U.S. Healthcare Better than Europe 2

My last post drew a couple of responses that are worthy of addressing in a separate post. FS has this:

Ken Blanchard, you would do well to actually back check where the statistics you cited come from. When they are comparing "Europe" and "the US" in that Lancet Oncology Study, they are including such places as Slovenia, The Czech Republic, and Poland in "Europe" and excluding wealthier countries like Portugal and France. Also the US oncology data they use for this study only covers a small fraction of the total US population.

We can only go with what we have, but here is an interesting bit from WebMD about another study:

July 16, 2008 -- Where you live plays a role in cancer survival, according to a new study that shows the U.S., Japan, and France recorded the highest survival rates among 31 nations for four types of cancer. Algeria had the lowest survival rates for all four cancers.

"This is the first direct comparison of so many countries as far as I am aware," says Michel Coleman, MD, a professor of epidemiology and vital statistics at the London School of Hygiene and Tropical Medicine and the study's lead author.

Coleman and colleagues drew on data from nearly 2 million cancer patients, ages 15 to 99, whose medical information was entered into 101 population-based cancer registries in 31 countries. The patients had been diagnosed with one of four cancers: breast, colon, rectum, or prostate cancers during the years 1990-1994. They were followed up to 1999, with the researchers comparing five-year survival rates.

The highest survival rates were found in the U.S. for breast and prostate cancer, in Japan for colon and rectal cancers in men, and in France for colon and rectal cancers in women, Coleman's team reports.

So the U.S. is second to none when it comes to surviving breast and prostate cancer, the second and third most commonly diagnosed cancers. Maybe our lead over Europe in the most common cancer, colorectal, is entirely due to those dreadfully lax Slovenes and Poles. But in this study, at least, we were competing with France and Japan.

And here is a summary of the Lancet Oncology study from MedScape Today:

Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this "probably represents differences in the timeliness of diagnosis," they comment. That in turn stems from the more intensive screening for cancer carried out in the United States, where a reported 70% of women aged 50 to 70 years have undergone a mammogram in the past 2 years, one-third of people have had sigmoidoscopy or colonoscopy in the past 5 years, and more than 80% of men aged 65 years or more have had a prostate-specific antigen (PSA) test. In fact, it is this PSA testing that probably accounts for the very high survival from prostate cancer seen in the United States, the authors comment.

Now it may be that Iceland has a better record, or that the Lancet study doesn't cover all cancers. And again, there are those Czechs, Slovenes, and Poles. But it is absurd to argue that Americans are getting worse healthcare than in Europe. We are clearly getting the best treatment available.

Both FS and my buddy Ken seem to think that a lot of Americans are not getting adequate healthcare treatment. That may be true, but if it were, wouldn't we have some reliable numbers? To be sure, cancers can go undiagnosed and untreated, but deaths have a way of showing up on statistics. If millions or even thousands die from cancers that were not treated because of a lack of insurance, surely someone would be able to produce those numbers. And just as surely, the President would be using them. We constantly hear that 47 million Americans lack health insurance. Imagine if the President could say this:

Every year ten thousand Americans die from prostate cancer because they could not afford health insurance.

Wouldn't he be saying that? He ain't, because it ain't true. Ken has this:

So it is not that we have broken healthcare, as much as we have a broken healthcare system. That is why the WHO ranks the US system 35th in the world and life expectancy as 27th in the world, behind virtually all advanced nations. This, despite our costs measured as %GDP as high as #2 in the world (behind only Marshall Islands).

That ranking of the US healthcare system as 35^th is absurd, as the information above show. Does anybody really think they have a better chance in Saudi Arabia? That life expectancy is low in the US compared to other advanced nations is true. But a lot of things that affect that statistic are not amendable to health care, like obesity, smoking, accident and crime rates. There is no evidence that the life expectancy deficit in the US is more than marginally related to factors that are amendable to healthcare reform.

Our healthcare system is not in crisis, nor is it broken. It does have at least two problems: too many people uninsured and too rapid a growth in costs. I think that the constant attempts to paint the system as broken and in crisis make it harder to address those problems.

Comments

[FascistSocialist]

It's very, very hard to get population data on people who are treated in the US health care system. Unequivocally impossible to get data on people who aren't. Where do you suppose such data is collected?

Plus there's the problem of prostate cancer, for example. The vast majority of people who get prostate cancer, have slow growth prostate cancer and die of other causes (so whether it's treated or not does not matter for their survival). There is no data to suggest that screening for prostate cancer improves survival rates. Instead what it does is provide biased statistics by diagnosing people who don't need to be diagnosed and would not die of prostate cancer regardless. Diagnosing all these people is good for surgeons and pharmaceuticals who perform unnecessary operations and sell prostate cancer drugs respectively.

