An April Wall Street Journal editorial lauded the U.S. health-care system for giving American patients “more value—better outcomes and longer lives” than European health-care systems. The editorialist was praising a new study which, according to lead investigator Tomas Phillipson at the University of Chicago, demonstrated that “the costs of cancer care [in the U.S.] were indeed ‘worth it’.”
Whether the study actually proves this point is debatable. The analysis found the biggest gain in cancer survival in the U.S., for example, in prostate and breast cancer, two cancers that are plausibly over-diagnosed in the United States. It’s easy to live a long time if your doctors find a pre-cancer and call it cancer. The investigators claim that they have taken care of this lead time bias by also looking at overall cancer mortality in the U.S. and Europe during the same time, where they find a dramatic reduction in prostate cancer deaths across the population. On the other hand, that analysis also finds a dramatic increase in stomach cancer deaths in the United States relative to Europe. As a physician, I have to say I cannot make much sense of these results. The authors don’t provide any good explanation for what U.S. physicians might have been doing (compared to their European colleagues) to increase prostate cancer survival so much, nor any idea what U.S. doctors were doing to so badly screw up the care of patients with stomach cancer.