Shooting the Messenger on Socialized Medicine

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When Rudy Giuliani said the survival rate for prostate cancer is 82 percent in the U.S. but only 44 percent in Britain, which has socialized medicine, you'd think a typical American response would be sympathy for the Britons, and the logical British response, outrage at its government.

You'd think wrong. The U.S. press corps devoted considerable energy -- and in some quarters, heated emotion -- to knocking down Giuliani's statistic, even when it had to twist logic like pretzels to do so. Meanwhile, the only outrage detected in Britain was against Giuliani -- for mentioning it.

Yet Giuliani's point, which is that socialized medicine systems fare badly compared to our own, remains valid.

Among those springing to the defense of Britain's National Health Service: the Boston Globe, the Washington Post, the Associated Press, the New York Times, the St. Petersburg Times, Reuters, and, predictably, lefty columnists Paul Krugman of the New York Times and Eugene Robinson of the Washington Post.

Take the AP story, which sought to take down Giuliani's statistics this way:

The American Cancer Society says that survival rates are actually higher and that it's misleading to compare the two countries.

The group cautions that screening for prostate cancer is much more widespread in this country — meaning that in the U.S., higher survival rates include many whose lives probably weren't in danger and whose cancers might have gone unnoticed in the U.K.

Five-year survival rates were 95 percent in the U.S. and 60 percent in the United Kingdom, which includes Britain, in 1993-1995, the most recent time period with data to compare, the group said.

Today, rates are higher — 99 percent in the U.S. and an estimated 74 percent in the U.K.

Doctors in the two countries have different approaches. That's because while aggressive prostate cancer can kill, it often grows so slowly, and is found when it's so small, that men die of something else before it ever threatens their lives or even causes symptoms.

So there is disagreement — and studies conflict — over whether the chances of survival for men with low-risk tumors really improve with aggressive treatment, or if they can be closely monitored and treated only if their tumors grow, thereby avoiding side effects such as impotence and incontinence.

When you read that carefully you realize the thrust of the argument is that the U.S. system is not better than Britain's at handling prostate cancer because the U.S. system screens more aggressively for this cancer and catches it earlier.

But isn't catching cancer early a good thing?

You'd think so, but apparently not when it makes socialized medicine look bad. "Doctors in the two countries," says the AP, "have different approaches. That's because while aggressive prostate cancer can kill, it often grows so slowly, and is found when it's so small, that men die of something else before it ever threatens their lives or even causes symptoms."

So if you are a British man using the National Health Service your taxes pay for, the NHS has decided that you don't need to know if you have prostate cancer early. After all, it "often" grows slowly, so why should you have the option of early treatment that could save your life? The British government will make this intensely personal decision for you.

Meanwhile, your brothers in the United States will find out early that they have it, and will decide for themselves if they want to risk side effects by treating it early.

The AP story failed to tell readers that the American Cancer Society is not a neutral party to the debate over the merits of competing health systems. The American Cancer Society is devoting its entire $15 million advertising budget in the coming year to advocating universal health insurance in the United States. It's advocacy arm, the American Cancer Society Cancer Action Network, shills for an expansion of publicly-funded health care in the U.S., as in this statement by its president excoriating President Bush for wanting to expand SCHIP by $5 billion instead of $35 billion over the next five years:

The President today sided with the tobacco industry instead of America’s children with his veto of the bipartisan bill to expand the State Children’s Health Insurance Program (SCHIP). The President's action strikes a blow against efforts to provide health insurance to low-income children and to save lives through an increase in the federal cigarette tax.

The SCHIP bill passed both houses of Congress last week with strong bipartisan majorities. We strongly urge lawmakers to do what's right for public health — not what’s most advantageous for the tobacco industry — by overriding this veto.

The American Cancer Society is pushing a petition to all presidential candidates saying, "imagine a world where every man, woman and child has access to the proven screening exams that can detect cancer early and even prevent it," yet when the U.S. does better than Britain at screening for prostate cancer, it calls the early screening a "misleading" factor in comparing the quality of the two countries' systems.

Many of the news stories cited above noted that Giuliani got his statistic from Dr. David Gratzer of the conservative Manhattan Institute, an exceedingly reputable source, but they often went on to deride the reliability of Gratzer's work. None of them fairly represented Gratzer's compelling defense of the accuracy of Giuiliani's remarks. An excerpt:

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. Economist John Goodman, in Lives at Risk, arrives at precisely the same conclusion: “In the United States, slightly less than one in five people diagnosed with prostate cancer dies of the disease. In the United Kingdom, 57 percent die.” None of this is surprising: in the UK, only about 40 percent of cancer patients see an oncologist, and historically, the government has been reluctant to fund new (and often better) cancer drugs.

The press corps is willing to defend socialized medicine, even if it kills them.