Talk:Canadian and American health care systems compared/Archive 2

From Wikipedia, the free encyclopedia

Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Contents

OR

  1. . Too few citations.
  2. . More important and unavoidable for pages like these (they perhaps shouldn't exist in the first place, as comparison pages are almost always OR): "Synthesis of published material serving to advance a position" Sijo Ripa 09:19, 24 July 2006 (UTC)

I completely agree on both points. -AED 09:55, 24 July 2006 (UTC)

It might make sense to take this to Wikipedia:Articles for deletion. We shouldn't have an article with an essay-like title. Jkelly 03:48, 26 August 2006 (UTC)
Similar "comparison" articles have survived AfD in the past, so it's likely that this one would, too. I think OR can be minimized if content is made to conform to WP:V. Strict enforcement of this policy, however, seems to meet with resistance. -AED 19:01, 26 August 2006 (UTC)

Bad Statistics

"the overall performance for health care is much better in Canada than the US; Canada ranks 7th in overall performance, while the USA ranks 70th, worse than China, and comparable to Iraq."

from the source provided http://www.who.int/whr/2000/en/annex10_en.pdf I see 37th and 30th respectfully... whereas china is 144 and Iraq is 103.

Can someone show me where is says 7th and 70th??

John 66.57.10.155 06:18, 14 September 2006 (UTC)

Politics of health (privatization)

This section is poor. The assertion that there are private emergency departments in Quebec is totally unfounded. Overall, the article implies that there is more private (that is, market-based) medical care in Canada than there really is. Readers are not informed that many operations deemed "private" are in fact physician practices that operate independently of formal systems, but which nonetheless bill all their services to the government (I added this clarfication to the opening section).

This article is useful conceptually in that addresses a flashpoint of comparison between the two countries and provides some good basic information. As far as POV is concerned, it is really more ill-informed on the economic aspects of health care than it is an apology for the Canadian system, as some here have argued.

Some of the issues discussed at the end do not really pertain to the comparative topic. A separate article on Canadian health care economics would be more desirable for covering those controversies.

Hwhitbread 04:22, 22 November 2006 (UTC)


From CBC [www.cbc.ca/health/story/2006/11/24/private-emergency.html] There is a private medical centre operating in Montreal that provides services for minor emergencies, but Godley said his centre will offer full emergency medical, diagnostic and surgical procedures. So, obviously, hwitbread's complaint is only partially correct. the article is about B.C.'s private emergency room. Also, see earlier CBC articles about the mandatory renting out of hospitals to private health firms during off hours. I agree that the article is biased, but it seems more that there are free-marketeers in canada writing about how much better the american system is, and socialised health care proponents in the states writing about how much better canada's is. --Chalyres 06:33, 20 December 2006 (UTC)

So not neutral

I completey dispute the fact that this article is neutral. While I was reading this I completely felt the biasis. My problem was with this:

"Drug abuse and violence are all more common in the United States than in Canada[citation needed], and all place a burden on the health care system... Recent history has meant that the United States has far more veterans and war wounded, also somewhat increasing cost. Accounting practices also differ and in Canada fewer capital investments are included in health care costs[citation needed]. Another important caveat is that research and development spending in Canada is lower, but Canada still benefits from the research done in the United States[citation needed]. This leads some scholars, such as David Gratzer, to argue the actual cost difference, while still real, is much smaller than the straight GDP numbers would indicate.[citation needed]"

What is up with that? C'mon, no citations?

CHANGE THE ARTICLE FELLOW WIKIS!

Although, I did like the comparison thing, I've always been a sucker for a good American/Canadian perpspective. 66.183.154.180 23:39, 2 December 2006 (UTC)


The bias in this article is troubling. I tend to believe it is an inadvertent bias that generates from the authors of the various studies cited and that the author of this article related to it easily, yet innocently and unintentional, as a matter of custom from their upbringing.

I believe it would be must enlightening and advantageous to the author if percentages were not used to quantify value relating to the GDP of the two countries and that instead a statement of the GDP of each country is made at the beginning (with cited authority), then when amounts spent are referenced these are instead stated in their calculated U.S. dollar currency equivalent.

On one hand this could easily show that, for the generally statistic model of health care provided (those procedurally "routine" ails) the Canadian Health Care System provides exceptional care, yet on the other hand the U.S. capitalism/free market health care system, as being compared here, it's customers spending quite a bit more in actual dollars, would be given the opportunity for reasonable and accurate elaboration.

For instance, the investment of U.S. pharmaceutical companies in R&D from their current profits to develop future products for future profits (the free market incentive system) which has been the same incentive to derive the drugs and diagnostic equipment, i.e. MRI, CT, angioplast, etc., and how this has decreased mortality rates all over the world via those nations who buy the drugs and/or equipment.

The point being that this article fails miserably to show how the U.S. capitalism and free market health care system, and businesses funded thereby, make a contribution through the free market system to the entire world and every health care system willing to buy the drugs and equipment to meet their citizen's needs, drugs and equipment these nations haven't and cannot afford to develop, that their government is unwilling or unable to afford the development of.

Understand that knowing you are a dual citizen (if I accurately understand what you stated under "Cost of Care Cleanup") creates a form of (unintentional innocent cultural) bias which is natrually reflected in your article failing to set forth the aid that the free market economy, capitalism, has provided and the results therefrom: a net positive effect on all health systems because these U.S. companies will sell the result of their R&D and re-investment of profits to the rest of the world whose publically funded health care systems cannot afford to make such investment.

I bring this forth to you in the interest of balance if this article is aimed at informing people versus merely citing study after study with whatever happens to appear related to the study, especially those items that highlight the higher cost/return ration in percentages and does not take into account the investment of those dollars, as a historical reality that developed the current technologies and thereafter for this same investment system as used today (for a profit) being the investment in the drugs and technologies of the future, ones that other health care systems willing to afford them will be able to use.

This is a very important influence to these studies as without the profit driven (free market) pharmaceutical companies, for instance, Canada (as well as any other nation than the United States) would not have many sources to be negotiating buying pharmaceuticals from in bulk, or diagnostic equipment, or patented procedures determined by studies funded by these pharmaceutical companies via grants to the private and public U.S. colleges and universities as well as their own studies.

Cheers, and I hope you take this suggestion seriously as otherwise it would then appear this article was not intended to be informative but instead as intentionally biased political propaganda and inappropriate to be posted on wikipedia.

