Giuliani's Prostate Cancer Figure Is Disputed
By JULIE BOSMAN
The New York Times
Published: October 31, 2007
In a radio advertisement playing in New Hampshire and in speeches along the campaign trail, Rudolph W. Giuliani has cited statistics to cut at the heart of his Democratic rivals’ health care proposals, which he has derided as European-style “socialist” plans that will lower the standard of care in the United States.
“I had prostate cancer five, six years ago,” Mr. Giuliani, aRepublican presidential candidate, said in a speech that has been turned into the radio commercial. “My chance of surviving prostate cancer — and, thank God, I was cured of it — in the United States? Eighty-two percent. My chance of surviving prostate cancer in England? Only 44 percent under socialized medicine.”
Mr. Giuliani’s Democratic rivals would argue that they are not advocating government-run health care in their plans to extend coverage to the uninsured. But, beyond that, the 44 percent figure that Mr. Giuliani has been citing is in dispute.
The Office for National Statistics in Britain says the five-year survival rate from prostate cancer there is 74.4 percent. And doctors also say it is unfair to compare prostate cancer statistics in Britain with those in the United States because in the United States the cancer is more likely to be diagnosed in its early stages.
“Certainly, if you intensively screen for prostate cancer, you will find early disease,” said Dr. Ian M. Thompson, chairman of the department of urology at the University of Texas at San Antonio. “And simply because you find it earlier, you will always have longer survival after the disease is diagnosed.”
Maria Comella, a spokeswoman for Mr. Giuliani, said yesterday that the 44 percent figure came from an article in City Journal, a publication of the Manhattan Institute, a conservative research organization.
“The citation is an article in a highly respected intellectual journal written by an expert at a highly respected think tank which the mayor read because he is an intellectually engaged human being,” Ms. Comella said in an e-mail message.
That article, titled “The Ugly Truth About Canadian Health Care,” was written by Dr. David Gratzer, a senior fellow at the Manhattan Institute and an adviser to the Giuliani campaign.
In an interview, Dr. Gratzer said the statistic came from the Commonwealth Fund, a nonprofit group in New York specializing in health care policy issues, but he acknowledged that it was seven years old and “crude.”
But the Commonwealth Fund said yesterday that Dr. Gratzer had misused its research by calculating a five-year survival rate based on data on prostate cancer incidence and mortality rates in the United States and Britain.
“Five-year survival rates cannot be calculated from incidence and mortality rates, as any good epidemiologist knows,” the group said in a statement.
Dr. Gratzer dismissed the Commonwealth Fund’s statement, saying the group had “an ideological bias.” Asked if Mr. Giuliani would continue to repeat the statistic, and if the advertisement would continue to run, Ms. Comella responded by e-mail: “Yes. We will.”
Gina Kolata contributed reporting.
THE CLAIM: GIULIANI’S PROGNOSIS WOULD BE WORSE IN BRITAIN and THE FACTS
The Washington Post
Wednesday, October 31, 2007; Page A06
“I had prostate cancer, five, six years ago. 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.”
— Rudy Giuliani, New Hampshire radio advertisement, Oct. 29, 2007
The former New York mayor has had experience battling prostate cancer, but he’s confused about the stats, according to several experts we consulted.
THE FACTS
As factual support for the presidential candidate’s claim, his campaign cited an article by David Gratzer that appeared in the City Journal, published by the Manhattan Institute, a conservative New York think tank, slamming the Canadian and British systems of “socialized” medicine. The article provides no sources for its assertions about five-year survivability rates for prostate cancer.
Experts from the National Cancer Institute and the urology departments at Johns Hopkins University and the University of Kansas agreed that Giuliani’s figures were way out of date, if they were ever accurate at all. The latest official figures for five-year “survivability” rates for prostate cancer are about 98 percent in the United States and 74 percent in England.
More important, the survivability figures tell us little about the differences in the quality of treatment received by prostate cancer patients in the United States and Britain. Doctors in each country have different philosophies about how to treat the disease, and these differences have greatly influenced the survivability statistics.
In the United States, there has been a big emphasis since the 1990s on early screening through prostate-specific antigen (PSA) testing. Five-year survivability rates have increased simply because the slow-developing disease is being diagnosed at a preliminary stage. If the diagnosis is made early, the chance of surviving for five years is close to 100 percent. Britain is several years behind the United States in the widespread use of PSA testing.
Another way of comparing treatment of prostate cancer in the United States and Britain is to look at the mortality rates. Here the two are much closer. About 25 men out of 100,000 are dying from prostate cancer every year in both countries. The likelihood of dying from prostate cancer is roughly comparable in the two countries, despite different treatment philosophies.
