The coverage of Rudy Giuliani’s epidemiological error about his chances of surviving prostate cancer in England wasn’t perfect, but it was enough to get his campaign to stop using his fuzzy numbers in radio ads.
In the ad, aired in New Hampshire on October 29, Giuliani said that “My chances 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.” Giuliani was really saying that he would have died in England because of care under the British National Health Service, that bastion of socialized medicine that American politicians have used as whipping boy since 1948. Every time the mere hint of some kind of national health insurance system surfaces on the political agenda, out comes the specter of bad care in England, whether true or not, and whether anyone is talking about a national system or not. Guiliani has used the theme repeatedly on the campaign trail.
When the ad first aired, the AP moved two stories that were framed as a dispute—between critics who said his numbers were wrong and Giuliani who insisted they were right. The lead of one dispatch began: “Rudy Giuliani is defending the survival rates he quotes when talking about his prostate cancer, amid criticism he understates the figures and makes unfair comparisons.” The lead of another: “No one argues that Rudy Giuliani was diagnosed with prostate cancer, underwent treatment and survived. Yet there is a dispute about the statistics he quotes about his chances of survival.” The headline on a rather cursory New York Times story screamed out, “Giuliani’s Prostate Cancer Figure Is Disputed.”
But there was no dispute: Giuliani’s numbers were flat wrong, and the handful of news stories and columnists who challenged him showed what good coverage of the campaign should be. Among them: The Washington Post, The American Prospect, and The St. Petersburg Times, which had the courage to forthrightly say, “the figures aren’t accurate,” stand out. In almost all the stories, however, the Giuliani campaign insisted that the ads would continue running, furthering the notion that the numbers really were in dispute. But his campaign told CJR the ads are no longer running anywhere, and it looks to us like the alert coverage is the reason.
Giuliani first used the wrong numbers in a speech in Rochester, New Hampshire, in early August that was reported in seacoastonline.com. In that speech, he also said that his chances of surviving prostate cancer in France were only 62 percent, in an attempt to bolster the point he was making, that single-payer health systems in other countries “are cracking.” Seacoastonline.com, an online service of the Seacoast Media Group made up of the Portsmouth Herald and other papers, didn’t challenge the numbers. No one did until the radio ads started running in New Hampshire.
Giuliani got the numbers from an article in City Journal, published by the Manhattan Institute, a conservative think tank, whose author Dr. David Gratzer is a Giuliani campaign adviser. He cited an old report from The Commonwealth Fund, a New York-based philanthropic organization that produces health research studies. The Fund quickly set the record straight, noting that its 2000 report did not address survival rates and that anyway, such rates cannot be calculated from the numbers in the report. That report featured a chart that showed the incidence of prostate cancer—that is, the number of men who get the disease—was 136 per 100,000 men in the U.S. and 49 per 100,000 men in the UK. The U.S. number was higher because there’s more screening done here, using a test that itself is controversial and may detect cancers that will never need treatment. Thus, focusing on survival rates is misleading because more screening finds more disease, earlier disease, and false positives for disease. And men who have prostate cancer that’s detected earlier survive longer. Five-year survival rates in the U.S. for a disease that often takes fifteen years to kill are about 98 percent; in the UK those survival rates are about 74 percent.
The apples to apples bottom line is the mortality rate—how many men actually die from the disease. Here there’s not much difference between the two countries, and the statistics don’t help Giuliani. The Commonwealth study showed that these rates were similar—26 per 100,000 in the U.S. and 28 per 100,000 in the UK. The Times of London also reported that mortality rates are still about the same.
The American Prospect got the larger point and zeroed in on the real question that the press should be asking Giuliani and other candidates: How good is American health care?
On that question, The Commonwealth Fund recently released data showing how the U.S. compared with five other countries. American health care came up short in several respects. In England, for example, 45 percent of adults said they could get to see a doctor the same day when they needed medical attention. In America only 30 percent of Americans could. In the UK, more than 80 percent of primary care doctors had advanced information technology to provide such things as drug alerts, quick lab results, and access to hospital records. Not even 20 percent of American primary care docs do. How about getting care at all? Half the people in the U.S. said they had skipped a test or treatment, did not visit a doctor even though they had a medical problem, did not fill a prescription, or skipped a dose of their medicine because they could not afford the cost. In the UK, only 13 percent of people said they had one of these problems.
A footnote: The Des Moines Register, a pivotal paper in a pivotal primary, asked each candidate what other country they would like to live in aside from the U.S. Guess which one was first on Giuliani’s list? The United Kingdom. He also named Israel, Italy, and Japan, all countries with national health insurance systems. Hmmm.