Does the New York Times Hate American Medicine?

While reading the New York Times’ massive investigation into whether CT Scanners are more medical scam than vital diagnostic tool, it was difficult not to give up after the following graph:

“Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care.”

Who says this? More to the point, why is this comment even in the piece when it pushes a fact that is easily disproved?  Last year, the journal Lancet Oncology published a huge comparative study of cancer survival rates in European countries and contrasted them with United States. The results:

Colon and rectal cancer: 65.5 percent in the U.S. vs 56.2 percent in Europe.
Breast cancer: 90.1 percent in the U.S. vs 79 percent in Europe.
Prostate cancer: 99.3 percent in the U.S. vs 77.5 percent in Europe.

All cancers (age adjusted), Men: 66.3 percent in the U.S. vs 47.3 percent in Europe.
All cancers (age adjusted), women: 62.9 percent in the U.S. vs 55.8 percent for women.

No individual country surpassed the U.S. on any of these measures – and these percentage differences add up to lives saved. If that doesn’t amount to “better care,” what does?

The authors of the study say much of the difference reflects better “timeliness” of diagnosis in the U.S., particularly with regard to prostate cancer, resulting from more intensive screening. One of the authors, Professor Michel Coleman of the London School of Hygiene and Tropical Medicine, authors, also told the BBC that Britain’s poor showing was due to a lack of cancer specialists compared to other countries.

Another recent study from the Annals of Oncology shows a correlation between survival rates in the U.S. and access to newer (and more expensive) cancer drugs. Britain’s Telegraph cited one of the study’s authors, Dr. Nils Wilking, a clinical oncologist at the Karolinska Institute in Stockholm:

“Our report highlights that in many countries new drugs are not reaching patients quickly enough and that this is having an adverse impact on patient survival. Where you live can determine whether you receive the best available treatment or not.

To some extent this is determined by economic factors, but much of the variation between countries remains unexplained. In the US we have found that the survival of cancer patients is significantly related to the introduction of new oncology drugs.”

Now perhaps CT scanning is mostly a waste of time, with a high price tag to consumers and high dosage of radiation to boot; but it’s also the fact that a snapshot of medical technology does not reflect that major developments in health care are often evolutionary. Small benefits in technology and drugs pave the way for further small developments, and eventually, these all add up to significant changes in treatment. Initial risks can also be reduced along the way (think early x-rays), while new uses and applications can arrive through a pure inspiration.

But the case against CT scanners shouldn’t involve deploying false claims that they are part of a massive fraud being perpetrated on the public by American medicine.

5 Responses to Does the New York Times Hate American Medicine?

  1. Merrill says:

    For a blog dedicated to getting numbers right, I’m surprised at your failure to discuss the lead-time bias and specificity errors that account for a large proportion of the differentials in U.S. and European cancer survival rates.

  2. noahpoah says:

    The Times piece is on the use of CT scans for cardiology, not cancer detection, so these cancer statistics are tangentially relevant at best.

  3. This criticism is directed not at the the relevance of CT scanners to cardiology, but to the Time’s general criticism of technology and health care; so any example which disproves that claim is legitimate.

    Bear in mind too that most doctors see CT scanners and medical imaging technology in general as being *the* single biggest breakthrough in medicine in the past 50 years.

  4. jim says:

    Merrill: please explain lead time bias and specificity error and their relevance??

  5. Philip Mohr says:

    Mr. Butterworth’s “tanget” into cancer statistics seems as acceptable as the New York Times bold statement about American healthcare being more expensive and no more effective than those of other countries. The New York Times made the generalization first – going from CT scanners to a total budget for American healthcare. Mr. Butterworth is merely showing that their generalization is wrong, even if their criticism of CT scanners is correct.

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