24.117.206.70 18:37, 14 August 2007 (UTC)

Anonymous user, are you aware that Siemens (Germany) and Hitachi (Japan) are major designers and manufacturers of MRIs and CTs? Nbauman 23:30, 14 August 2007 (UTC)
Have you read the article fully? The U.S. is not lucky enough to have a free market health care system. Direct government control of the market approaches 45% and indirect restrictions certainly makes the American system more socialist than free. The free portion of that market just happens to be more productive. JoeCarson 13:41, 15 August 2007 (UTC)

Cost of care cleanup

Made a few small changes. Edited the paragraph about the theory explaining the differences in cost between canada and the states. the source argues against socialised health care, that should be mentioned.
also added "police-reported" to the line about the differences in crime. the only statistics available are police-reported, and both the fbi and the Juristat (which compiles data within canada) clearly make this distinction. Both the FBI and Juristat would be a potential citation for that sentence, though i have not seen one source which clearly compares the two. the differences in 2003 were 2.1 percent murders in canada to 5.4 in the states. while that confirms the assertion, unless someone can find sources more recent (i'm not buying the Juristat report--in canada, information can cost quite a bit of money). There are SO many uncited statements in this article that i'd argue it should be re-written from the ground up. And before anyone accuses me of being the national of one country believing the other is better, i'd point out that i currently live in one and maintain citizenship in the other and do not, for a second, believe that either side has even a slightly better health care system than the other. I'm hoping never to get sick in either country. --Chalyres 05:44, 20 December 2006 (UTC)

Good Job!

You know, this is a pretty damn controversial topic, the sort of topic that is supposed to demonstrate wikipedia at its worst. And yet, I was pleasantly surprised to see the general overall quality of the article. Yeah, there are some POV soft-spots and it definitely needs to be made more encylopaedic, but it's advancing nicely.. Keep up the good work! Cacofonie 01:39, 1 February 2007 (UTC)

American system underperforms other nations

I had to reword this statement because the references didn't say that at all. Out of the three references, one of them was a dead link, and the other was some random news article that didn't state that the American system underperforms all, most, or even some nations with universal coverage, only that Canada's performs favorably. It actually states specifically that the American system outperforms others in specific categories while the Canadian system outperforms in others.

The only credible source -- and in my opinion the bias of the source and the study is questionable -- is from the Commonwealth fund. The cited study's methodology is based on surveys given to doctors and adults who indicated their health as fair or poor in 6 different nations. Now, I don't know about anyone else, but from my perspective this is a very questionable source to be adding to an encylopedic reference. Surveys are always opinion based. You can't compare what an arbitrary, or even two thousand arbitrary New Zealend doctors say about coverage in New Zealand vs. two thousand arbitrary doctors in another country and chalk these anecdotes up to encyclopedic fact about the quality of healthcare in a nation.

I reworded the statement to indicate that some studies suggest that the US system underperforms the Canadian system. I'm sure we can dig up some references that say the opposite to add balance to this article.

Emach 17:51, 25 June 2007 (UTC)

How about the World Health Organization? Their study from 2000 also rates Canada's system as outperforming the U.S. I've added that as a reference. -- Sfmammamia 21:05, 25 June 2007 (UTC)
The Commonwealth Fund publishes its results in peer-reviewed journals like Health Affairs. [1] Can we all agree that a publication in a major peer-reviewed journal is a reliable source? Nbauman

Should we expand this article?

The article would be more encyclopedic if it compared many different health care systems, not just North America.JoeCarson 15:28, 6 July 2007 (UTC)

I am also thinking about including info about health disparities as they relate to different racial and ethnic groups. There have been ample studies in the US, but I'm not sure about Canada.JoeCarson 15:30, 6 July 2007 (UTC)

I like the focus of this article on the most local comparison with the U.S., but I don't have a strong opinion about expanding the article. I just wanted to note that there's already a somewhat U.S.-focused article on Health disparities among racial and ethnic groups. Linking it here would make sense, but only it can be done with a sourced comparison to Canadian similarities or differences. -- Sfmammamia 16:42, 6 July 2007 (UTC)

NPOV tag

This is a one-sided piece. There are plenty of critics of the Canadian system, and whole books (e.g., Sally Pipes) favorably comparing American healthcare to Canadian healthcare, and plenty of studies that do the same (e.g., [2]), but they can't be found in this article. Nor is there anything about the fact that Americans subsidize Canadian healthcare prices through pharmaceutical research and price discrimination--the word "pharmaceutical" is entirely absent from the article, and American pharmaceutical availability is far superior, because Canada won't purchase the newest drugs. THF 04:39, 8 July 2007 (UTC)


