Merrill Goozner beat me to the keyboard (damn, he's good) with a followup note about Rudy Giuliani's misguided statement that the US has a far better prostate cancer survival rate than the UK (home of "socialized medicine," as Rudy points out).
In a nutshell, any comparison of prostate cancer survival in the US and UK is apples and oranges because Brits don't love the PSA test like we do. Nobody loves it like we do. Nobody loves screening tests like we do. Nobody wants to find - or count - some of the cases we find and count in our totals: early, non-aggressive tumors that won't kill anyone but which will drive men to anxiety and aggressive treatment.
So our survival rates are - by definition - inflated. We count survivors who wouldn't have died of prostate cancer anyway! Epidemiologists call this "lead-time bias."
Some have said that five-year survival rates are becoming meaningless. Howard Parnes, chief of the Prostate Cancer Research Group at the National Cancer Institute is quoted saying, "When you introduce screening and early detection into the equation, the survival statistics become meaningless. You are identifying many people who would not otherwise be diagnosed."
With U.S. prostate cancer five-year survival rates approaching 100%, some have said "it almost looks like this is not a disease!"
So this isn't nit-picking. There are huge policy implications of a presidential candidate believing that his country's health care system is so much better than another country's - and basing it on such flawed assertions.
Posted by schwitz at November 4, 2007 08:39 AM | TrackBackThis is a very important point. One of the difficult issues in urology is whether to operate or expect a person diagnosed with prostate cancer. I know a large number of urologists who do not want to know their own PSA. ;-)
What is best? Socialiced or privatized health care? Does it really matter if it is the government or the insurance company who is trying to keep costs down? In a "sozialised" system, you are at least not kept away from health care because you are poor. As a Norwegian I find it hard to understand why this is accepted in a sivilized country.
Posted by: OJ at November 14, 2007 03:44 AM