Prostate cancer in Britain and the USA

Paul Krugman has attacked Rudy Giuliani for a dishonest ad on health care--or perhaps an ignorant one, as the case may be. This is a test for the media, as well as a scandal in its own right, Paul says. Will those feckless reporters and editors at The New York Times call Giuliani to account for this? Probably not, seems to be Paul's opinion:

OK, Rudy Giuliani has just released an ad claiming that the survival rate from prostate cancer is much higher in America than in Britain, thus proving the failure of socialized medicine.

The problem is that his claim is just plain false. In fact, mortality rates from prostate cancer are almost the same in America and Britain.

So, will this get as much attention as, say, the Edwards haircut or the Hillary laugh? Will it get any coverage at all? Bear in mind that health care is the central domestic issue of this election — and Rudy has just showed that he doesn’t know a thing about it.

Giuliani's claims in the ad are indeed misleading. First, prostate cancer is a very bad example. Worse, in my view, is the implication that his Democratic opponents are proposing "socialised medicine" remotely similar to  Britain's NHS. That can only be a deliberate deception.

To say that prostate cancer survival rates are much higher in the US than in England is not "just plain false", however. It is just plain true. Five-year survival rates are higher in both America and England than Giuliani said. In the United States they stand at close to 100 per cent. In England they are 25 points lower. Figures for prostate cancer are notoriously misleading, though, because early detection (at which the US excels) delivers little improvement in mortality.

Chiefly because of better diagnosis, America records a far higher incidence of prostate cancer--and nearly all of those early-detected cases survive five years. Men with prostate cancer, which develops slowly, often die of something else. If you are a man with prostate cancer, it may not matter very much whether your cancer is diagnosed early, or whether you live in Britain or America.

But does Paul therefore think that cancer survival rates, correctly measured, are similar for all cancers, including those for which early detection is important? If so, he is mistaken. See this report, entitled "Cancer Survival Rates Improving Across Europe, But Still Lagging Behind United States" (and remember that England's rates, not broken out, are among the worst in Europe).

Taking recent figures, female five-year cancer survival rates are 62.9 per cent on average in the US and 52.7 per cent in England. To compare America's privately insured with England's NHS patients, you'd need to bump up that American survival rate a bit (the uninsured most likely have lower survival rates--otherwise why worry about universal coverage) and bump down the English one (because some Brits have private insurance, and so buy better care).

Nationally, American cancer survival rates are significantly better. Certainly not by the 40-point margin Giuliani implied, but still. And the politically salient question is this: If you have cancer, would you rather be an American with insurance or an Englishman without? The answer is obvious.

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Another "overconfident" surgeon still operating in Australia

How many more people will he hurt before they get around to de-registering him?

One of Australia's leading cosmetic surgeons is under investigation for allegedly performing unlicensed operations following the emergency admission to hospital and surgery on a woman who had undergone an extensive makeover in his inner-city clinic. Millionaire doctor, television personality and former president of the Cosmetic Physicians Society of Australia Simon Rosenbaum has been slapped with restrictions on his practice in Queensland and Victoria after medical authorities alleged he posed a "serious potential risk" to "vulnerable persons".

The Brisbane surgery of Dr Rosenbaum, who is under investigation by two state health watchdogs, as well as Medicare, was raided earlier this year as part of the investigation that may soon widen to other cosmetic physicians. Dr Rosenbaum - a 20-year veteran of the cosmetic surgery explosion in Australia - has performed thousands of operations in his clinics in Fortitude Valley, Brisbane, and South Yarra, Melbourne. The procedures are touted as being cheaper than those performed in hospitals because of the lower fixed costs in the clinics.

But for almost a year, authorities have been investigating his practice following post-surgical complications to the woman in Brisbane which required emergency surgery to stop internal bleeding and to drain half a litre of blood. The woman, who worked as a nurse in Queensland, underwent a breast augmentation, mini-abdominoplasty and liposuction in a three-hour operation conducted by Dr Rosenbaum last October in his Australian Clinic for Cosmetic Surgery in Brisbane. The operation cost $20,000.

It is alleged Dr Rosenbaum - a regular guest of the Good Medicine television program - has been "performing complex procedures" in a clinic not licensed to do so and on patients under general anaesthetic, also without an appropriate licence for his clinic. According to documents obtained by The Australian, the woman returned to a hotel room after her operation and soon felt "very unwell and clammy", had a rapid pulse and was unable to remain standing. She called Dr Rosenbaum, who examined her that night, before telling her to visit his clinic the next day where she was put under observation. The Medical Board of Queensland also alleged Dr Rosenbaum put her under observation at his clinic the next day for eight hours - despite "clinical indications that immediate referral to hospital was appropriate" - before taking her to a Brisbane hospital.

In letters to medical authorities, Dr Rosenbaum said he was "not aware of the regulations affecting the administration of anesthesia". [Spare us!] Yesterday, he denied any patient had been put under general anesthesia in his clinics and that his rate of complications was "10 times" better than the average. "The reason I have been singled out is because of professional jealousy by the plastic surgeons," he said. "They ... are very successful in getting government bodies to do their dirty work."

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