This article does have criticism of the Canadian health care system, in the sections on "Drugs" and "Technology." The problem is that the editors couldn't find evidence to support those criticisms. If you can find evidence, feel free to add it.
I do think we should clearly distinguish between claims made in peer-reviewed medical journals and claims that have never been peer-reviewed. Sally Pipes doesn't seem to have published anything in a peer-reviewed medical journal, as far as I could tell from PubMed.
It's not a fact that Americans subsidize Canadians with pharmaceutical research -- Canadian investigators publish articles in every major medical journal and they're particularly strong in evidence-based medicine. A group in Vancouver just published that study on SSRIs and birth defects that you may have seen in the news last week.
The article doesn't use the word "pharmaceutical", but it does use the word "drug", and it does mention some of the complaints about Canadians not getting new drugs as quickly as Americans.
Some people claim that it's an advantage to get new drugs faster, but many doctors disagree. After all, Vioxx didn't save any lives.
It did seem to make a difference in heart attacks, though. You do have a point with the WebMD article. Cardiology is a major peer-reviewed publication, and Kaul does seem to have a point that survival after heart attacks was better in the U.S., because of aggressive revascularization, than in Canada in the early 1990s. The 2004 article in Health Affairs also said that Canada had lower survival after heart attacks than Australia and New Zealand, although they didn't have comparative data for the U.S. Nbauman 06:12, 8 July 2007 (UTC)
Neither WP:NPOV nor WP:RS requires "peer review", but there are plenty of peer-reviewed studies favoring the US that are not included. And, again, if this article wasn't so one-sided, there wouldn't be any trouble finding them. I leave it to others to do. THF 11:26, 8 July 2007 (UTC)
The WikiProject_Medicine/Reliable_sources#Cite_peer-reviewed_scientific_publications_and_check_community_consensus WikiProject Medicine requires peer-reviewed sources, but I won't hold you to that.
In my reading of the peer-reviewed literature, this article follows the peer-reviwed studies, which are summarized by the Open Medicine article.
Every scientist loves to read peer-reviewed studies on both sides of a controversy, but I haven't seen many (except for that one in Cardiology) that disagree with the Open Medicine article. If you believe that this study is one-sided, and there are peer-reviewed studies on the other side that I've looked for and haven't found, then I welcome having you show me what they are. Nbauman 21:32, 8 July 2007 (UTC)
Many of these issues are economic issues and public policy issues, not medicine issues, and medical journals, even the peer-reviewed ones, handle economic issues poorly. THF 22:03, 8 July 2007 (UTC)
There are peer-reviewed journals like Health Affairs. I read the New England Journal of Medicine, BMJ and sometimes JAMA, and they regularly invite policy experts, like Bill Frist, to submit articles and editorials. If you can find other sources as reliable as peer-reviewed journals, I'll be glad to read it. But if somebody makes claims without supporting data, I don't think fair-minded people are going to believe it. Nbauman 22:26, 8 July 2007 (UTC)
If you want to support the npov tag you have to provide reliable sources.--BMF81 22:32, 8 July 2007 (UTC)
First, there are many sources cited in this article that are not peer-reviewed, so there's a separate POV problem that one RS standard is established for criticisms of Canada while a softer standard is established for paeans. Second, I've provided multiple reliable sources that meet Wikipedia criteria (one which cites many more), and more are readily available if one doesn't POV-push. There are many many economists and public policy officials who find fault with the Canadian system, yet somehow the article doesn't identify any of them. There are many many economists and public policy officials who explain the issues involved in relative pharmaceutical pricing in Canada and the US, from Calfee to Danzon to Pitts on down, and none of them are cited. That you claim that you haven't seen any of them indicates an echo-chamber problem. The Fraser Institute is cited once in the introduction, but not once are any of its substantive critiques addressed. The POV tag remains because the article doesn't even attempt to include all significant points of view. THF 22:52, 8 July 2007 (UTC)
I believe the RS standard of peer-reviewed articles should be applied to both criticism and praise of Canada. I haven't added anything that wasn't peer-reviewed. If it's necessary to use less reliable sources to find critics, I'm willing to do that, for the article to include critics.
Under Wikipedia rules, if you think the article is missing something, you're supposed to go ahead and add it. Nbauman 03:39, 9 July 2007 (UTC)
While Wikipedia rules encourage people to do the fixing themselves, and it would certainly be better for the project if I had the time to do the extensive rewrite this article requires, it's hardly a rule requiring a critic to do so. See, e.g., the discussion at Talk:Competition_law#Criticising_vs._contributing. I tag to identify the problem, and hope others fix. THF 04:26, 9 July 2007 (UTC)
Would you be willing to compile a list of references for us to check out?JoeCarson 12:42, 9 July 2007 (UTC)
  • There is extensive discussion of problems with Canadian healthcare in the Chaoulli v. Quebec decision.[3]
  • Similarly, CMAJ reports that Quebec breast cancer patients have had to sue over potentially fatal wait-times for cardiology.[4]
  • The Kaul study in Cardiology
  • Dale Rublee, "Medical Technology in Canada, Germany, and the United States," Health Affairs, Fall 1989
  • A Seismic Shift: How Canada’s Supreme Court Sparked a Patients’ Rights Revolution
  • Michael Walker, "From Canada: A Different Viewpoint, Health Management Quarterly, Spring 1989
  • Michael Walker, "Cold Reality: How They Don't Do It in Canada," Reason, March 1992
  • Ed Haislmaier, Problems in Paradise: Canadians Complain about Their Health Care System (Washington: Heritage Foundation, February 19, 1992).
  • United States vs. Canadian Health Care: An Information Package (Washington: National Committee for Quality Health Care, March 1990).
  • "Canadians Cross Border to Save Lives," Wall Street Journal, December 12, 1990.
  • John Lancaster, “Surgeries, Side Trips for ‘Medical Tourists’; Affordable Care at India’s Private Hospitals Draws Growing Number of Foreigners,” Washington Post, October 21, 2004, p. A1 (Canadians forced to travel to India to get healthcare).
  • Nadeem Esmail and Michael A. Walker, “Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition,” Critical Issues Bulletin (Fraser Institute), October 2005.
  • Clyde Farnsworth, "Now Patients Are Paying amid Canadian Cutbacks," New York Times, March 7, 1993.
  • The Top Ten Things People Believe About Canadian Health Care, But Shouldn't
  • Buyer Beware: The Failure of Single-Payer Health Care\
  • Lives At Risk: Single-Payer National Health Insurance Around the World, by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick
  • The Fraser Institute, Sally Pipes, Jack Calfee, David Frum, and the Atlantic Institute for Market Studies have repeatedly written on the subject, and cite numerous additional sources.

-- THF 15:17, 9 July 2007 (UTC)

