7 ms·

The other commenter is pointing out the flaw in your argument. You're claiming that Australians are less likely to see stage IV cancer than Americans due to a w

by sxg 6y ago

The other commenter is pointing out the flaw in your argument. You're claiming that Australians are less likely to see stage IV cancer than Americans due to a worse healthcare system in America. As the other commenter states, that's a very believable argument that fits the narrative about America's healthcare system. However, the data doesn't support that claim. If Australians truly see fewer cases of stage IV cancer because of a better healthcare system, then we should expect to see higher 5-year survival rates for those cancers in Australia. As the other commenter brought up, 5-year survival rates are higher in America than Australia for the most common cancers. So it's unlikely that your original argument is correct. Sure, America's healthcare system is deeply flawed, but it's important to attack it on fair grounds. We can't solve a systemic issue by raising claims and arguments that aren't supported by evidence. EDIT: Furthermore, identifying early stage cancer is an extremely problematic and difficult field regardless of healthcare system and country. In America, we currently screen asymptomatic healthy adults for breast cancer and colon cancer. We screen people with a smoking history for lung cancer. However, the benefits to overall mortality of these cancer screening tests is controversial. While in theory identifying stage I cancer should result in improved overall mortality, the data doesn't clearly show that. Take a look at length-time bias (https://en.wikipedia.org/wiki/Length_time_bias https://en.wikipedia.org/wiki/Length_time_bias). It's possible that a substantial portion of the cancer screening that's done in America (and the stage I cancers found in Australia) selectively identify indolent cancers that are unlikely to be harmful to patients.

floatingatoll 6y ago
> You're claiming that Australians are less likely to see stage IV cancer than Americans due to a worse healthcare system in America I'm claiming that Australian citizens are more likely to bring cancer to their provider when it's still at stage 1, because the citizens do not risk bankruptcy when seeking diagnosis and treatment, resulting in treatment of cancers beginning prior to their reaching stage 4. This would, if true, create a scenario where: In Australia, the few stage 4 cancers seen are the cancers that failed treatment at stage 1, stage 2, and stage 3; they are extremely likely to be fatal, as they've already failed essentially every treatment available. But in United States, the stage 1-2-3 "this is treatable" filtering out isn't occurring, because patients with cancer are waiting for age 65 to seek diagnosis, and so our stage 4 treatment success rate is higher because we didn't treat the treatable cancers earlier in the stages. Do the above comparisons of AU vs US 'stage 4 survival rates' take into account the successful treatments at stages 1-3 that would presumably be occurring in AU? Do they take into account the incidences of 'this would have been treatable if diagnosed in stages 1-3' that are presumably occuring in US? EDIT: Do they hold true for each individual type of cancer? Do they hold true when normalized for spending on a given type of cancer as a percentage of all cancer spending? I'm aware that these are not easy things to compare or assess, and I understand that it's preferable to some to make no statement at all rather than make an approximation that doesn't hold up to a full-power statistical analysis. If someone does know of such a thesis, I suppose my most compact question would be: "For each type of cancer: Does the Australian health care system tend to diagnose earlier than the United States health care system, provide care at a higher or lower total cost of treatment, with a higher or lower rate of success?"
- sxg 6y ago
  > I'm claiming that Australian citizens are more likely to bring cancer to their provider when it's still at stage 1, because the citizens do not risk bankruptcy when seeking diagnosis and treatment, resulting in successful treatment of cancers prior to their reaching stage 4. I understand your argument: you're saying that by treating stage 1–3 patients early on, the stage 4 patients will have a shorter survival. But in the US, stage 4 patients also include many patients that would have been stage 1–3 in a different country, and because these cancers may not be quite as aggressive as the other stage 4 cancers, the 5-year survival will be higher. I'm on board with this part of your argument. The part that doesn't hold up is patients regularly coming in to their doctors with symptomatic early stage cancer. In early stages, many cancers are completely asymptomatic. Even when we screen completely asymptomatic patients for early stage cancer in the US, we don't actually see clear cut overall mortality benefits. So how is it that these Australians are presenting to their doctors so early on with cancer symptoms? EDIT: The holy grail of cancer screening has three features: - Identifies dangerous cancers shortly after they form - Perfectly separates cancer from non-cancer - Patients live longer Medical science itself (regardless of healthcare system and country) can't reliably meet the above three goals. So I'm skeptical that patients having easy access to medical care like in Australia would result in improved cancer survival.
  - floatingatoll 6y ago
    That is an excellent question, thank you for clarifying.
  - thret 6y ago
    Perhaps Australians present to their doctors early for all symptoms, and it is the doctors who diagnose cancer? I can't speak for everyone in Australia but for me, if I am sick I have to see a doctor in order to get 'sick leave'. I have unlimited paid sick leave provided a doctor has recommended it. It also doesn't cost me anything to see a doctor or get any kind of test or treatment/surgery done - it is all covered by work.
    - sxg 6y ago

