Archive for November 8th, 2007

Giuliani’s health care statistics still a joke.

Nov 08, 2007 in Health Care, Politics

Dan Finkelstein tries to support Rudy’s statistics junk regarding Britain’s NHS (which, one shouldn’t have to say, isn’t the world’s best socialized medical system) and prostate cancer survival rates. Turns out, just like our press pleads for people to look past some of our negative health care statistics, the numbers for prostate cancer survival in Britain have been chosen very selectively without a broader look. A commenter, Nick Strong, takes Finkelstein down.

The hypothesis that patients are dying in the UK of undiagnosed prostate cancer is ridiculous. Patients do not die of prostate cancer unrecognised. If the disease has advanced sufficiently to cause death the signs are obvious and would be cited as the cause of death. So there is not an epidemic of undiagnosed prostate cancer deaths in the UK. It remains the case that the statistics show that prostate cancer death rates are approximately equal in the two countries.

So why might a larger proportion of patients diagnosed with prostate cancer die of it in the UK that in the US? To understand this one has to understand the nature of the disease and the different approaches of the health systems of the two countries.

Prostate cancer is very common among older men. At post mortem examination of patients dying of other causes an incidental finding of symptomless prostate cancer occurs frequently – as many as 80% of men over 80 . Hence the saying about prostate cancer that goes “you are much more likely to die with it than of it”. In the UK most patients with prostate cancer do not have the condition diagnosed prior to dying, and the cancer has no bearing on the cause of death.

On the other hand in the US there is a vast industry of early cancer diagnosis, hence your chance of being diagnosed with early symptomless prostate cancer before you die – of something else – is much higher in the US that in the UK. So as a result it is true to say that a smaller proportion of all patients known to have a diagnosis of prostate cancer during life will die of it in the US than in the UK. But it is not true to say that if you have prostate cancer – either diagnosed or unknown – that your chance of dying of it differs between the two countries. In fact the similar death rates per head of population strongly suggest that there is little difference.

The likelihood of developing prostate cancer is the same in the US as in the UK. The rate of diagnosis is higher in the US but the death rate is the same. So the only conclusion that can be drawn from these facts is that the US health system spends a lot more money than the UK in the diagnosis of early prostate cancer without any demonstrable benefit.

Where’s the beef?