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Wednesday, October 31, 2007

Panel Attrition and Rudolf Giuliani

Julie Bosman calls Giuliani on one of his false claims in The New York Times. In fact she does the blogosphere one better.

“I had prostate cancer five, six years ago,” Mr. Giuliani, a Republican presidential candidate, said in a speech that has been turned into the radio commercial. “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 percent under socialized medicine.”

Mr. Giuliani’s Democratic rivals would argue that they are not advocating government-run health care in their plans to extend coverage to the uninsured. But, beyond that, the 44 percent figure that Mr. Giuliani has been citing is in dispute.

The Office for National Statistics in Britain says the five-year survival rate from prostate cancer there is 74.4 percent. ”

So how did Giuliani get the 44 % number ? He was quoting someone who claimed to obtain survival rates

by calculating a five-year survival rate based on data on prostate cancer incidence and mortality rates in the United States and Britain.

“Five-year survival rates cannot be calculated from incidence and mortality rates, as any good epidemiologist knows,” the group [the comonwealth fund] said in a statement.

Why not ? Can't you tell the probability that people in the US survive prostate cancer by diagnoses minus deaths divided by diagnoses ? Sadly no. Very sadly, in fact, because there is a third possibility other than survival for five years after diagnoses and death from prostate cancer -- death from something else.

Even with no treatment at all, diagnosing early stage prostate cancer in elderly people will imply many diagnoses followed by deaths from other causes.

As noted by Kevin Drum, the US experience with prostate cancer is actually worse than the UK experience. Death rates are the same. A cancer diagnosis is a horrible experience. Cancer treatment is horrible. The Diagnoses of cancers which will not kill the patient is a cost a very heavy cost.

As noted by Bosman and dozens of bloggers, the case of prostate cancer is, in fact, an argument against the health care plans presented by the Democrats. The vast majority of US residents with prostate cancer are covered by medicare when they are diagnosed and treated. The Democrats essentially plan to extend such coverage to more people. They do not plan a system of publicly employed physicians as in the US. Thus they will not protect us from over energetic doctors who tell us things we don't want or have to know.

So Giuliani is presenting an argument which is based on a totally false claim of fact and which would, if true, imply that his opponents proposed plans are ideal.

What makes me sure that he will gain votes this way ?

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