U.S.

Factcheck.org on Giuliani's Prostate Claims

Summary
Rudy Giuliani insists he was "absolutely accurate" to say that men with prostate cancer have a 44 percent survival rate in England, despite being contradicted by FactCheck.org, major news organizations and several cancer experts.

The Canadian psychiatrist who first came up with the figure, despite his admission to us that the statistic is "technically" not a survival rate at all, is also defending the figure as valid and describing criticism of his figure as a "malignant rumor." The conservative think tank which published the figure also is defending it.

We find no merit in these rebuttals, nor do the cancer experts we consulted. A professor of biostatistics at Johns Hopkins University calls Giuliani's figure "very misleading," and the chief of urology at a leading medical school calls it "complete nonsense." No less an authority than Britain's health secretary says Giuliani's cancer statistic is wrong. We agree.

Giuliani is entitled to his low opinion of what he calls "socialized medicine" in Britain, and to his strongly held belief that patients generally fare better in the U.S. We take no position for or against the British system or the various health-care proposals bring advanced in the 2008 presidential campaign. We do object to Giuliani's continued use of a false statistic to support his argument.

Analysis
Last week, we reported that Rudy Giuliani had used a false statistic in a radio ad in New Hampshire in which he claimed that the chance of surviving prostate cancer was only 44 percent in England and 82 percent in the U.S. We tracked that figure back to its source, Giuliani campaign adviser David Gratzer, who admitted to us that his numbers "technically" weren't survival rates at all. We reported that Gratzer had calculated his percentages from figures given in a report published in 2000 by two Johns Hopkins University researchers, and that both authors said Gratzer had drawn an erroneous conclusion. One of them told us that Gratzer's 44 percent figure was wrong, "misleading" and meaningless.

Meanwhile, several mainstream news outlets also disputed Giuliani's ad, including ABCNews.com, which accused the former mayor of "Fuzzy Health Care Math," PolitiFact.com, which called his claim "false," and The Washington Post, which called his statistic "wrong" and awarded him "four Pinocchios," designating a campaign "whopper."  By the end of the week, no less an authority than British health secretary Alan Johnson complained that Giuliani was making a "political football" of the British health system, saying: "Our rate of prostate cancer survival is actually much higher than has been claimed. The latest data shows a survival rate of over 70 per cent – and increasing."

But even while creating something of an international incident, Giuliani steadfastly refuses to admit error. Gratzer, meanwhile, now maintains that his calculations are a valid measure of the chances of survival, despite his early admission to us that his figure is not a "survival rate," as Guiliani claims it is.


"Complete Nonsense"
Gratzer is not a cancer researcher. He has published a handful of articles in peer-reviewed medical journals, but none that we could find regarding cancer or survival rates. He is a Canadian psychiatrist who writes chiefly opinion pieces for conservative U.S. publications that are critical of Canadian-style health care systems.

A day after our original story was published, Gratzer issued a response to the widespread criticism of his 44 percent figure. In that article, he did not mention our article, but cited other news organizations, calling the criticism a "malignant rumor" and maintaining that they were wrong and he and Giuliani were right. He also backtracked: While his original article incorrectly called his statistic a "survival rate" (something he admitted to us was "technically" not true) he now calls his figure a "snapshot." But he then implies that his figure is just as valid as official government statistics. Gratzer says of the official United Kingdom figures: "Those data look at five-year survival rates – that is, they track cancer patients for five years and report on their survival. Their approach is different from mine. They don't examine what we might call a 'snapshot,' as my data do: that is, examining how many people with a particular disease die during a given interval of time – say, a year."

What Gratzer dismissively calls "their approach" is actually the one taken and supported by the National Cancer Institute, the Centers for Disease Control and Prevention, the American Cancer Society,and the Mayo Clinic, among other recognized authorities on the subject. We find no other cancer researchers who use a "snapshot" figure, and several who say Gratzer is blowing smoke:
Marie Diener-West, a professor of biostatistics at Johns Hopkins University Bloomberg School of Public Health, says it's "inappropriate" and "very misleading" to calculate a survival rate in the way Gratzer attempted.

Peter Albertsen, professor and chief of urology at the University of Connecticut Health Center, calls such calculations a "very dangerous thing to do" and "complete nonsense."
Despite what these and other recognized authorities are saying, no correction is forthcoming from the Manhattan Institute, where Gratzer is a senior fellow and whose magazine published the opinion piece from which Giuliani first plucked the 44 percent figure.  Instead, the group has mounted a vigorous defense of his work. The conservative think tank's home page now includes a prominent box that says "Gratzer's statistics are correct" and lists several articles by him along with links to a number of Republican and conservative commentators who have come to Giuliani's defense (often by merely repeating Gratzer's erroneous method). The Manhattan Institute, incidentally, is not ideologically neutral. It is a conservative, free-market think tank that favors a health care system of private (not government-run) insurance. Its Web site advocates "opening Medicare and Medicaid to private insurance markets and putting consumers, not bureaucrats, in control of their own health care spending through health savings accounts and targeted vouchers."

Wrong Again
As for Giuliani, he also continues to insist that the 44 percent figure is "absolutely accurate" and implies that critics are merely confused about dates:

Actually, the 44 percent figure isn't correct now and wasn't correct in 2000 either, despite what Giuliani claims. As we mention above, the statistics Giuliani cites never constituted a "survival rate" in the first place. And it's true that survival rates for prostate cancer in England were lower in 2000 than they are now, but they weren't even close to 44 percent. According to the U.K.'s Office of National Statistics, the five-year relative survival rate for patients diagnosed with prostate cancer between 1993 and 1995 (and thus followed up to 1998 or 2000) was 59.8 percent, well above the 44 or 43 percent that Giuliani cites for the year 2000. The National Cancer Institute's Surveillance Epidemiology and End Results database puts concurrent U.S. rates at 95.4 percent. As with the more recent figures, there is indeed a significant difference, but the numbers bear no relation to Giuliani's claims.

Wrong on Breast Cancer, Too
In an October 30 interview with Fox News' Neil Cavuto, Giuliani not only stood by his figures, but expanded his claims to other forms of cancer – and strained yet another cancer statistic:

Giuliani is continuing to make this claim, most recently at a campaign event in Iowa, according to the Quad-City Times. Actually, the United States' five-year relative survival rate for breast cancer is about 89 percent, according to the National Cancer Institute. By contrast, the most recent available five-year survival rates in France, England and Canada were 85 percent, 81 percent and 86 percent, respectively. Even taking into account the difficulties with international comparisons, this is at most a spread of 8 percentage points. Describing 89 percent as "much greater" than 81 percent is a stretch, in our judgment.

Giuliani has a point about Cuba, a poor country where cancer mortality is indeed high, and survival less likely than in the U.S. According to a 1997 report from the American Association for World Health, Cuba saw an increase in breast cancer mortality after mammography began to be severely restricted due to the difficulty of importing spare parts and x-ray film. In any case, none of the leading Democratic candidates are embracing a health care system like Cuba's, or Britain's, for that matter.

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