OK, that's something to work with. I want to pull out the best evidence from that list. I wish those articles from Health Affairs (1989) and CMAJ (which refers to cases in 1989) were recent. The Chaoulli case is important, but it also goes back to the state of health care in 1990.
Everybody agrees that the Canadian health care system had wait times, possibly resulting in deaths of patients, in the past. We can say that.
The Canadian health managers claim that they've reduced the waiting times substantially since Chaoulli. I'd like to see the best evidence for and against that claim.
The CAMJ, under its editor John Hoey, was ranked one of the top 5 medical journals in the world, and it's open access. I recommend you search there if you're looking for evidence. I'd consider anything from the CAMJ to be reliable (and it's certain to be better-written and more understandable than anything from Heritage or Fraser).
I'm going to add a section to the article about waiting lists in Canada. You may not like it, but this is just a quick draft and you're free to come up with your own arguments. I think waiting lists are an important issue and I think it's important to present the strongest arguments on both sides.
I also think there's good evidence to support the argument that lower expenditures on technology resulted in worse outcomes for myocardial infarction, and I'll try to add that. Nbauman 18:11, 9 July 2007 (UTC)
You seem to be implying that by your rejection of the Heritage and Fraser POVs there is a standard other than WP:V and WP:RS to be applied in judging whether an article meets the WP:NPOV requirement of fairly representing all notable points of view. I'd like to see the rationale for that. THF 18:18, 9 July 2007 (UTC)
I agree that Heritage and Fraser are notable points of view that belong in the article. I just don't believe that they're reliable. I'm willing to include unreliable POVs, even when they're wrong, as long as I can add accurate information along with them. I'd say the same about Michael Moore.
If you show me an article from Circulation that says Canadian outcomes are worse than U.S. in heart attacks, I would assume that it's accurate (although it reflects the situation in 1990-93, not today).
The most accurate information I know of is peer-reviewed medical journals. For Heritage, Fraser and Michael Moore, their work is reviewed by like-minded believers in their ideology. At the CMAJ, NEJM, JAMA, and other journals, their articles are reviewed by people who both agree and disagree with the views of the author, and they challenge the authors on facts and unsupported arguments. They insist that the author make the best arguments for and against his position. Which do you think will be more accurate? Nbauman 20:03, 9 July 2007 (UTC)
Again, WP:NPOV rejects the sort of value judgments you're making. I think a lot of medical journals are inaccurate, even when peer-reviewed, but I don't get to delete them, even if I can present stone tablets carved by God refuting them: the standard is verifiability, not accuracy, and that way we avoid a lot of arguments and permit collaborative editing even when editors disagree on the underlying facts. Because these are not extraordinary claims, there's one threshold for WP:V, which is WP:RS, and Fraser and Heritage pass that threshold. THF 20:11, 9 July 2007 (UTC)
WP:RS says, "Reliable sources are authors or publications regarded as trustworthy or authoritative in relation to the subject at hand. Reliable publications are those with an established structure for fact-checking and editorial oversight." The Heritage and Fraser reports I've read didn't pass that threshold. But I'm not going to press the issue. I think we have to include all significant positions, even the ones that are wrong. And I haven't yet read their studies which are linked in this article, so I'll withhold judgment until I do. Nbauman 22:13, 9 July 2007 (UTC)
I just read the Fraser Institute report by Esmail. It has some problems. They openly state that this is an advocacy piece to show the benefits of free markets, and it's obvious.
They also divide the mortality by the incidence of cancer, which as I explained above is meaningless. I've never seen that in a medical publication, and I don't think any medical journal would let them do that. Neither of the 2 authors are doctors. The Fraser Institute board is composed of economists.
They give a lot of statistics on waiting times, depending heavily on a study by Blendon in JAMA, which I know and consider reliable. However, they don't discuss actual medical outcomes. For example, they discuss patient satisfaction. But they don't give survival rates for any of these diseases. What difference does it make how long you have to wait longer to see a specialist -- if you have a better chance of surviving despite that wait?
They also cherry-pick the data by comparing Canada to the U.S. when the comparison favors the free-market system, i.e. waiting times, and dropping the U.S. when the comparison goes against the free-market system, i.e. infant mortality, life expectancy, quality adjusted years of life. Most of the report doesn't deal with the facts -- they just give their opinions on the benefits of the free market.
The US has a free market system? Zuh? You do know what you're talking about right?--Rotten 18:48, 10 July 2007 (UTC)
They even argue that government support for the poor isn't necessary because the charitable sector can do that more efficiently.
Nonetheless I think this is a valid --thugh wrong -- point of view that could be included in the article. Nbauman 23:10, 9 July 2007 (UTC)
This is the talk page for discussing improvements to the Canadian and American health care systems compared article. This is not a forum for general discussion about the article's subject. Your opinion about the Esmail report is irrelevant. (Don't take it personally: my opinion about the Esmail report--that I trust economists more than doctors on this economic issue--is also irrelevant, unless I publish something about it in a reliable source.) THF 23:19, 9 July 2007 (UTC)
I'm discussing here the merits of the Fraser report, not the merits of Canadian health care. You were complaining above that the substantive issues in the Fraser report were not discussed in the article. I'm explaining to you why I don't think the issues in the Fraser report were substantive, and why the last person who dealt with it couldn't find anything substantive either. I believe there are problems with the Canadian health care system. This Fraser report doesn't tell us what they are. If you can find a substantive issue in this Fraser report, I wish you would tell me what it is, so we can include it in the article. Nbauman 00:29, 10 July 2007 (UTC)

"Free market" health care system

Personally, I object to the premise that the US has a "free market" health care system. I'd rather strip that notion out of this article.--Rotten 19:40, 10 July 2007 (UTC)

I don't see where the article itself says that. If you see a section where that is implied or stated, please go ahead and edit it. -- Sfmammamia 21:11, 10 July 2007 (UTC)
I think he means the section on Canadian_and_American_health_care_systems_compared#Medical_professionals
It's one of the more confusing sections. If there's a theme in there, I can't find it. It's repetitive, and keeps rambling through several unconnected ideas. Worst of all, it has essentially no sources. For that reason alone, I think we could delete the entire section (especially since the article is getting pretty big). If somebody wants to write a section on medical professionals, CMAJ should have all the information you need. Nbauman 22:42, 10 July 2007 (UTC)
I've made a few edits, removing the "free market" reference. It appears that OECD health data is the source of income statistics as well as the per-capita figures, which I updated. The latest update is coming out July 18. If someone has access to the full data set and can check/update these stats, it would be helpful. I agree that this section needs additional sources, but I think it would be better to improve the section rather than deleting it altogether. -- Sfmammamia 01:54, 11 July 2007 (UTC)
I haven't looked closely at this question with respect to this article, but all these references to primary sources makes me wonder if we have a WP:SYN//WP:NOR problem. THF 03:19, 11 July 2007 (UTC)

Zywicki cite

WP:V states Self-published material may, in some circumstances, be acceptable when produced by an established expert on the topic of the article whose work in the relevant field has previously been published by reliable third-party publications. Todd Zywicki is one of the three most prominent bankruptcy law scholars in the United States, and his blog entry (on a notable blog, no less) qualifies. I'm restoring the cite. THF 02:33, 11 July 2007 (UTC)

Thanks for the explanation, and sorry for the extra effort to restore it. Given the scrutiny and debate over appropriate sources for this article, it's good to document such decisions here for other editors to see. -- Sfmammamia 03:14, 11 July 2007 (UTC)
Where has Zywicki's work on the subject of bankruptcies caused by medical expenses been previously published by reliable third-party publications? Nbauman
Here, and in his congressional testimony as well. THF 06:08, 11 July 2007 (UTC)