J. Brantley Thrasher, chairman of the Department of Urology at the University of Kansas, said it is “impossible to say” on the basis of the statistics whether a prostate cancer patient has a better chance of surviving under a “capitalistic” or “socialistic” medical system. American doctors tend to be more “interventionist” and more likely to advocate surgery than their counterparts in Britain or Canada, where greater emphasis is put on “active surveillance.” In the United States, a patient with a good health-care plan is “more empowered to make decisions” for himself.
Maria Comella, deputy communications manager for the Giuliani campaign, sent us the following e-mail explaining the mayor’s mistake without quite acknowledging it:
“Mayor Giuliani is an avid reader of City Journal and found the passage in the Gratzer article himself. He cited the statistics at a campaign stop, and the campaign used a recording from that appearance in the radio ad. The citation is an article in a highly respected intellectual journal written by an expert at a highly respected think tank which the mayor read because he is an intellectually engaged human being.”
THE PINOCCHIO TEST
Giuliani is simply wrong when he claims that his chances of surviving prostate cancer are almost twice as high in the United States as in England, under a “socialized” medical system. We award Giuliani four Pinocchios.
To find out the winner of the Fact Checker’s first Geppetto award, and coverage of Tuesday night’s Democratic debate, visit
The serial exaggerator strikes again
By Steve Benen
The Carpet Bagger Report
Posted October 30th, 2007 at 9:15 am
At this point, it appears Rudy Giuliani is just daring the national media. Following up on yesterday’s item, the candidate who can barely go a day without making a wildly misleading exaggeration, has unveiled a new radio ad with a truly audacious whopper, even by Giuliani’s low standards.
OK, Rudy Giuliani has just released an ad claiming that the survival rate from prostate cancer is much higher in America than in Britain, thus proving the failure of socialized medicine.
The problem is that his claim is just plain false. In fact, mortality rates from prostate cancer are almost the same in America and Britain.
So, will this get as much attention as, say, the Edwards haircut or the Hillary laugh? Will it get any coverage at all? Bear in mind that health care is the central domestic issue of this election — and Rudy has just showed that he doesn’t know a thing about it.
It’s really not that complicated. Giuliani, in his campaign spot, claims that the survival rate for prostate cancer patients in the U.S. is 82%, while in England, it’s 44%. Giuliani argues that a universal-coverage system necessarily leads to worse care and more deaths.
But Giuliani doesn’t know what he’s talking about, and his claims were easily debunked.
Keep in mind, this wasn’t just an off-hand comment Giuliani made on the stump. This was a carefully crafted pitch, and put on the air. Giuliani didn’t just flub the facts in response to a voter’s question; he’s intentionally trying to deceive the public with a misleading ad.
And how has the media responded to the leading Republican candidate getting caught lying in a campaign ad? So far, by largely ignoring it.
Reader R.K. alerted me to a discussion on yesterday’s Hardball, where MSNBC’s Chris Matthews showed the ad in its entirety. Matthews and his guests then scrutinized the ad for quite a while. How many mentioned that the ad’s central claim was demonstrably false? None.
Matthews got the discussion started by saying, “Boy, that is classic Live Free or Die, self reliance, the Granite State. Perry, this is like main lining right into that psychology of New Hampshire, which is leave me alone. I don’t trust socialism. Is it going to work in these days, when people are really challenged on health care?”
Perry Bacon discussed the ad in the context of other candidates’ healthcare pitches. Jill Zuckman talked about the ad in the context of taking on Hillary Clinton. Matthews repeatedly asked whether the ad would “work,” by which he meant, win support from voters.
It didn’t occur to any of them to even question Giuliani’s central claim, better yet point out that it’s completely wrong.
As for digging into the policy details a little more, Ezra did a handful of good posts on the subject yesterday, but included a gem last night when he noted the circumstances of Giuliani’s life-saving cancer treatment.
…Giuliani’s case for the superiority of our “free market” health care system goes something like this: While on health insurance provided by New York state, he was treated, using a surgery developed by Europeans, for prostate cancer, a disease that most commonly afflicts those covered by the federal government’s single-payer health care system. Take that, Europe/national health insurance.
Yep, Giuliani is that clueless.
In an effective political system, this would be a fairly big deal. A leading candidate produces an ad (one of a small number created by the campaign) with an obvious falsehood. If reporters cared half as much about this as haircuts, cackles, and cleavage, the process might actually function.