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Politics

Giuliani botches cancer stat

In criticizing socialized medicine, he gets his numbers wrong.

By LISA GREENE and MELISSA AUGUST, Times Staff Writers
Published November 1, 2007

An expert says cancer mortality rates may make a better comparison between nations' health systems than survival rates, which Republican presidential hopeful Rudy Giuliani uses.
	[AP photo]

Giuliani, who was treated for prostate cancer, says he's lucky to have had the disease in the United States.

"I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States: 82 percent. My chances of surviving prostate cancer in England: only 44 percent under socialized medicine," Giuliani says in a new campaign ad.

Giuliani's campaign defended those numbers Wednesday, which it got from a quarterly magazine published by a conservative think tank. But the figures aren't accurate. National survival rates show a gap between the two countries, but it's not nearly as large as Giuliani says it is. And experts say the two figures can't be compared anyway because of differences in how the rates are measured.

The ad caused a stir in medical circles after the Commonwealth Fund, the group that did the research, issued a statement condemning the misuse of its numbers.

"I find it personally distasteful to have Mr. Giuliani exploiting cancer patients to make a political statement," said Andrew Vickers, associate attending research methodologist at New York's Memorial Sloan-Kettering Cancer Center.

Different measures

The figures Giuliani uses do raise a larger question about how prostate cancer is treated in the two countries. But that difference has nothing to do with socialized medicine, Vickers said.

"It's a difference in medical philosophy," he said.

In the United States, five-year survival rates are more than 99 percent, according to the National Cancer Institute. If Giuliani's figures were correct, treatment in the United Kingdom would be truly awful - it would have the same five-year survival rate as in the United States fifty years ago.

But in the United Kingdom, the Office for National Statistics says the country's five-year survival rate is nearly 75 percent.

That's still substantially lower than in the United States, but many medical experts say even this comparison is misleading.

That's because in the United States, men are routinely screened for prostate cancer. But many men develop prostate cancer as they get older, even though the cancer grows so slowly it never needs treatment. Vickers has done studies showing that in autopsies, about 40 percent of 70-year-old men who die for other reasons also have prostate cancer.

That means many U.S. men diagnosed through screening would never need treatment. That, in turn, artificially inflates the U.S. survival rate compared to the United Kingdom's, where more men are treated only after they develop symptoms.

For the United States, the plus side is screening may save more lives, Vickers said. But the benefits are open to debate, since it also means men who would never have gotten sick from prostate cancer are exposed to serious side effects from its treatment, such as impotence and incontinence.

A Giuliani spokesman said Wednesday that the campaign will continue to use the ad and pointed out that David Gratzer, the author of the article who also advises Giuliani's campaign, still says the figures are accurate.

"The bottom line is, the mayor is illustrating a point that you are essentially better off in the U.S. system than the European system," said campaign spokesman Elliott Bundy. "You are better off in a system of competition and choice rather than a government-mandated health care system."

A more accurate comparison between the countries would be to look at mortality rates, said prostate cancer epidemiologist Lorelei Mucci, an assistant professor at Harvard Medical School and Harvard School of Public Health. In the United States, about 15.8 of every 100,000 men die of prostate cancer, while in the United Kingdom, the figure is 17.9 deaths.

"They're essentially quite similar," she said.

Origins of the figures

Giuliani's campaign has said he got the figures from City Journal, a magazine published by the Manhattan Institute.

City Journal cited a 2000 report by the Commonwealth Fund, a foundation that supports health policy research. But the fund disputes City Journal's use of the report, which doesn't cite survival rates. Gratzer apparently extrapolated the rates from other figures in the report.

"I think it was just an error on the part of a staffer," said fund president Karen Davis. "The numbers basically aren't right."

The fund conducted a 2004 study showing the United States generally in the middle of the pack compared to five other countries, including the United Kingdom, on various health measures.

"It doesn't mean private insurance is good, and it doesn't mean public insurance is bad," Davis said. "We really need a more open approach to find out who's doing well at what."

Vickers, who moved here from Britain several years ago, said Giuliani's ad was irresponsible.

"As a prominent individual who is a cancer survivor, I would think it's more incumbent on him to be accurate in the way he uses cancer statistics," he said.

Still, even if the comparison is faulty, Mucci said, she gives Giuliani credit for speaking up.

"It had been really a silent epidemic, until the past few years," she said. "Now, so many men are coming out and talking about having this disease, it's putting a public face on it."

Statement

"I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States: 82 percent. My chances of surviving prostate cancer in England: only 44 percent under socialized medicine," Giuliani says in a new ad.

Ruling

His statistics are way off and his comparison of health care models is faulty.

For more rulings, visitPolitiFact.com

[Last modified October 31, 2007, 23:53:37]