"Web sites now give Ontario waiting times"

Web sites give waiting times for all the provinces. Why single out the province with the best waiting times, rather than the ones where people still have to wait two years for hip surgery? THF 21:01, 11 July 2007 (UTC)

The letter was written by the head of the Toronto University Health Network, so he gave the Toronto web site. If you have the links to other web sites with different waiting times, what are they? Do you have any evidence that people now are waiting 2 years for hip surgery, as opposed to 2003? Nbauman 02:34, 12 July 2007 (UTC)
Google name of the province plus "waiting times." Easy enough to find all of them, such as this Nova Scotia one indicating that over a third of patients in some regions are waiting over a year for hip replacements as of March 2007 (and that several still hadn't had surgery after waiting 540 days), and that a significant number of patients are waiting over three months for breast biopsies. And I picked that one at random. THF 03:59, 12 July 2007 (UTC)

Fact after the chart on cancer mortality

However, incidence rates for all cancers tend to be higher in the U.S., although this is not true of all cancers. Incidence rates for certain types, such as colorectal and stomach cancer, are actually higher in Canada than in the U.S.[60]

There is no need for this fact. The graph says this fact already. User:Renny11

We cannot make statements that draw conclusions only from the data in the table, because that would violate WP:OR. There has been lengthy discussion about even including the table. I have made an attempt at reorganizing the entire cancer section so that the several studies that have been added over the last few weeks flow together a little better, including the one that was lingering below the table. -- Sfmammamia 15:18, 18 July 2007 (UTC)
I always meant to ask what that statement meant. When it says, "incidence rates for all cancers tend to be higher in the U.S., although this is not true of all cancers," I think it means, "incidence rates for some cancers are higher in the U.S., and incidence rates for other cancers are higher in Canada." I would change it to read that way.
As a professional tip, when you try to rewrite a statement based on a medical article, it's much easier to go back to the original source and see what the facts actually were, than to try to figure out what the writer before you was trying to say. Nbauman 18:18, 18 July 2007 (UTC)
A "professional tip"? Are you a professional Wikipedia editor?--Rotten 21:06, 18 July 2007 (UTC)
Professional medical editor. Nbauman 23:28, 18 July 2007 (UTC)
Agreed, and summary statement modified, though not exactly as suggested. -- Sfmammamia 19:14, 18 July 2007 (UTC)
JoeCarson, I don't want to get into an edit war. do you understand what statistical signficance is? Nbauman 17:13, 19 July 2007 (UTC)
Then make good edits and there will be no need to fix them. And don't patronize me. Do you know the integral of ln(x)? JoeCarson 21:19, 19 July 2007 (UTC)
Let's do a thought experiment. We want to determine the average mass of 10 year olds in our neighborhoods. Method A: I weigh them all on my nifty Tanita scale set to kg. I average the masses. Method B: You construct a gigantic balance and buy standardized weights. You place all the 10 year olds in your neighborhood on one side and add weights to the other until you reach parity. You divide by the total number of 10 year olds in your neighborhood.
Our methods are not guaranteed to give comparable results, but it is illogical to reject the possibility that they do.JoeCarson 21:36, 19 July 2007 (UTC)
JoeCarson, let's take an example from the quantum physicists. If you throw a bunch of watch parts in a box, shake the box, and turn it over, it's illogical to reject the possibility that a complete watch will fall out.
But the possibility of those cancer data being compatible by chance is like the chances of a complete watch falling out.
People have been collecting cancer statistics in a serious way for about 50 years. They've made lots of mistakes along the way, and they've figured out how to avoid making those mistakes. They've done a lot of things that seemed logical but turned out to be wrong. There are standard conventions for reporting and describing cancer statistics, and if you don't use those conventions, you're going to get the facts wrong and mislead people.
If you suggest that they may, by chance, be comparable, you're deceiving people.
It may seem logical to you, but it's not. In science you take logic and you check it against facts. The experience of medicine is that when people use the logic you're using here, they turn out to be wrong.
If you're doing a study where peoples' lives depend on an accurate measurement of hemoglobin, and you have 2 labs measuring hemoglobin, and they don't callibrate their machines the same way, and they use different machines, you have to say that the results are incompatible. You can't say that the results might by chance turn out to be the same. No medical journal in the world would let you do that.
Every medical journal in the world would print statistics like that with a disclaimer saying that they're not compatible.
You haven't even read the complete Canadian report in your own footnote, because they explain this. They give the example of prostate cancer, where the more people you test the more prostate cancer your report, and where there are incompatibilities from state to state in the U.S. Your own sources explain why those statements are wrong.
And in any case, it's WP:OR and [[WP:SYN] to collect data and draw conclusions from those data. Nbauman 22:28, 19 July 2007 (UTC)



According to QM, there is a non-zero probability that you will have tunneled into your neighbors bedroom in the next five minutes. But the possibility of those cancer data being incompatible is like the chances of you getting into your neighbors bedroom by any method that cannot be described by classical physics. I do not doubt that they have error associated with them, but it is illogical to state they are so different as to be completely incompatible without data to back it up.


Replace tunneling into your neighbors with the decay of your favorite radioactive substance of long half-life if you're nitpicky.
We should certainly be more cautious with the language but the section does not currently present any conclusions not found in the refs. JoeCarson 22:58, 19 July 2007 (UTC)
I deal with statistics like this all day. You're speaking nonsense. I'll have to get someome from the Wikipedia Medicine project to review this. Nbauman 00:59, 20 July 2007 (UTC)


You've made that claim before. It certainly doesn't show. If you don't like the data, bury your head in the sand. But it behooves the editors to present the data. JoeCarson 10:16, 20 July 2007 (UTC)

Length of cancer section

I did a quick word count of the overall article and the cancer section. Rough word count for overall article (not including references): 5,800. Rough word count for cancer section: 725 words. My opinion is that the section is getting rather long, plenty for one topic in this comparison, and my suggestion is that we look for ways to trim, or at very least, stop adding here. Other thoughts? -- Sfmammamia 18:56, 20 July 2007 (UTC)

I don't think we can do anything with it because we have a disagreement over what is valid text and what isn't. To put it as impartially as possible, JoeCarson is writing conclusions and/or interpretations (or whatever term you prefer) that I believe are wrong, and I can't convince him otherwise. Any attempt to shorten it would get into a lot of disagreements about what should go and what should stay. Nbauman 19:22, 20 July 2007 (UTC)
What conclusions? The conclusions of the authors of the papers I cite? JoeCarson 10:22, 21 July 2007 (UTC)
By the way, thanks for coming over to the light side. Me holding you to a higher standard got you to add some real value to this section.JoeCarson


