has a habit of saying things, on issues that range from health care to national security, that are demonstrably untrue. And the American people have a right to know that.”

To paraphrase Mr. Krugman, surely the American people deserve op-ed columnists who do their homework on the subject.

Perhaps the 74% number has some legitimate basis - but how can we know if the source is not provided. 44% and 74% may be a case of "apples & oranges". But one thing is clear - Rudy Giuliani is not just plucking spurious statistics out to the air to support his position. I'm not so sure about the New York Times and the Washington Post.