Giuliani, prostate cancer, and David Gratzer

Gratzer responds to the intense criticism of his use of statistics:

Let me be very clear about why the Giuliani campaign is correct: the percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. The Organisation for Economic Co-operation and Development reports on both the incidence of prostate cancer in member nations and the number of resultant deaths. According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer, and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; and, consequently, that just 43 percent survived.

Comments

Anonymous
There is a more interesting quote from the article:
So why do the critics think that Britain’s survival rates are as high as America’s? The main reason is that they are citing overall mortality rates, which are indeed, as Ezra Klein writes, similar across various countries. That is, the percentage of all Americans who die from prostate cancer is similar to the percentage of all Britons who do. But this misses the point, since a much higher percentage of Americans than Britons are diagnosed with prostate cancer in the first place.
Silly me, and I thought population data is considered more accurate measure than cured/detected ratio. Have David Gratzer ever learned about overdiagnosis and lead-time bias (in his article he also mentions US and British 5-year survival rates)?
Let’s see. More Americans are screened, more Americans are diagnosed, the same percetage of population dies, but the ratio of cured/diagnosed is better in the US. Well, there is also more overdiagnosis in the US, and it is very easy to cure a cancer that wouldn’t have progressed within a person’s lifetime. One would expect these numbers when comparing screened group vs unscreened group regardless of what one thinks about US and British healthcare. No, I am not advocating single payer, I personally prefer the US, but this doesn’t negate the fact that the only thing this article demonstrates is that David Gratzer has never learned epidemiology.
Forget epidemiology, any child who learned algebra in school could show that (c+o)/(d+o) > c/d where c,d,o > 0; and c < d. If you are too dense to see it, I'll be happy to show it; a 5th grader may be able to do it too.

So how does David Gratzer’s article show anything other than he is clueless? If anything one may use British numbers to say that extra screening in the US doesn’t help as the same percentage of population dies. Of course, than one can argue about US lifestyle, or other confounding factors, since this is a population study, not an RCT. Anyway, this is not the post about risks or benefits of PSA, only about what the numbers in the article show (or don’t show).
How can a doctor like David Grazer who supposedly knows about PSA and overdiagnosis and who supposedly learned algebra in school can claim that the ratio of cured/detected is a better measure than the population data? Mind-boggling.
David
This is exactly why Gratzer — who is in person apparently a perfectly nice guy — is nevertheless completely unreliable when it comes to data. The mortality/diagnosed ratio is classic data cherry-picking, designed to put forward the number that best supports the case in question — i.e., that nationalized health care is bad and “free market” (or at least quasi-free market) healthcare is good.
Jon Cohn cleaned Gratzer’s clock on this point a while back in their TNR debate — I’d link to it, but it looks like TNR has just changed hosts and not all their content has migrated yet. I originally linked to their debate here (you’ll have to scroll down or search on “cohn” or “gratzer,” as it’s a long post), and that link might work again one day.
Andrew Robinson
First of all, I think It’s great that a Canadian born physician could single handedly help influence who will be the next leader of the United States (albeit opposite the way intended) by simply not leaving a poison pill like this for Giuliani to pick up. Classic.
Secondly, if we are going to completely misuse statistics, why don’t the proponents of health care reform point out that prostate cancer survival data for white americans is much higher than for black americans? Shouldn’t Rudy be saying “thank god I’m not in Europe, and thank god I’m not a black man!”
Anonymous
But you get all this “data” about how USA healthcare is “ranked” below Slovenia or Outer Elbonia, and how so many tens of thousands of deaths are caused by “medical error” which could be a skipped Tylenol dose on a terminal cancer patient, or “medical bankruptcy” when substance abuse is defined as an illness.
How come those “statistics” don’t get jumped on with the alacrity of Giuliani’s statement?
The data may well be wrong in this case. Thing is, this is not the first time, nor the only time, that UK cancer outcome is faulted when compared to the Continent, let alone the USA.
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/ncancer121.xml
http://www.statistics.gov.uk/cci/nugget.asp?id=861
http://www.guardian.co.uk/uklatest/story/0,,-6864405,00.html

Giuliani, prostate cancer, and David Gratzer

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