I suggest we remove the Honolulu/Toronto paragraph. It does not add anything that isn't covered by the rest of this section and neither city is representative of the demographics of the nation it is in. Let me know if you feel strongly about keeping this in. Also, I plan to remove the prostate cancer data in the table because of screening differences elaborated upon earlier in the section. Any constructive suggestions are appreciated. JoeCarson 16:40, 21 July 2007 (UTC)

Agreed. Honolulu/Toronto paragraph removed. -- Sfmammamia 20:43, 22 July 2007 (UTC)
Actually, the Honolulu/Toronto paper gives unusually strong evidence that the poor get better treatment in Canada than the U.S., if I remember correctly. I think that's an important point to make, although I don't know if this is the section for it. It's significant because lots of people claimed that Hawaii had the best access to health care for the poor in the U.S. Even the best state in the U.S. can't provide care for the poor. Nbauman 04:19, 24 July 2007 (UTC)
Nbauman, please look over the section as it stands now. As I read it, it still references two comparison studies that came to similar conclusions, although one comes right out and cites socio-economic disparities in U.S. survival rates, and another alludes to disparities in the U.S. by race. I think the point is supported by those two broader studies. It seems to me the more local study is just more of the the same. -- Sfmammamia 06:25, 24 July 2007 (UTC)

Hsing article

JoeCarson, is the article Hsing A. W., Tsao L., Devesa S. S., International trends and patterns of prostate cancer incidence and mortality, Int. J. Cancer, 85, 60-67, (2000) available on the Internet? Do you have a copy of it? Nbauman 19:22, 20 July 2007 (UTC)

http://dceg.cancer.gov/pdfs/hsing852000.pdf -- Avi 22:09, 20 July 2007 (UTC)


The Mackillop paper is worth a read too. They talk about the problems with prostate cancer comparisons as well. I plan to add more info about their sans prostate comparison soon for better flow with the Hsing paragraph. JoeCarson 10:25, 21 July 2007 (UTC)

Why does this article exist?

If a person wants to compare the health care systems of America and Canada, they can do it by reading the American and Canadian health care systems' respective articles. This page is more like an essay than an article; it has no business in an encyclopedia. It's like having an article comparing the PS3, Wii, and Xbox 360. We don't need an article explaining why the US sucks and why Canada is the greatest thing since sliced Norway. Dylan Bragers 00:27, 22 July 2007 (UTC)

Because it's a POV fork and a way for certain editors to push a political POV. Oops, did I just say that? I meant it's a great article and we should STRONG KEEP or something. I guess it's here as a reminder of why nobody should ever take Wikipedia seriously as an encyclopedia. --Rotten 03:15, 22 July 2007 (UTC)
You might find instructive the discussion conducted during an AfD vote on this article in August 2005. It is archived here. See especially SimonP's comments regarding other such articles here on Wikipedia. -- Sfmammamia 03:50, 22 July 2007 (UTC)
It is absolutely not true that you can take the American and Canadian health care articles and compare them. For all the reasons we've been discussing, you can't simply take the number of days survival for breast cancer in Canada and compare them to the number of days survival for breast cancer in the U.S. -- even though politically-motivated people like David Gratzer have tried to do that.
There have been many articles in medical journals, which we have cited, comparing the two health care systems. They published them because there was an important reason to do so. Nbauman 23:24, 23 July 2007 (UTC)
Pretty much everything has already been said here, but you might also be interested to learn that the encyclopedia does have a fairly exhaustive comparison of the PS3, Wii, and Xbox 360. - SimonP 02:05, 24 July 2007 (UTC)
That doesn't invalidate his question.--Rotten 02:21, 24 July 2007 (UTC)
The answer is that it's very important in medicine to compare different health care systems. Doctors always compare different systems -- they compare states in the U.S., regions in Sweden, rural vs. urban areas, high-income vs. low-income areas, and they do all kinds of country comparisons. For example, there are many epidemiological studies of how cancer incidence compares between Asians in Asia, Asians who have emigrated to the U.S., and Asians who were born in the U.S., and these studies have produced valuable information about how diet affects cancer. I've been to medical conferences and I've seen many international studies, in which they try to figure out the reasons between the results they get in the U.K. vs. the U.S., the U.S. vs. Canada, etc. Most review articles on major diseases will mention the variations between countries, if it does vary. For example, multiple sclerosis is common in temperate climates but rare in tropical climates.
One of the major comparisons is Canada vs. U.S., because their medical practices have so few differences that comparisons can identify specific differences that affect results.
That's why it's important in medicine.
An encyclopedia should cover important topics of medicine. Therefore it belongs in Wikipedia.
Furthermore, it's important because of the interest in reforming U.S. health care, possibly to a single-payer plan on the model of Canada. People want the facts, and they come to Wikipedia to find out. This page has a high rank on Google (where you will also find many books and medical journal articles), so this is what internet users are choosing in the marketplace of ideas. If lots of people want to read this information in Wikipedia, we shouldn't take it away from them.
That's why it belongs in Wikipedia.
I think a lot of people object to having any discussion of single-payer health care, or comparisons of the Canadian and U.S. health care system, because they are politically opposed to government-funded health care, and don't want Wikipedia to contain anything to support it. That's not a good reason to exclude it. That's WP:CENSOR. Nbauman 04:09, 24 July 2007 (UTC)

Name of the article.

Wouldn't it be better if the name of this page was "Comparison of the Canadian and American health care systems" or something similar other than the current one? This one sounds a little awkward to me. - Fedayee 19:15, 22 July 2007 (UTC)

The current title follows a structure in keeping with other similar Wikipedia comparative articles. Examples: Canadian and Australian politics compared, Canadian and American politics compared, Canadian and American economies compared. For that reason, in my opinion the title should stay as is. -- Sfmammamia 20:30, 22 July 2007 (UTC)

Investment

Companies that sell medical devices, like General Electric, pay organizations like the Manhattan Institute and the Fraser Institute to write reports claiming that Canada has "underinvested" in technology, i.e., by not buying enough GE CT and MRI machines.

