>5-year survival rate is an extremely misleading statistic. Much of the increase in the US is simply attributable to the fact that we detect the cancers earlier, so that patients pass out of the 5-year window before they die.
This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective.
5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate.
Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.
If you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better. So you can't just look at cancer survival rates.
I meant what I said about AND CHANGE NOTHING ELSE but experience tells me I have to repeat it. Merely detecting it earlier, BUT DOING NOTHING ABOUT IT, will improve your cancer survival stats.
<If you detect cancer earlier AND CHANGE NOTHING ELSE...>
That is a meaningless population unless you are suggesting that providers are working hard to detect cancer and then, having found cancer, choose to not treat it at all.
Ugh, no, I'm not using that as a population to compare to.
Here, let me put it into a story.
We're comparing the health care of two countries, A & B. The survival rates of cancer are better in country A.
So researchers study what country A does to get better results. They find that it has a system of early detection followed by slathering people with chicken blood.
Well, you aren't sure if the chicken blood is the right thing, but surely the early detection means people are healthier, right?
No, because . . . ahem, "if you detect cancer earlier AND CHANGE NOTHING ELSE you cancer survival rates will look better."
In fact, country A and country B may be exactly the same when it comes to treating cancer. But because of very real statistical artifacts like
https://en.wikipedia.org/wiki/Will_Rogers_phenomenon, it leads to statistics showing the country A is better when people have the exact same outcomes.
Perhaps you think that rubbing with chicken blood is an unfair comparison of the US health care system, because it uses science-y stuff. But measuring outcomes
is hard. Lots of things that people naturally assume improve health outcomes (see other discussion on this page about annual checkups) don't. Some things
that we assume improve health care outcomes actually worsen outcomes. Radical chemotherapy is the go-to example. And insurance companies were required to pay
for it, too, following expensive court cases. (Health care costs were held nearly flat in the US under HMOs, which put a lid of costs but had no noticeable
negative impact on outcomes. This pretty much broke their cost containment. They were also unpopular because they said no a lot.)
So figuring out if the US has better cancer outcomes is hard, because the US really puts a big emphasis on early detection, but it might be just early
detection which makes the stats look good.
I'm not trying to push a narrative right here. There are a bunch of different health care systems in the world, and the one thing we know about the US
system is that it costs more. This is not necessarily a bad thing, because it's possible we are getting more benefit (by pushing new treatments) but it's
also something that the US has not explicitly decided to do, neither by policy nor by the invisible hand of a bunch of individual actors in the market.
I don't understand what you're getting at. It is completely pointless to talk about "detect cancer earlier AND CHANGE NOTHING ELSE". Nobody does that. Even if the health care system did nothing but detect - which is an absurd idea of course - the patient in question would surely do something.
If you don't detect cancers, that will not stop people from dying to cancer.
The U.S. health system is expensive because it uses a lot of money for some cases that would receive less attention somewhere else. Some of these are difficult cases that other health systems even cannot treat; others are trivial things where the private insurance system spends a lot for some people while there are uninsured people who get no attention for things that could be cured or prevented relatively easily.
The priorities are not necessarily right; at least they are not producing optimal "bang for the buck" in national health - U.S. spends a lot but still people suffer from preventable diseases.
But early cancer detection is one of the undoubtedly good things.
(Infant mortality rate in the USA was lower than in my country in 1950; now it is more than double. Cuba is better than United States, if we can trust the statistics. However, I'm surprised that Canada is not that much better either.)
> It is completely pointless to talk about "detect cancer earlier AND CHANGE NOTHING ELSE".
No it isn't. I'm trying to ram home the statistical point with a counter-factual. I have to say this extreme because some people Just Don't Get It and keep on trying to talk about something else.
A system that ONLY detects cancers earlier will show better cancer survival numbers even if actual outcomes don't change at all. No, seriously.
Let's lay out an actual example.
Alice, Bob, Charlie, and David exist. Charlie has a minor cancer he won't die if. David has a major cancer he will die of.
In Country B, since detection is heavily correlated with the seriousness of cancer, they detect David has cancer, and David dies. Cancer survival rate = 0 of 1, or 0%.
In Country A, they detect Charlie and David have cancer. David dies, Charlie doesn't. Cancer survival rate = 1 of 2, of 50%.
> If you don't detect cancers, that will not stop people from dying to cancer.
No one said this.
> But early cancer detection is one of the undoubtedly good things.
This is wrong. I know your gut tells you this is true. Your gut is wrong.
Increased detection sometimes helps and sometimes hurts. There are a lot of people, like Charlie in the above example, who would never die of cancer, but because of increased detection they now undergo risky cancer treatment. All treatment involves risk, and for cancer treatment this is particularly true. Again, look up the history of radical chemotherapy. The people who underwent it had worse outcomes than people who had nothing at all done to them.
Researchers usually find that people in palliative care do better than people in active treatment. This isn't enough to say that no treatment is always better, but it is enough to say that some treatment is often worse.
Because so many people have your gut reaction, though, "early detection" is a popular way of throwing money at the problem in America.
> Infant mortality rate in the USA was lower than in my country in 1950; now it is more than double. Cuba is better than United States, if we can trust the statistics.
Here's good questions to ask yourself when looking at infant mortality.
1. What's the difference between a miscarriage, a stillbirth, and a dead newborn? Particularly, what does it mean when this answer changes between countries, and even within countries?
2. How do the numbers change if you compare white Americans to white Canadians and black Americans to black Canadians?
There isn't such a system, anywhere. Even if you could have a public health care that detects and tries not to treat, you still cannot effectively forbid people from getting treatment themselves - if you make a law against it, people will try to escape the country to get treatment. So if you have a better detection rate, there will be actions to treat.
>Increased detection sometimes helps and sometimes hurts.
Perhaps the fallacy here is the belief that the helps/hurts ratio of treatment is 50/50? It isn't.
Of course there are cases where the treatment actually made things worse. There are more cases where the treatment has no significant effect.
But it is rather silly to assume that cancer treatments would have a net negative of zero effect.
Regarding the infant mortality rate, the definitions of miscarriage, stillbirth and dead newborn are not so different between developed nations that it would change this. Where IMR is lower, also stillbirth rate is lower, so it's not really about moving the boundary between these.
This does not make sense. The earlier you detect cancer, the higher is the likelihood that treatment is effective.
5-year survival rate absolutely correlates with 10-year survival rate and 30-year survival rate.
Though it is undoubtedly true that in the long term, we're all dead. That is however not a meaningful indicator of health care system effectiveness.