The issues are extremely complex. See the paper below for explanations on how the researchers tried to examine incidence, progression, survival from onset, overall mortality, in just two conditions (breast cancer and prostate cancer). What they forgot, however, is that survival from a given condition doesn't necessarily mean overall survival. Those kept alive by medical intervention for a given condition might well suffer ill effects from treatment, might be more vulnerable to other illnesses and might die of something else.....This is a big problem with disease-based studies as evidence of medical care effect. What counts is overall life in good health and postponement of death---not disease-specific measures.
URL: http://www.nber.org/tmp/43284-w15213.pdf
NBER working paper w15213 by Preston et al (Low Life expectancy in the United States: Is the health care system at fault? (2009)
Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]] On Behalf Of Victor Rodwin
Sent: Saturday, August 15, 2009 4:49 PM
To: [log in to unmask]
Subject: Re: Question
My note was rejected since I sent from g mail acct so I'm trying again. thanks for your response, Howard. I agree, obviously!
Victor
From: Victor Rodwin <[log in to unmask]>
To: Howard Berliner <[log in to unmask]>
Date: Sat, 15 Aug 2009 09:46:43 -0400
Subject: Re: Question
Howie,
I couldn't agree more with you. But I have two more questions for all of you.
1) If the evidence suggests that our cancer survival is due to earlier diagnosis, better screening, doesn't this indicate that the strength of our system comes from our grass roots mobilization, women's movement (Baron Lerner) and therefore says little about our treatment system, particularly if a small fraction (how small?) of those who receive early diagnoses of cancer cannot even receive treatment?
2) Can we really make valid comparisons of cancer survival across oecd nations. I believe that cancer registries like SEERS or the French registries from which I've tried (with Michael Gusmano to interpret data) are not designed to draw national population-based data on disease prevalence. Thus, although important for evaluating treatment, I'm not sure we can draw valid inferences about cancer incidence (from registries) across nations; and even if I'm wrong, we run into the problem of how to interpret different relative survival rates across national health systems, which leads us back to the first point.
I would welcome any insights all of you (Tim, Jo, Michael ..) would have on these points, knowing full well that I'm guilty of not responding to all of your queries in the past!
Victor
Victor G. Rodwin
Professor of Health Policy and Management
Wagner School of Public Service
New York University
The Puck Bld. 3d Fl.
295 Lafayette St.
New York, N.Y. 10012
Tel: 212-998-7459; Fax: 212-995-4162
Home fax: 646-536-9285
website: http://wagner.nyu.edu/rodwin
Co-Director, World Cities Project
International Longevity Center, USA
212-517-1300
fax: 212-288-9122
website:http://www.ilcusa.org/pages/projects/world-cities-project.php
----- Original Message -----
From: Howard Berliner <[log in to unmask]>
Date: Saturday, August 15, 2009 12:50 pm
Subject: Re: Question
To: [log in to unmask]
> Victor,
>
> I can't deal with your second point, but on the first, one can only imagine
> what we could do to cancer survival rates if we matched our excellence
> in
> screening with the ability to pay for actual treatment. On mothers day
> baseball players wear pink ribbons for breast cancer awareness (not
> treatment); on fathers day, there is always something about prostate cancer
> screening. Every weekend in the spring some group walks over the brooklyn
> bridge for various disease awareness campaigns (and the same thing happens
> in Central Park). We have perfected how to get people involved in public
> health campaigns--we have not figued out a way to get their treatment
> paid
> for as yet
>
> Howie
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