They have never proven that Canada needs any more CTs and MRIs, and in fact studies have shown that the health outcomes without them are just as good. (Sometimes they do more harm than good. There was a case history in the NEJM this week in which doctors using CAT scans missed a diagnosis until somebody took a plain film. There was a study published this week which found that women who had many CAT scans were getting doses of radiation high enough to cause more cancer.)

When you say that a CT scan is an "investment", you're pulling a word out of the GE sales literature. If a machine isn' useful or needed, it's not an investment.

"Investment" is POV -- the POV of equipment company salesmen. "Spending" is the neutral term.

You can't write in the article on your own authority that something is an "investment." That's an accounting term. You're not an accountant. That's WP:SYN. Under WP rules you need a reliable source that calls in an investment.

I challenge you to find a reliable source that uses the term "investment" for buying CT or MRI scans in Canada. The only people who use that term are the equipment vendors and the people they pay. Nbauman 02:21, 26 July 2007 (UTC)


You clearly do not understand the meaning of investment. A failed enterprise was still an investment. My purchase of a Ford Focus was an investment, a very bad investment in hindsight. Now I know and will never buy a Ford product again, but the car was still an investment. I do not care so much about using the word "investment" as I do about the quality of that sentence. Two "spending" sounds awkward. If you feel so strongly about that word, find an alternative that doesn't make the sentence sound awkward.JoeCarson 10:16, 26 July 2007 (UTC)
Just saw the new edit. That's fine. JoeCarson 10:18, 26 July 2007 (UTC)


Race/Ethnicity and misc.

I have just added a bit of info on ethnic/racial differences in health outcomes. I have copies of all the cited papers if anyone is interested. I also have a few others that I did not include. If anyone wants a particular journal article and doesn't have access to a university library, let me know soon. I'll be happy to send you a copy, but I go on vacation in a week and I doubt I will check wikipedia until I get back so let me know ASAP. JoeCarson 15:34, 27 July 2007 (UTC)

I don't quite understand that section. You say:
The U.S. and Canada differ substantially in their demographics, and these differences may contribute to differences in health outcomes between the two nations.
But all the sources we've compiled say that the differences in health outcomes are small. They're usually so small that they're not clinically significant, which was the conclusion of the Guyatt meta-analysis and Hussey in Health Affairs. The differences in outcomes between the U.S. and Canada in treatments with the best evidence, such as heart attacks, heart failure, breast cancer, and leukemia are much less than the difference from year to year as each country adopts newer treatments, like PCI and CABG for heart disease, and new chemotherapy for breast cancer. Any Canadian data for 2006 will show better outcomes than any U.S. data for 1996, and vice versa.
The only significant difference we've found is waiting times for specialists, costs, and access.
Are there supporters of the U.S. system who say, "Yes, the Canadians have better health outcomes, but that's because the U.S. has more poor people and minorities who are are worse off. It's not the fault of the health care system"? If that's what you're trying to say, get a quote from a reliable source and give the best evidence and significant viewpoints for and against it. Nbauman 01:18, 29 July 2007 (UTC)


Yes, health differences do seem small, but racial/ethnic differences do have an affect on macro figures like infant mortality (though whites in U.S. still worse than whites in Canada) and micro figures like specific cancers that are much more common in certain groups. The source for that sentence writes that different demographics can account for much of the infant mortality differences. I've said exactly what I was trying to and provided a source. If I expand that part of this section further, I will provide sources, but I do not anticipate elaborating more on that point. I am much more interested in raw data that the reader can use to draw their own conclusions. JoeCarson 09:52, 30 July 2007 (UTC)

Illegal immigrants

Wouldn't illegal immigrants also affect care in both countries, particularly in the US? Having a huge underground immigrant population would seem to affect the statistics a bit, no?--Rotten 07:31, 28 July 2007 (UTC)

Of course, and this is already mentioned in the article. See section "Price of health care," third paragraph. If you believe the subject is inadequately dealt with there, please feel free to expand on it, with appropriate sources, of course. -- Sfmammamia 23:58, 28 July 2007 (UTC)

Breast cancer statistics

I was just reading the data from the North American Association of Cancer Registries which is one of your sources. If you compare their rates for in situ breast cancer, they report twice to three times the rate in the U.S. as in Canada. As I explained above, carcinoma in situ is a low grade of breast cancer, and some oncologists don't think it's cancer at all. Only about 5% of untreated patients with breast carcinoma in situ go on to develop cancer. But if you do very aggressive breast cancer screening, you find a lot of carcinoma in situ.

This means that you can't compare the incidence and mortality of breast cancer in the U.S. and Canada, unless you separate the carcinoma in situ and the other cancers. Otherwise, if you mix them together, the U.S. numbers will show an inaccurately higher incidence rate, and an inaccurately higher cure rate (since 95% of carcinoma in situ isn't really invasive cancer, and the patient didn't need to be cured with surgery in the first place).

How much of the breast cancer in that table is carcinoma in situ? Nbauman 00:44, 30 July 2007 (UTC)

Good point, I was thinking about removing those cancers as well. Other sources have pointed out problems with breast cancer statistics. Though, we do mention this a couple of paragraphs above the table, so hopefully it has not led anyone astray. JoeCarson 09:42, 30 July 2007 (UTC)

Canadian health care -- Walk-in Clinics

Perhaps some information about walk-in clinics can be added (I'm thinking of adding info to this section --

""Coverage and access

In Canada, every citizen has coverage, but access can still be a problem. Based on 2003 data from the Canadian Community Health Survey,[29] an estimated 1.2 million Canadians do not have a regular doctor because they "cannot find" one, and just over twice that number do not have one because they "haven't looked". Those without a regular doctor are 3.5 times more likely to visit an emergency room for treatment.[29]"" )

In my neighbourhood, those without a doctor tend to go to walk-in clinics instead of the ER, after campaigns not to abuse emergency rooms in order to combat ER waiting lists from those with non-life threatening diseases.99.245.173.200 18:08, 31 July 2007 (UTC)

Cancer section

I am concerned about the continuing presence of the 1997 cancer mortality tables when the source for that data is no longer available. It seems that with the recent changes to that section and additions of other sources, the specificity presented in the tables may be unnecessary. Removing it would require some changes in wording, but I don't think the major points now made in the section would be affected. I hesitate to remove it because it appears a couple other editors are invested in the portrayal of content in this section, and one of the quoted sources on which the section relies is not available to me to check it against the points made. Other thoughts or comments? -- Sfmammamia 16:31, 6 July 2007 (UTC)

