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	<title>Comments on: THE SOCIALIZED MEDICAL SYSTEM DONALD BERWICK &#8220;LOVES&#8221;</title>
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	<link>http://www.healthcarebs.com/2010/06/01/the-socialized-medical-system-donald-berwick-loves/</link>
	<description>Cleaning the Augean Stables of the Health Care Debate</description>
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		<title>By: Catron</title>
		<link>http://www.healthcarebs.com/2010/06/01/the-socialized-medical-system-donald-berwick-loves/#comment-460356</link>
		<dc:creator>Catron</dc:creator>
		<pubDate>Fri, 04 Jun 2010 20:00:25 +0000</pubDate>
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		<content:encoded><![CDATA[<p>I&#8217;ll ignore the Giuliani red herring (you <a href="http://www.city-journal.org/html/eon2007-10-31dg.html" rel="nofollow">lost that argument</a> 2 years ago) and it was your comrade (not yours truly) who introduced the mortality issue. I assumed he didnâ€™t know the difference, but maybe he was just tossing in his own red herring.</p>
<p>In your last comment, you accused me of â€œmaking upâ€? up the 80% stat. Now youâ€™re telling me that itâ€™s merely â€œout of date.â€? You need to be more consistent with your calumnies. As to the tired &#8220;you guys do more screening&#8221; argument, it isnâ€™t worth refuting (again).</p>
<p>Regarding your new stats, can we trust numbers from any agency serving a government notorious for <a href="http://www.nursingtimes.net/the-health-service-is-wasting-precious-time-fiddling-figures-to-hit-performance-targets/1896291.article" rel="nofollow">fiddling</a> <a href="http://adamcollyer.wordpress.com/2010/02/26/nhs-waiting-list-scams-go-on/" rel="nofollow">data</a>? A regime that will condone stacking patients in A&#038;E parking lots to improve wait time stats would hardly stick at fudging these data.</p>
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		<title>By: Marc Brown</title>
		<link>http://www.healthcarebs.com/2010/06/01/the-socialized-medical-system-donald-berwick-loves/#comment-460341</link>
		<dc:creator>Marc Brown</dc:creator>
		<pubDate>Fri, 04 Jun 2010 17:54:14 +0000</pubDate>
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		<description>David, I thought we&#039;d got past this error in interpretation (the Gratzer/Giuliani mistake). Please allow me to make the following points as it&#039;s important that correct information is posted.

1. You are confusing survival with mortality. I (and the person on AmSpec) made the point that mortality rates from prostate cancer are not widely different between the US and the UK. Indeed, as you&#039;ll see that for all cancers from this table (http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer) the UK actually as the lowest death rate for cancer per 100,000 of the 16 nations listed, including the US. 

2 And the key point is that what you are posting are (unsourced) out of date 5 year survival data. That is, the percent alive over 5 years after diagnosis. As you do know I&#039;m sure, the US has a much higher rate of prostate screening that picks up many more cancers, many of which will never be life threatening. So the US 5 year survival rate is artificially high and in fact the latest US prostate screening study shows no benefit to screening. And the latest figure from England shows a 80% 5 year survival for prostate (see http://www.statistics.gov.uk/cci/nugget.asp?id=861), and where prostate cancer is picked up early we have a better than US rate of 98.5% 5 year survival - showing the NHS works very well but that it&#039;s tough to get English men to see doctors.

So - I&#039;m sure you don&#039;t think that the figures you posted mean that American men are almost twice as likely not to die from prostate cancer, but I&#039;m not sure what you do think they mean.</description>
		<content:encoded><![CDATA[<p>David, I thought we&#8217;d got past this error in interpretation (the Gratzer/Giuliani mistake). Please allow me to make the following points as it&#8217;s important that correct information is posted.</p>
<p>1. You are confusing survival with mortality. I (and the person on AmSpec) made the point that mortality rates from prostate cancer are not widely different between the US and the UK. Indeed, as you&#8217;ll see that for all cancers from this table (<a href="http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer" rel="nofollow">http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer</a>) the UK actually as the lowest death rate for cancer per 100,000 of the 16 nations listed, including the US. </p>
<p>2 And the key point is that what you are posting are (unsourced) out of date 5 year survival data. That is, the percent alive over 5 years after diagnosis. As you do know I&#8217;m sure, the US has a much higher rate of prostate screening that picks up many more cancers, many of which will never be life threatening. So the US 5 year survival rate is artificially high and in fact the latest US prostate screening study shows no benefit to screening. And the latest figure from England shows a 80% 5 year survival for prostate (see <a href="http://www.statistics.gov.uk/cci/nugget.asp?id=861" rel="nofollow">http://www.statistics.gov.uk/cci/nugget.asp?id=861</a>), and where prostate cancer is picked up early we have a better than US rate of 98.5% 5 year survival &#8211; showing the NHS works very well but that it&#8217;s tough to get English men to see doctors.</p>
<p>So &#8211; I&#8217;m sure you don&#8217;t think that the figures you posted mean that American men are almost twice as likely not to die from prostate cancer, but I&#8217;m not sure what you do think they mean.</p>
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		<title>By: Catron</title>
		<link>http://www.healthcarebs.com/2010/06/01/the-socialized-medical-system-donald-berwick-loves/#comment-460299</link>
		<dc:creator>Catron</dc:creator>
		<pubDate>Thu, 03 Jun 2010 17:26:58 +0000</pubDate>
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		<content:encoded><![CDATA[<p>OK, Marc, here are the <a href="http://www.thelancet.com/journals/lanonc/article/PIIS1470204508701797/abstract?isEOP=true" rel="nofollow">numbers</a>:</p>
<blockquote><p><i>US prostate survival rate = 91.9%</p>
<p>UK prostate survival rate = 51.1%</p>
<p>Difference = 40.8%</p>
<p>40.8% / 51.1% = 80%</i></p></blockquote>
<p>To put it in terms a â€œprogressiveâ€? can understand: If you have 5 apples and add 4 more, you have increased your apples by 80%. Likewise, if your cancer survival rate is 51.1% and you increase it to 91.9%, you have gained 80%.</p>
<p>As to the commenter at AmSpec, his assertion that American and British men have â€œsimilarâ€? prostate survival rates is preposterous. It isnâ€™t supported by any credible study (which is why he hasnâ€™t quoted his source).</p>
<p>Here&#8217;s a nice chart showing how your country stacks up:</p>
<p><img src="http://img505.imageshack.us/img505/1023/cancertj3.jpg" alt="David Catron" style="width: 470px; height: 360px; border: #333 1px solid" title="David Catron" height="360" width="470" /></p>
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		<title>By: Marc Brown</title>
		<link>http://www.healthcarebs.com/2010/06/01/the-socialized-medical-system-donald-berwick-loves/#comment-460286</link>
		<dc:creator>Marc Brown</dc:creator>
		<pubDate>Thu, 03 Jun 2010 11:51:49 +0000</pubDate>
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		<description>I see someone beat me to it at AmSpec but just to emphasise that making up stats such as the ridiculous 80% better survival for prostate cancer does not help your case. I see also that people are also noticing the far better performance of the NHS in treating conditions such as diabetes. And when you&#039;re ready, do ask yourself if primary care is better in the US.</description>
		<content:encoded><![CDATA[<p>I see someone beat me to it at AmSpec but just to emphasise that making up stats such as the ridiculous 80% better survival for prostate cancer does not help your case. I see also that people are also noticing the far better performance of the NHS in treating conditions such as diabetes. And when you&#8217;re ready, do ask yourself if primary care is better in the US.</p>
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