In an award-winning journalism career spanning nearly three decades, Glenn Kessler has covered foreign policy, economic policy, the White House, Congress, politics, airline safety and Wall Street. He was The Washington Post's chief State Department reporter for nine years, traveling around the world with three different Secretaries of State. Before that, he covered tax and budget policy for The Washington Post and also served as the newspaper's national business editor. More »
"I had prostate cancer, five, six years ago. My chances 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."
--Rudy Giuliani, New Hampshire radio advertisement, October 29, 2007.
The former New York mayor has had personal experience battling prostate cancer, but he's confused about the stats, according to several experts we consulted.
As factual support for the mayor's claim, the Giuliani campaign cited an article that appeared in the "City Journal," published by the Manhattan Institute, a conservative New York think tank, slamming the Canadian and British systems of "socialized" medicine. The article by David Gratzer provides no sources for its assertions about five-year survivability rates from prostate cancer.
Experts from the National Cancer Institute and the Departments of Urology at Johns Hopkins University and the University of Kansas agreed that Giuliani's figures were way out of date, if they were ever accurate at all. The latest official figures for five-year "survivability" rates for men diagnosed with prostate cancer are around 98 per cent in the United States and 74 per cent in England.
More importantly, the survivability figures tell us little about the differences in the quality of treatment received by prostate cancer patients in the United States and Britain. Doctors in the two countries have different philosophies about how to treat prostate cancer, and these differences have greatly influenced the "survivability" statistics.
In the United States, there has been a big emphasis since the early 1990s on early screening through PSA (prostate-specific antigen) testing. Five-year survivability rates have increased simply because men are being diagnosed with prostate cancer at a very preliminary stage of a slow-developing disease. If you are diagnosed early on, your chances of surviving for another five years are close to 100 percent. Britain is several years behind the United States in the widespread use of PSA testing.
"When you introduce screening and early detection into the equation, the survival statistics become meaningless," said Howard Parnes, chief of the Prostate Cancer Research Group at the National Cancer Institute. "You are identifying many people who would not otherwise be diagnosed."
Another way of comparing treatment of prostate cancer in the U.S. and Britain is to look at the mortality rates from the disease. Here the two countries are much closer. The graph below shows deaths per 100,000 males in each country. About 25 men out of 100,000 are dying from prostate cancer every year in both the U.K. and the U.S.
There are several points to be made about this graph:
If you are a black man, as opposed to a white man, in the United States, your risk of dying from prostate cancer shoots up;
According to Patrick Walsh, professor of urology at Johns Hopkins, the British data probably understate the number of people who have died from prostate cancer in Britain. Some prostate cancer-related deaths in the U.K. were classified as deaths from pneumonia before 1984 and after 1992.
Nevertheless the two lines track each other closely. The likelihood of dying from prostate cancer in the two countries is roughly comparable, despite different treatment philosophies.
Brantley Thrasher, chairman of the Department of Urology at the University of Kansas, said it was "impossible to say" on the basis of the statistics whether a prostate cancer patient had a better chance of surviving under a "capitalistic" or "socialistic" medical system. American doctors tend to be more "interventionist" and more likely to advocate surgery than their counterparts in Britain or Canada, where greater emphasis is put on "active surveillance." In the United States, a patient with a good health care plan is "more empowered to make decisions" for himself.
"You can't say that it's better to have prostate cancer here or in some other country," with a developed health care system, said Dr Thrasher, who also serves as a spokesman for the American Urological Association.
UPDATE: Maria Comella, deputy communications manager for the Giuliani campaign, sent us the following e-mail explaining the mayor's mistake without quite acknowledging it:
Mayor Giuliani is an avid reader of City Journal and found the passage in the Gratzer article himself. He cited the statistics at a campaign stop, and the campaign used a recording from that appearance in the radio ad. The citation is an article in a highy respected intellectual journal written by an expert at a highly respected think tank which the mayor read because he is an intellectually engaged human being.
UPDATE II: According to ABC News.com, Gratzer got his statistics from a 2000 study by the Commonwealth Fund, a private thinktank on health care issues. The Commonwealth Fund released a statement on Tuesday contesting Gratzer's interpretation of its data.
--Thanks to Robert D. Lafsky, M.D., of Leesburg, Va., for being the first of several readers to suggest this Fact Check, after the Giuliani claim was reported in Sunday's WaPo. Use the "Contact the Fact Checker" box below to send in tips.