The Final Facts on Rudy Cancer Ad: Death Rates, Not Survival Rates

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  • 11/09/2007
I guess I shouldn't be tossing numbers around after being flagged for bad math just a few minutes ago. But you still have to take a turn at bat even after a strike out, so here goes.

Everyone is missing the point on the UK-US cancer comparison because everyone is too lazy to do real research. Which is how this fight over facts instead of philosophy started in the first place. If anyone had bothered to check with me -- and they didn't -- I could of told them straight up that five year survival rates can be tinkered with and explained away but age-adjusted death rates by cancer and by stage...well, they don't lie. But you actually have to do a little work with the numbers, which most health care policy wonks don't do. They regurgitate or pick and choose the facts that fit their perspective. Right and Left.

Survival rates do have some value in measuring differences.

Survival rates for lung, breast and prostate cancer – which means your chance of being alive five yeas after being diagnosed with cancer has increased more rapidly in the US for lung, prostate, breast and cervical cancer. Breast cancer five-year survival rates are higher and death rates are lower for women in the US regardless of age or stage of cancer. The age adjusted survival rates for lung cancer in the UK is about 8 percent, half that of the United States.

But often there are holes in survival rates because of time lags or gaps in regional reporting. The recent survival rates are a case in point. The UK doesn't include them for England and Wales. Just Scotland and Ireland. The Lancet study -- which uses old data too -- says it does not have age adjusted five year survival rates for those two important part's of Her Majesty's sinking healthcare system. But the UK does have year to year death rates for major forms of cancer by age. And boy do they stink.

Death rates from prostate cancer in America declined an average of 4 percent a year from 1994 to 2004 while they increased by 1 percent a year during the same time frame in England and Wales. And for man 65 or over, while the death rate from prostate cancer also declines about 4 percent year – regardless of race in America, men of the same age in England saw their chances of dying climb by 20 percent.

Screening rates climbed at about the same rate in both countries. So the difference is explained by access to medicines. For instance, NICE refused to approve reimbursement for Taxotere for men with prostate cancer that were failing to respond to hormonal treatment that improved survival. Taxotere not only was shown to extend life by up to a year but also reduce in pain and fatigue of those with no chance of cure to maximize their remaining time with their loved ones. It took months of lobbying from doctors and patient groups until NICE approved cleared its use in June of 2006. Yet today many NHS health trusts refused to cover it because it is not “cost effective.” In America, Taxotere is standard of care.

You can't find the death rate stuff just anywhere. You have to dig for out and run the numbers yourself. Easier when you don't have a real job like David Gratzer who is a real doctor and treats patients full time in Canada. Unlike the dishonest folks at Commonwealth who have billions to go with plenty of free time. And unlike Paul Krugman who gets paid to dump on people like David who has done more in a single day to advance healthcare than Krugman's attacks on anyone who doesn't agree with him has ever done.

Gratzer was making a point. If anything the death rates show that he was probably being conservative in his claims. He should be praised for being restrained and even more so for being willing to correct the record so publicly. The same cannot be said for his critics.

A recent article in Britain’s Daily Mail makes the same point the Giuliani ad tried to get across: “I won't let Daddy die: Girl of six raises £4,000 for life-saving drugs the NHS won't provide” When Britain’s National Health System said it would not pay for Tarceva, the drug her father needed to fight lung cancer, six year old Chantelle Hill put up posters throughout her neighborhood asking for donations so she could buy the drug herself.

Tarceva is not a cure but it does extend life and improve quality of life. And it’s use widely by cancer doctors in America. But Britain’s National Institute for Health and Clinical Excellence (NICE) – which evaluates what the NHS should pay for -- found it was not cost effective.

The fact is, cancer patients in the UK do worse than they do in America not because of statistical manipulations by the Giuliani campaign but because cancer care in Britain is rationed out of cost considerations.

Chantelle Hall is going door to door in England to raise the funds she needs to buy the drug keeping her father alive because her health system thinks it isn’t cost effective. Rudy Giuliani ran an ad essentially making the point that he is glad America has a health system that, while in need of change, doesn’t force kids to make that choice on a regular basis. His numbers might be off but his heart was in the right place. So is David Gratzer's. The same can’t be said for his critics.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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