by sxg 6y ago

floatingatoll 6y ago

> You're claiming that Australians are less likely to see stage IV cancer than Americans due to a worse healthcare system in America I'm claiming that Australian citizens are more likely to bring cancer to their provider when it's still at stage 1, because the citizens do not risk bankruptcy when seeking diagnosis and treatment, resulting in treatment of cancers beginning prior to their reaching stage 4. This would, if true, create a scenario where: In Australia, the few stage 4 cancers seen are the cancers that failed treatment at stage 1, stage 2, and stage 3; they are extremely likely to be fatal, as they've already failed essentially every treatment available. But in United States, the stage 1-2-3 "this is treatable" filtering out isn't occurring, because patients with cancer are waiting for age 65 to seek diagnosis, and so our stage 4 treatment success rate is higher because we didn't treat the treatable cancers earlier in the stages. Do the above comparisons of AU vs US 'stage 4 survival rates' take into account the successful treatments at stages 1-3 that would presumably be occurring in AU? Do they take into account the incidences of 'this would have been treatable if diagnosed in stages 1-3' that are presumably occuring in US? EDIT: Do they hold true for each individual type of cancer? Do they hold true when normalized for spending on a given type of cancer as a percentage of all cancer spending? I'm aware that these are not easy things to compare or assess, and I understand that it's preferable to some to make no statement at all rather than make an approximation that doesn't hold up to a full-power statistical analysis. If someone does know of such a thesis, I suppose my most compact question would be: "For each type of cancer: Does the Australian health care system tend to diagnose earlier than the United States health care system, provide care at a higher or lower total cost of treatment, with a higher or lower rate of success?"

sxg 6y ago
> I'm claiming that Australian citizens are more likely to bring cancer to their provider when it's still at stage 1, because the citizens do not risk bankruptcy when seeking diagnosis and treatment, resulting in successful treatment of cancers prior to their reaching stage 4. I understand your argument: you're saying that by treating stage 1–3 patients early on, the stage 4 patients will have a shorter survival. But in the US, stage 4 patients also include many patients that would have been stage 1–3 in a different country, and because these cancers may not be quite as aggressive as the other stage 4 cancers, the 5-year survival will be higher. I'm on board with this part of your argument. The part that doesn't hold up is patients regularly coming in to their doctors with symptomatic early stage cancer. In early stages, many cancers are completely asymptomatic. Even when we screen completely asymptomatic patients for early stage cancer in the US, we don't actually see clear cut overall mortality benefits. So how is it that these Australians are presenting to their doctors so early on with cancer symptoms? EDIT: The holy grail of cancer screening has three features: - Identifies dangerous cancers shortly after they form - Perfectly separates cancer from non-cancer - Patients live longer Medical science itself (regardless of healthcare system and country) can't reliably meet the above three goals. So I'm skeptical that patients having easy access to medical care like in Australia would result in improved cancer survival.
- floatingatoll 6y ago
  That is an excellent question, thank you for clarifying.
- thret 6y ago
  Perhaps Australians present to their doctors early for all symptoms, and it is the doctors who diagnose cancer? I can't speak for everyone in Australia but for me, if I am sick I have to see a doctor in order to get 'sick leave'. I have unlimited paid sick leave provided a doctor has recommended it. It also doesn't cost me anything to see a doctor or get any kind of test or treatment/surgery done - it is all covered by work.
  - sxg 6y ago