The type of prostate cancer that kills people, the fast growing kind, is nearly impossible to screen for. The only data that suggests that anyone should be screened for prostate cancer suggests screening for 50 year old black males (a demographic that is not well screened).

The US does have good screening for two of the three cancers that should be screened for (breast, colon and cervical) the treatments themselves are the same between the continents. Screening for cancers is one thing we do a lot of in this country, in the case of prostate cancer, for example, it is not done well.

[FascistSocialist]

Ken, I know you're probably not a statistician, but these percentages mean very little without knowing the per capita rate. For instance the US might have 99.9% 5 year projected survival rate for prostate cancer and European countries might have 75% 5 year projected survival rate. But, since Europeans are only diagnosing the people who actually are at risk of being affected adversely from their prostate tumor it is entirely possible that you end up with the following:

If you live in Europe you have a 2 in 100,000 chance of dying from prostate cancer.
If you live in the US you have a 4 in 100,000 chance of dying from prostate cancer.

But as we're diagnosing say... 400% more people, it doesn't matter that we have 100% more people dying per capita because we have a much higher % of people diagnosed with prostate cancer and this results in an absurdly biased statistic like 99.3 vs 77.5

[Doug Jensen]

Ken Blanchard wrote:
"Our healthcare system is not in crisis, nor is it broken. It does have at least two problems: too many people uninsured and too rapid a growth in costs. I think that the constant attempts to paint the system as broken and in crisis make it harder to address those problems."

I must assume that you are aware that the "crisis" and "broken" parts of the United States health care system are explicitly the fact the too many people can't afford the very high insurance rates nor the additional out of pocket price of health care. Those have always been the issues, never has it been the ability of the wealthy to obtain quality health care in the United States. Therefore, Ken, I must assume you are being deceptive and/or dishonest, neither of which would I consider to be a virtue. Do you? I assume your answer would be yes to both.

[George Mason]

Fs seems to be confusing the incidence of cancer with survivability. Two entirely different statistics. Incidence is dependant upon genetics, diet, environment, cultural influences(smoking, drinking, etc.)and other factors. Survivability is very much a function of where you reside. The best place to reside if you want to survive cancer is the U.S.A.

[FascistSocialist]

No, George, I'm not. If you took the time to read my posts, you would understand what I'm saying.

[FascistSocialist]

You're confusing fatal forms of prostate cancer with non-fatal forms. In the US we diagnose and treat non-fatal forms of prostate cancer so extensively that it skews our survival rate upward. In other health care systems they neither diagnose nor treat non-fatal slow growth prostate tumors.

So let's say there are 100 men and 1 of every 100 gets fatal, fast growth prostate cancer while 98 get a slow growing prostate cancer. And lets say the incidence is the same between Europe and the US.
Now let's say, in the USA, we have a bizarre practice of diagnosing and treating all 99 of those people even though only one needs treatment, and the 1 dies but the other 98 survive for 5 years. That's a 98.9% Survival rate!
Now let's say in Europe, with the same 100 people, 1 fast growth and 98 slow growth. They treat the 1 fast growth who also dies, and 3 people with slow growth tumors are also treated. That's a 75% survival rate. But the incidence of death from prostate cancer in both populations is 1 in 100.

This is where that 99.7 vs 77.5 statistical difference comes from.

It is not science based to screen people for prostate cancer, yet we do it here in the US because it is profitable for the company that makes the screening test. It also makes money for hospitals and surgeons who operate to remove these slow growing tumors just to be on the "safe side".

This is a result of not practicing clinical guidelines, not a result of "better medicine" in the US.

[Bazzerk]

Just look at the rankings provided by the World Health Organization (WHO). I have mentioned them to many Americans and they just dont seem to understand or realize that WHO are the authority for health within the United Nations! Last time I looked the U.S came in 37th for the healthcare it provides to its citizens. We also spend more on healthcare than any other country in the world per person! I have noticed that Republicans will not be drawn to these figures which I find quite appalling when you consider they will for everything else to do with the United Nations! The U.S healthcare system is struggling and it is only going to continue to get worse, your healthcare should not be a business it should be about your health!

[Sashandeep]

No it isn't.A diet HIGH in dairy products is thhogut to be a possible risk factor for prostate cancer. Note the words high', thhogut' and possible'.And a risk factor is not a cause. Insurance companies regard being male' as a risk factor for having a car crash, but being male doesn't cause car crashes.The greatest risk factor for prostate cancer is getting older. It's extremely rare in men under 50; over 80% of men diagnosed with it are over 65 and half of all cases occur in men over 75. It's so rare in young men that there are no statistics available for the disease incidence in men under 35.

[David]

That explains it then!If it haenpped to men it would have been sorted out long ago, instead women suffering with breast cancer have to also put up with permanent hairloss while the men get away with it.Somethings never change do they.