dcnovice
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quote:
I've posted it up three times - search the thread. Concord study, 2007. US has top survival rate of in damn near every type of cancer, heart disease, etc.
Is this the study you mean?
http://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(08)70179-7.pdf
I need to give it a more thorough read on paper, but it seems, at least at first glance, far more nuanced than your description of it.
For instance (emphases mine):
Simple ranking of countries by overall survival can be
misleading. Survival is very similar in many European
countries, at the centre of the global range, and a small
shift in the survival estimate in either direction can entail a
large change in the rank. Thus, even the national survival
estimates for Iceland and Malta have wide confi dence
intervals and unstable rankings because they are based on
populations of around 250 000 (fi gures 1 and 3). The
detailed data by country and region are tabulated by
continent, country, and region, rather than ranked: some
Articles
752 www.thelancet.com/oncology Vol 9 August 2008
estimates, based on sparse data, could not be agestandardised
(table 2).
The numbers of patients included in the analysis varied
widely, as did the proportion of the national population
covered by the data. These proportions aff ect the extent to
which the survival estimates can be deemed representative
of the country concerned. For example, in Algeria, Brazil,
and Germany, only 1–4% of the national populations were
covered by the data. Population coverage of participating
registries in Italy was about 15%, but they were concentrated
in the wealthier north of the country.22,30 The same point
also applies to the USA, however, because the data presented
here confi rm suggestions107 that cancer survival in
the SEER Program areas (10% population coverage during
the 1990s) was higher than in other parts of the country. By
contrast, regional variation in survival in Australia and
Canada was much less marked than in the USA
* * *
Cancer survival is a valuable indicator for international
comparison of progress in cancer control,76,124,125 despite the
fact that part of the variation in cancer survival identifi ed in
this study could be attributable to diff erences in the
intensity of diagnostic activity (case-fi nding) in participating
populations. Notably, the very same point applies to
international comparisons of cancer incidence. If overdiagnosis—which
depends on diagnostic intensity—is
more marked in one country than another, then it will
certainly be harder for researchers to compare incidence,
mortality, and survival in those countries.
* * *
Survival from cancers of the breast, colorectum, and
prostate varied with the type of health insurance in a
population-based study: survival was highest in patients
who had private insurance, intermediate with federal
insurance, and lowest with no insurance. Another study97
suggested that prostate cancer is not more biologically
aggressive in blacks than whites. Late stage,98 less treatment,
and higher mortality seem to be associated with
black race, low socioeconomic status, and poor survival in
the USA. 99–101 Extensive reviews have led to the conclusion
that racial disparities in cancer treatment, which are not
explained by clinical factors, lead to worse outcomes in
blacks.102,103 Analysis of SEER data suggested that some
racial diff erences in treatment and cause-specifi c survival
persist after adjustment for poverty.104 By contrast, the racial
diff erence in survival from colorectal cancer was almost
absent in patients managed under the equal-access,
integrated health-care Veterans’ Aff airs system. 105
quote:
If you want to say it measures the US commitment to help low income people - fine. If you want to say it shows that services are delivered unfairly - fine.
We may have to agree to disagree on this one. To my eye, whether a health care system leaves out or underserves large chunks of the population is a key factor in assessing its effectiveness.
After all, access differences kill people. The CONCORD findings, for instance, noted that the striking differences in cancer-survival rates among American blacks and whites vanish when access to healthcare is equal, as in the VA.
quote:
When by every real measurement, american health care is vastly superior.
So far, you've only offered a single study measuring a single variable. While cancer-survival rates are certainly not unimportant to me, I'm not sure they alone count as "every real measurement."
quote:
And not some bullshit european statistic based on life expectancy - where US fares poorly because of obesity, lack of exercise, gun & accident deaths, illegal immigration, etc.
It seems a bit odd to argue that life expectancy isn't a basis for assessing healthcare. Ditto for obesity and lack of exercise.
_____________________________
No matter how cynical you become,
it's never enough to keep up.
JANE WAGNER, THE SEARCH FOR SIGNS OF
INTELLIGENT LIFE IN THE UNIVERSE
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