Comments on: Giuliani, prostate cancer, and David Gratzer http://www.kevinmd.com/blog/2007/11/giuliani-prostate-cancer-and-david.html Tue, 14 Feb 2012 20:59:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/11/giuliani-prostate-cancer-and-david.html#comment-81653 Anonymous Tue, 06 Nov 2007 23:43:00 +0000 http://clients.emmense.com/kevinmd/2007/11/giuliani-prostate-cancer-and-david-gratzer.html#comment-81653 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.<br/><br/>How come those "statistics" don't get jumped on with the alacrity of Giuliani's statement?<br/><br/>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.<br/><br/>http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/21/ncancer121.xml<br/><br/>http://www.statistics.gov.uk/cci/nugget.asp?id=861<br/><br/>http://www.guardian.co.uk/uklatest/story/0,,-6864405,00.html 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

]]> By: Andrew Robinsonhttp://www.kevinmd.com/blog/2007/11/giuliani-prostate-cancer-and-david.html#comment-81616 Andrew Robinson Sun, 04 Nov 2007 03:17:00 +0000 http://clients.emmense.com/kevinmd/2007/11/giuliani-prostate-cancer-and-david-gratzer.html#comment-81616 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.<br/><br/>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!" 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!”

]]> By: Davidhttp://www.kevinmd.com/blog/2007/11/giuliani-prostate-cancer-and-david.html#comment-81544 David Fri, 02 Nov 2007 21:54:00 +0000 http://clients.emmense.com/kevinmd/2007/11/giuliani-prostate-cancer-and-david-gratzer.html#comment-81544 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.<br/><br/>Jon Cohn cleaned Gratzer's clock on this point a while back in their <a HREF="http://www.tnr.com" REL="nofollow">TNR</a> 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 <a HREF="http://venturebeat.com/2007/06/13/ringing-in-the-healthcare-reform-debate/" REL="nofollow">here</a> (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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/11/giuliani-prostate-cancer-and-david.html#comment-81519 Anonymous Thu, 01 Nov 2007 23:45:00 +0000 http://clients.emmense.com/kevinmd/2007/11/giuliani-prostate-cancer-and-david-gratzer.html#comment-81519 There is a more interesting quote from the article:<br/><i>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.</i><br/><br/>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)? <br/><br/>Let's see. More Americans are screened, more Americans are diagnosed, the same percetage of <b>population</b> 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.<br/><br/>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.<br/><br/> 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).<br/><br/>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. 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.

]]>