> They're pretty good at dealing with pregnancies, cancers, and emergencies
I agree with everything you say, except the part about cancer.
Even by European standards, the NHS is actually quite terrible at dealing with cancers - even "routine" cancers (like breast cancer and prostate cancer), let alone rare cancers. The five-year survival rate for prostate cancer in the UK is 55%, whereas in the US it's upwards of 90%. (Prostate cancer is an incredibly treatable form of cancer; for most people, as long as it's detected early and managed appropriately, they will die with prostate cancer as opposed to from it).
Of developed countries, only Japan, Portugal, and Denmark have worse five-year survival rates for prostate cancer.
> The five-year survival rate for prostate cancer in the UK is 55%, whereas in the US it's upwards of 90%.
Such survival rates are from date of diagnosis; IIRC, because prostate cancer detected early usually doesn't have interventions that are less harmful than the cancer is likely to be, there's considerable debate about the utility of screening; there has been considerable argument that the US tends to overscreen and over-intervene for prostate cancer.
If the UK doesn't do that and tends to screen in a way that tends to catch less of the less-imminently-dangerous prostate cancers, it would have a lower 5-year survival rate simply by not diagnosing prostate cancer where the diagnosis isn't usefully actionable; this doesn't mean they are actually worse at dealing with it.
> Prostate cancer is an incredibly treatable form of cancer; for most people, as long as it's detected early and managed appropriately, they will die with prostate cancer as opposed to from it
Prostate cancer is very often an extremely non-aggressive cancer with interventions that can have significant negative impacts, which is why, even when it's diagnosed “watchful waiting” or “active surveillance” are often the preferred management approaches; quite a lot of people will die with, rather than from, prostate cancer with no active intervention.
Population-wide 5-year survival rates from diagnosis are probably not a good metric for comparing countries with different screening practices; mortality rates are a better comparison metric, but also don't tell the whole story.
> Such survival rates are from date of diagnosis; IIRC, because prostate cancer detected early usually doesn't have interventions that are less harmful than the cancer is likely to be, there's considerable debate about the utility of screening; there has been considerable argument that the US tends to overscreen and over-intervene for prostate cancer.
Over-intervention and over-screening are two different problems, particularly for prostate cancer, where screening is low-cost and low-risk. In the US, most cases of prostate cancer do not require invasive intervention if detected early, but they will begin treatment, as well as more regular monitoring of the cancer. When screening costs are low, overscreening is not particularly problematic as long as it doesn't result in overtreatment (which is demonstrably true for prostate cancer in the US)
Again, this is not limited to prostate cancer. The difference is the most stark there because the screening costs and risks are both low, but the UK still does a much worse job at treating breast cancer, colorectal cancer, lymphoma and leukemia, which are the other deadly common cancers.
For all cancers, not just prostate cancer, the US over-screens a small amount, but the UK underscreens by a massive amount, resulting in many people detecting cancer when the window of optimal treatment has long passed. That's the reason that the UK is close to last place among developed countries for five-year cancer survival across all common forms of cancer, not just prostate cancer.
> Over-intervention and over-screening are two different problems, particularly for prostate cancer, where screening is low-cost and low-risk
They are distinct but not unrelated, particularly in a system where treatment decisions are highly patient driven, especially for patients with financial means.
But my point is less about over screening than that differences in screening practices naturally produce difference in five-year survival statistics even in cases when they have no meaningful outcone in terms of disease progression, mortality, and quality of life, because more screening will detect more cases of disease earlier, even cases for which intervention would never be clinically indicated. If you do a lot better job at diagnosing cases for which there would never be intervention, you get a better 5-yesr survival rate but haven't done any better at dealing with the disease.
Note that I'm not arguing about whether the UK does deal with prostate cancer well, in fact what I've seen using mortality rates suggest they are a bit worse than the US, though much less bad then you'd think from 5-year survival rates. I'm just staying there 5-year survival rates aren't great metrics for systems that are different in conditions that lead to diagnosis.
> I'm just staying there 5-year survival rates aren't great metrics for systems that are different in conditions that lead to diagnosis
I agree. That's why looking at all common cancers as well is important. Leukemia and lung cancer are the opposite end of the spectrum - early intervention is critical for leukemia and most lung cancers. And the UK does a much worse job at treating those than almost all other developed countries, and particularly the US.
