If Rudy Giuliani were English, he might also be dead

The New Hampshire
By Robert Goldberg
December 7, 2007

"I HAD prostate cancer, five, six years ago," Rudy Giuliani said in a radio spot that has aired in New Hampshire. "My chance 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."

It's an argument against government-run health care that shoots straight from the hip -- and straight from the heart, too. That's why supporters of socialized medicine immediately went on the attack, claiming that Giuliani had his numbers wrong.

While Rudy's numbers may have been off, he certainly got the big picture right.

By any measure, cancer survival rates in Britain are lower than in America. By focusing exclusively on Rudy's numbers, the attacks on his ad simply ignored this disparity and the fact that it's caused by Britain's rationing of cutting-edge care and timely treatment.

Giuliani isn't the only one trying to get that message across.

In Britain, according to a recent issue of the Daily Mail, a 6-year-old girl named Chantelle Hill has put up posters throughout her neighborhood pleading for donations to buy the cancer drug Tarceva for her father, as Britain's National Health Service had refused to pay for it.

Tarceva is not a cure, but because the drug extends one's life, it is used widely by cancer doctors in America. Britain's National Institute for Health and Clinical Excellence (NICE), the agency that evaluates what treatments the NHS will pay for, found it not to be "cost-effective."

So simply because of cost, cancer treatments in Britain commonly are rationed or unfunded altogether. That's why survival rates -- or one's chance of being alive five years after diagnosis -- are significantly higher in America than in Britain for lung, prostate, breast and cervical cancers.

For example, just look at breast cancer data. Regardless of a woman's age or the stage of her cancer, five-year survival rates are significantly higher in America than in Britain.

The same goes for lung cancer. The age-adjusted survival rate for this form of cancer in Britain is about 8 percent. In the United States, it's double that.

When Rudy was diagnosed with prostate cancer in 2000, the age-adjusted survival rates in Wales and Scotland were 71 percent, compared to 78 percent for the whole of Europe and a whopping 99.3 percent in the United States.

In other words, when caught early enough, prostate cancer is for all intents and purposes curable in America. For British men, however, it poses an enormous risk.

Some critics contend that these stark differences can be chalked up to early detection or false positives. However, screening for prostate, colon and breast cancer has increased rapidly in Britain, yet American patients with those cancers still have higher survival rates.

From 1994 to 2004, death rates from prostate cancer in America declined an average of 4 percent per year, while in England and Wales they actually increased by 1 percent per year. For men 65 years of age or older, the U.S. death rate from prostate cancer declined 4 percent per year as well, while English males of that age group saw their death rate climb by 20 percent.

The real explanation for the success of the American health system in treating cancer lies in treatments, not screening and early detection.

Since 2004, for instance, Taxotere has been the standard treatment for Americans with prostate cancer who fail to respond to survival-enhancing hormonal treatment. Taxotere has not only been shown to extend life by up to a year on average, but it also reduces pain and fatigue, making a patient's remaining time just a little bit easier.

In Britain, however, it took until July 2006 (and a great deal of lobbying by doctors and patient rights groups) for NICE to approve reimbursements for the drug. And even today, NHS health trusts sometimes refuse to cover it.

Giuliani's critics can quibble with his numbers, but his message is spot-on. The data on cancer-survival rates in Britain and America speak for themselves -- and they confirm the mayor's point. When diagnosed with cancer, America is the place where one wants to be.

Robert Goldberg is vice president of the Center for Medicine in the Public Interest.