Another nearly fact-free Paul Krugman editorial

Though, to his credit, he doesn't rant about how his opponents are knowingly ignoring the facts in pursuit of an evil agenda.

In a recent blog, Krugman discusses a Lancet study on cancer survival rates in various countries.  The USA fares well in the study, and many opponents of ObamaCare cite that as evidence that the US health care system is superior.  Here is the summary graphic taken from Krugman's article:

Krugman argues that the longer USA survival rate may be due to better and earlier diagnosis of the disease, whether or not the actual treatment is any more effective.  He provides an excellent illustration of how this might happen

"Here’s how I understand the over-diagnosis issue, in terms of an extreme example: suppose that there’s a form of cancer that kills people 7 years after it starts, and that there is in fact nothing you can do about it. Suppose that country A screens for cancer very aggressively, and always catches this cancer in year 1, while country B chooses to invest its medical resources differently, and never catches the cancer until year 4. In that case, country A will have a 100% 5-year survival rate, while country B will have a 0% 5-year survival rate — because survival is measured from the time the cancer is diagnosed. Yet treatment in country B is no worse than in country A."

So far, kudos to Krugman.  However, does he resent any facts that the USA does indeed "over-diagnose"?  No.  One would think he could at a minimum support his argument with something, anything.  But he doesn't.  He ends with a short snipe at opponents of ObamaCare, "you shouldn’t buy the spin."

Plus, isn't early detection of cancer a good thing?  Well, as Science Based Medicine discusses, the facts are mixed.  The article explicitly discusses Krugman's theory, and states "there is a grain of truth buried under the absolutist statement but it’s buried so deep that it’s well-nigh unrecognizable".  The article has a great (if lengthy) discussion, repeating and elaborating on many of Krugman's points, including the issue that early detection can make survival rates appear to be longer, even if actual survival is no different.  Do they agree with Krugman?  Well... (italics added by me)

"Does all of this mean that we’re fooling ourselves that we’re doing better in treating cancer? That, after all, is the charge being made. Not at all."

In other words, it's complicated, but Krugman's argument that early detection is "spin" that might fool us is wrong - Krugman himself is providing the "spin".

I'd like to add something both Krugman and Science Based Medicine fail to mention.  Maybe today there are cancers for which early detection provides little or no benefit, because there are no effective treatments.  That doesn't mean that we will never develop effective treatments.  And, when we do, early detection will almost certainly be valuable.  So, early detection is an important step in the treatment of cancer.

In conclusion, I wish Krugman could have provided some facts to support his argument that the USA over-diagnoses cancer.  He may well be correct.  And, to his credit, he does hint at the complications, that "Real life isn’t that simple".  For the record, I'm completely undecided on the benefits of ObamaCare.  But, it Paul Krugman wants to convince me of his arguments, he needs to bring some facts.