So yes, some portion of the difference can be attributed to differences in screening practices, but screening practices are a relevant aspect of the entire system, and screening practices alone can't explain the UK's abysmal record for treating the more aggressive cancers which they do detect.
Last sentence in your post: would I be right in assuming that the incidence (e.g. cases per 100000 men) of prostrate cancer should be lower in UK than USA because more men in UK die with un-diagnosed prostrate cancer?
I'm unfamiliar with how the US stats get collected - is that 90% of "everyone who had prostate cancer" survives 5+ years; or is that "everyone who had prostate cancer and private medical insurance"? If so then that is rather shocking.
Prostate cancer may be something of an outlier given the hesitation people have in discussing it. This is something that has only really recently been attempted to be addressed in the UK. Campaigns fronted by comics like Bill Bailey have tried to make it normal to talk about. The British as a society are still so reserved that I imagine thousands die of preventable cancers and diseases simply out of embarrassment.
Edit - I've just had a look at Cancer Research's figures[1], [2] and, using data from 2010/11 - prostate cancer had a UK survival rate of ~84% or so - i.e. nearly the same as the US.
> I'm unfamiliar with how the US stats get collected - is that 90% of "everyone who had prostate cancer" survives 5+ years; or is that "everyone who had prostate cancer and private medical insurance"? If so then that is rather shocking.
It's looking at people with prostate cancer, regardless of insurance status.
> Prostate cancer may be something of an outlier given the hesitation people have in discussing it.
It's not limited to prostate cancer; for survival rates, the NHS does pretty terribly on almost every form of cancer compared to the US. I picked prostate cancer because it's something that's very treatable - the upper limit is close to 100% for five-year survival, which makes the UK's outcomes that much more unacceptable. But the story is the same for all other common cancers (let alone rare cancers, which the NHS is not optimized as a system to treat).
> I'm unfamiliar with how the US stats get collected - is that 90% of "everyone who had prostate cancer" survives 5+ years; or is that "everyone who had prostate cancer and private medical insurance"?
It's survival rate from point of diagnosis. Obviously, insurance and access will affect whether and when diagnosis occurs, but the effects aren't as simple as just limiting the scope to the insured or not.
> And yet the UK life expectancy is 81.2 vs 79.3 in the US.
I don't understand the point you're trying to make. [Treatable] cancer isn't the leading cause of death in any country[0], so no matter how good (or bad) a country is at treating cancer, you wouldn't expect that to be visible in the overall life expectancy rates.
[0] Ordinally, cancer is #2, but that includes untreatable cancers, and the tail is very long, so getting better at improving five-year survival rates for cancers won't budge your life expectancy at all, outside of the margin-of-error.
Do you have a better source for this data than, well, a bunch of numbers you posted to HN? In particular, an explanation by a researcher or other expert who has actually studied the difference and can explain it?
It's very easy to draw conclusions from statistics. It's much harder to draw correct conclusions from them.
> 2/3 of prostate cancer occurs in men over 65. That's the results of being on Medicare, the largest single payer health care system in the world.
First: no, the England branch of the NHS is still larger than Original Medicare (~53 million in England compared to 46 million on Original Medicare).
And that might be a reasonable way to interpret the data, except that two-fifths of Medicare patients (and growing) are not on Original Medicare - they use Medicare Advantage, which is privately run. Coincidentally, Medicare Advantage outperforms Original Medicare on medical outcomes across the board, including cancer treatment.
So no, the fact that the US is drastically better at keeping prostate cancer patients alive cannot be explained by the claim that Original Medicare is so phenomenally better that it accounts for the difference.
I agree with everything you say, except the part about cancer.
Even by European standards, the NHS is actually quite terrible at dealing with cancers - even "routine" cancers (like breast cancer and prostate cancer), let alone rare cancers. The five-year survival rate for prostate cancer in the UK is 55%, whereas in the US it's upwards of 90%. (Prostate cancer is an incredibly treatable form of cancer; for most people, as long as it's detected early and managed appropriately, they will die with prostate cancer as opposed to from it).
Of developed countries, only Japan, Portugal, and Denmark have worse five-year survival rates for prostate cancer.