Tuesday, November 06, 2007

Rudy: I Probably Wouldn't of Made It as a Brit

Rudy Giuliani has a campaign ad out claiming that his chances of surviving prostate cancer would've been significantly lower had he lived in the UK.

Here's the text of the ad:
My chance of surviving prostate cancer -- and, thank God, I was cured of it -- in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44% under socialized medicine.
Giuliani gets his figures from an article written by one of his advisers, David Gratzer, a senior fellow at the conservative Manhattan Institute. According to Gratzer, the numbers originate from "crude" -- Gratzer's own description -- Commonwealth Fund data on prostate cancer incidence and mortality published in 2000.

The Commonwealth Fund took issue with this use of its data, explaining: "Five-year survival rates cannot be calculated from incidence and mortality rates, as any good epidemiologist knows."

The problem with using incidence rates in combination with mortality rates to determine survival is that incidence says nothing about quality of treatment. In reality, the percentage of Americans dying from prostate cancer is not significantly different than the percentage of Brits dying from it, a fact that Gratzer even admits.

But that doesn't stop Gratzer and other conservatives from tossing in incidence rates to muddy the waters.

As health care blogger Joseph Paduda explains (emphasis in original):
What [Gratzer] may not remember from medical school is that prostate cancer is quite common among older men. It usually grows very slowly, so slowly that most of us end up dying from something else. Gratzer is correct when he says that more Americans than Britons are diagnosed with prostate cancer, but most of the diagnoses are likely of these very slow growing cancers that are unlikely to be fatal.
Here's a handy chart that illustrates the issue:

(Click for larger image.)

Put differently, Giuliani's likelihood of dying from prostate cancer wasn't any lower because he lived in the US; on the other hand, his likelihood of being diagnosed with it was higher because he lived in the US (and, importantly, was amongst the American population that had affordable access to good health care).

Although population certainly plays a role in incidence rates, the vast differences depicted above -- which correspond with the development of new detection procedures in the 1980s -- suggest that more aggressive screening in the US plays the biggest part.

And while screening and preventive medicine are good things, on the whole, Paduda describes the negative effect of intensive detection methods for a slow growing ailment like prostate cancer (emphasis in original):

What the diagnoses do, rather effectively, is scare the bejesus out of patients, and encourage them to get procedures that are not only costly and of uncertain benefit, but also may render the patient impotent, incontinent, or dead. Since the Brits don't do as much screening for prostate cancer, they don't do a lot of operations on patients that may not need them.

This is the real kicker since it strikes at the heart of the one area that conservatives have hit home in the health care debate: overutilization. By using incidence rates to boost the appearance of survival rates, conservatives are effectively undermining their argument about the need to judiciously reduce the amount of health care that's consumed.

Of course, policy consistency, like accurate figures, doesn't exactly make for supporters or voters; misleading campaign spots, on the other hand, can help quite a bit, which is why it's no surprise the Giuliani camp is refusing to stop airing its misleading ad.

UPDATE: The Washington Post news desk -- not the editorial page -- gives its take on the Giuliani ad today:
The former New York mayor would have us believe that he was off by one percentage point at most in calculating his chances of surviving prostate cancer in Britain. In fact, he was spectacularly wrong the first time and equally wrong the second time. Epidemiologists say that his claim rests on a faulty statistical methodology that would not earn a passing grade at top medical schools in the United States.
I'd say "spectacularly wrong" about covers it.

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