Tuesday, October 20, 2009

Our first guest contribution!

Barbara sent me this via email;  it addresses the commonly used statistical trick of touting 5 year survival rates as signs of success within out health care system ;  i'll post that and my response to her just after ;  Thank you Barbara for the contribution! 

Cancer Treatment and Health Care Reform

One argument you may hear against health care reform concerns cancer survival rates. The United States has higher cancer survivor rates than countries with national health care systems, we’re told. Doesn’t this mean we should keep what we’ve got and not change it?

Certainly cancer survival rates are a critical issue for people suffering from the deadly lung cancer  "http://www.maacenter.org/mesothelioma/" mesothelioma. So let’s look at this claim and see if there is any substance to it. 

First, it’s important to understand that “cancer survival rate” doesn’t mean the rate of people who are cured of a cancer. The cancer survival rate is the percentage of people who survive a certain type of cancer for a specific amount of time, usually five years after diagnosis. 

For example, according to the Mayo Clinic, the survivor rate of prostate cancer in the United States is 98 percent. This means that 98 percent of men diagnosed with prostate cancer are still alive five years later. However, this statistic does not tell us whether the men who have survived for five years still have cancer or what number of them may die from it eventually.

Misunderstanding of the term “survivor rate” sometimes is exploited to make misleading claims. For example, in 2007 a pharmaceutical company promoting a drug used to treat colon cancer released statistics showing superior survival rates for its drug over other treatments. Some journalists who used this data in their reporting assumed it meant that the people who survived were cured of cancer, and they wrote that the drug “saved lives.” The drug did extend the lives of of patients, on average by a few months. However, the mortality rate for people who used this drug — meaning the rate of patients who died of the disease — was not improved.

But bloggers and editorial writers who oppose health care reform seized these stories about “saving lives,” noting that this wondrous drug was available in the United States for at least a year before it was in use in Great Britain. Further, Britain has lower cancer survival rates than the U.S. This proved, they said, the superiority of U.S. health care over “socialist” countries.

This is one way propagandists use data to argue that health care in the United States is superior to countries with government-funded health care systems. They selectively compare the most favorable data from the United States with data from the nations least successful at treating cancer. A favorite “comparison” country is Great Britain, whose underfunded National Health Service is struggling. 

It is true that the United States compares very well in the area of cancer survival rates, but other countries with national health care systems have similar results.

For example, in 2008 the British medical journal Lancet Oncology published a widely hailed study comparing cancer survival rates in 31 countries. Called the CONCORD study, the researchers found that United States has the highest survival rates for breast and prostate cancer. However, Japan has the highest survival for colon and rectal cancers in men, and France has the highest survival for colon and rectal cancers in women. Canada and Australia also ranked relatively high for most cancers. The differences in the survival data for these “best” countries is very small, and is possibly caused by discrepancies in reporting of data and not the treatment result itself.

And it should be noted that Japan, France, Canada and Australia all have government-funded national health care systems. So, there is no reason to assume that changing the way health care is funded in the U.S. would reduce the quality of cancer care. 

Barbara O’Brien


Part of the reason the US has a higher 5 year survival rate in breast and prostate cancer is the phenomenon of misdiagnosis and unnecessary diagnosis sprinkled with a touch of early diagnosis.  Most of the men diagnosed with prostate cancer in the US are via screening PSA testing.  These are early stage largely benign prostate cancers that are incapable of altering the natural life expectancy of the individual,  yet when these men live beyond 5 years after their "cancer" diagnosis it's counted as a victory for 5 year survival.  The best estimates with PSA screening say that for every man who has his life prolonged from the test 48 are unnecessary diagnoses. 
Breast cancer screening via mammography does similar things to our 5 year survival rates.  For every women who has her life prolonged by mammography 2-10 have an unnecessary diagnosis while 10-15 were diagnosed earlier without altering prognosis. 
Our mortality rates have been pretty stagnant since the 1980s while our incidence rate have skyrocketed with our screening tests capturing many fold more patients than benefit from the "early diagnosis"
This has little to do with who pays for health care.  Great Britain is home to the second largest pharmaceutical company on earth, GSK,  and participates in the same wasteful and harmful preventative testing and vaccinations as the US.  We all pay for high health care costs one way or another.  In the US we all pay by insurance premiums going up year after year and wages decreasing to match.  We all pay for the tax money wasted through medicare and medicaid.  We all pay when a member of society is bankrupted by health care costs and unable to provide a good environment for their children to grow up.  We all suffer by being inundated with ads telling us we're not healthy unless we "talk to our doctor" about the latest useless expensive drug to treat a symptom of a sick society. 
The health care coverage debate is a distraction from the fact that the western health care system is a for profit industry.  This is true in so called nationalized health care systems or in the USA.  It is a good thing to prevent the bankruptcies from health care expenses but by simply nationalizing some of the costs we simply spread the pain out more evenly. 

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