Liberty and Medicine

Tuesday, August 21, 2007

Do survival rates matter?

Sure, I know that just one mention of why I dislike nationalized health care sends some of my left-of-center readers into a frenzy. It seems that the cause d’jour on the Left is the implementation of a state run system of health care in America. It is the public policy version of the Holy Grail.

Questioning nationalized health care is, to them, a similar sort of heresy as questioning the necessity of baptism by immersion at a Baptist tent revival. Alas, I’m used to the role of village atheist so I don’t mind.

Of the various state systems of health care the National Health Service in England holds a special place in the pantheon of state system -- mainly because it one of the first and one of the most pervasive. It has gone through a process of beatification in some circles. And I think it qualifies. And like anyone who is beatified that means it is declared holy on insufficient grounds and it is dead. Maybe it's not clinically dead but it certainly is on life support with the struggle more and more difficult each year.

Ask any member of the nationalize health sects where they would rather be sick, America or the U.K., and they will dutifully tell you how the British system is more fair and gives more health care to more people. That is the argument I generally hear. Giving out lots of care is easy and can be done cheaply. But the real issue is not what you give out but what are the results of the actual care given?

So ask yourself what you want to do if you had cancer. Would you prefer to get “equal” care or more effective care? Would you rather have a system that equalizes the treatment rate or one that maximizes survival rates?

A research team for The Lancet Oncology has looked at the survival rates for individuals diagnosed with cancer. This rate is determined by the number of patients who are still alive five years after being diagnosed with cancer. They ranked the various nations of Europe and then compared the survival rate to that of cancer patients in the United States -- the Great Satan of Health Care.

National Health Care covers England, Scotland and Northern Ireland and Wales.

If you are a female in Scotland, your chances of surviving five years after a cancer diagnosis is 48%. In Northern Ireland it is slightly better at 51% and even better in England at 52.7%. Wales comes out tops there with 54.1%. The percentage of American women who survive more than five years after a cancer diagnosis was 62.9%. This, by the way, is a higher survival rate than any of the European countries that were surveyed. And the survey included all the major European health system except France, where the statistics were not made available.

Male cancer survival rates show that 40.2% of Scottish men live five or more years after diagnosis. In Northern Ireland it is 42%, England is 44.8% and and Wales is 47.9%. The United States has a male survival rate of 66.3%.

If 100 English women are diagnosed this month with cancer, then 47 will, on average, die in the next five years. In the United States, with all the problems the health systems does have, an extra 16 women per 100, will live. Sure, its just statistics, unless you happen to be one of those 16 women. And for every 100 English men diagnosed this month 55 will die in the next five years. If the same 100 men lived in the United States an extra 21 of them would live.

One of the researchers from Scotland, Prof. Ian Kunkler saays that one reason for the low survival rate in the U.K is partially due to the long waiting periods before treatment. He says that there is “good evidence that survival for lung cancer has been compromised by long waiting lists for radiotherapy treatment.”

Oddly the BBC managed to report this story without once mentioning the higher survival rate in the United States. But they do publish the European mean survival rate for men and women. They have a graph showing the survival rates but it is not calibrated too finely. My best estimate from the chart is that mean average survival rate for women appears to be around 51% about 11 points behind the U.S. And for men it appears to be 47% or about 19 points behind the U.S.

Lung cancer survival rates in England and Wales are very depressing. Only 6% of either sex survive. The U.S. survival rate is between two to three times higher, or up to about 16%. However, one relatively new regimen of care developed in the U.S. has shown survival rates of up to 29%.

Perhaps there are arguments as to why one might prefer to live in England versus the US (I spend more time in the UK than I do the US myself) but certainly if survival rates count for something -- and they do those who are trying to survive -- I know which I would pick.

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