I tend to agree. Interpreting WHO statistics is also original research. It is much better to simply reference some of the secondary sources that analyze these numbers. - SimonP 17:58, 6 July 2007 (UTC)
There's a ton of easily obtainable data to parse through. We should replace the data in that table with one from a source that is easily accessed.JoeCarson 19:23, 6 July 2007 (UTC)
I write for medical publications, mostly for doctors, and I deal with these statistics all the time. I've had oncologists explain how they use these statistics and what their limitations are.
Many Canadian and American doctors compile cancer statistics to monitor the effectiveness of their own treatments, and to compare medical treatments elsewhere. Cancer is particularly complicated, and these statistical methods are fairly well established (and their limitations are fairly well recognized).
Because of the current debate over health care reform in the U.S., many people are using cancer statistics in the U.S. or Canada to support a political point. But many of them don't understand the statistics and get it wrong.
I think this section on cancer has a lot of original research, and the table in particular is original research -- and misleading.
You can compare the raw cancer incidence and death rates in 2 countries, but it doesn't demonstrate anything. Health statisticians have to correct those rates for many factors, including biases in reporting. It's difficult to compare the incidence between 2 U.S. states.
One of the Canadian government reports in the footnotes gave a good explanation for the example of prostate cancer. I used to write about prostate cancer, and I had to go through the prostate cancer statistics from U.S. sources (like SEER), and international sources. I reviewed prostate cancer statistics over the years. Everybody agrees that there are wide error ranges in the number of deaths, the number of prostate cancers, and the treatment effectiveness.
1. Prostate cancer deaths. Most elderly adults in developed countries have multiple diseases, usually heart disease, lung disease if they smoke cigarettes, and often cancer. Most elderly adults are not autopsied when they die, so nobody really knows why they died. In many states, the death certificate isn't filled out by a doctor. When they fill out the cause of death on a death certificate, even a doctor is usually making a guess from among the many conditions that could have caused the death.
During a couple of years when there were educational campaigns about prostate cancer to promote prostate cancer testing, the reported prostate cancer death rates went up, even though treatments were improving. Every urologist and oncologist I spoke to told me that this was almost certainly a statistical artifact as a result of over-reporting. So if U.S. doctors are more likely to attribute a death to prostate cancer than Canadian doctors, the statistics will report that prostate cancer deaths are increasing in the U.S. compared to Canada. But the deaths are actually the same.
2. Prostate cancer incidence. The more men you test for prostate cancer, the more prostate cancer you'll find. Most men will go for 15 years with prostate cancer, not even know they have it, and die of a heart attack or stroke. Prostate cancer tests pick up early prostate "cancers," many of which will never develop into harmful disease if you leave them alone. But the U.S. tests very aggressively for prostate cancer, so we report more prostate cancer cases.
3. Prostate cancer treatment effectiveness. Prostate cancer is usually treated by invasive surgery which leaves men impotent. If you treat young, relatively healthy men, with early prostate cancers, you'll have good results. If you treat older men, with advanced prostate cancer, you'll have bad results. If U.S. urologists are over-aggressive (as some people think they are), and diagnose and treat early prostate cancers that would never have caused any problems, they'll have great outcome statistics. But they're not saving lives; they're simply performing unnecessary surgery. Of course they have great outcomes: the patients were healthy to begin with.
Look at the table. It compares breast, prostate, intestinal, stomach, lung, and NHL. When I read medical textbooks, they give the incidence and mortality of every disease. It's tempting to divide the mortality by the incidence. In a steady population, that would be the mortality rate for the disease. But in a real population, it's not. Take lung cancer. The mortality rate from lung cancer is 100%. Everybody who gets lung cancer dies eventually (I think the 15-year overall survival is under 5%). So what does that .788 number tell you about outcomes? Nothing.
Look at breast cancer. I've written a lot about studies on breast cancer treatment, so I had to figure out the original studies. To simplify, there's early-stage and late-stage breast cancer. Early stage breast cancer can often be cured; with late-stage breast cancer, you're shooting for another 2 1/2 years of life. So the main thing that affects a doctor's survival statistics is his mix of early- and late-stage breast cancers. This table just lumps early and late breast cancers together under one heading.
(More significantly, doctors often diagnose and treat something called breast carcinoma in situ, which is controversial. A lot of doctors think that it's not really cancer, and you should leave it alone unless it progresses to something that really is cancer. But if a doctor treats a lot of carcinoma in situ, his mortality and recurrence statistics will be great, because his patients are young and healthy, and carcinoma in situ hardly ever progresses to cancer anyway. The U.S. diagnoses breast cancer -- and carcinoma in situ -- very aggressively.)
Look at "intestinal" cancer. This must mean colorectal cancer. I just wrote about surgical outcomes in colorectal cancer. Colon cancer is much easier to treat than rectal cancer, so the surgeons who do the most rectal cancer tend to have worse outcomes. Some populations have more colon cancer, some have more rectal cancer. If Canada has more rectal cancer, Canadian doctors will have worse outcomes, and vice versa.
There are other things you don't distinguish in that table. Cancers have different stages and grades, and there are different mixtures in different countries. NHL includes different diseases with completely different outcomes.
Cancer and epidemiology are two of the most complicated specialties in medicine. When I write for publication, I wouldn't write any conclusions that weren't explicitly stated in the doctors' article. Collecting numbers like that and comparing them in a table is a misleading and unjustified interpretation of the data. It's certainly original research in Wikipedia terms. I realize it took a lot of work, but I've often written a draft of an article that turned out to be all wrong, and I had to just rip it up and start all over.
When I want to compare the Canadian and American health care system, I'll find doctors who have compared it, and published their results in peer-reviewed journals[5], and quote their conclusions. Nbauman
It seems to be getting worse. Even though there's been significant effort put into this section over the last week or so, what it contributes to the overall article is very unclear to me, as the section does not point to a clear set of conclusions about what cancer data has to say about the comparison of the two health systems. At this point, I'm leaning toward deleting the whole section. -- Sfmammamia 18:27, 7 July 2007 (UTC)
The Canadian government has published comparisons between the two systems. They're very useful for doctors and health planners, because Canadian and U.S. doctors often do things slightly differently. For example, U.S. must be over-using CAT scans, because Canadian doctors often get the same outcomes without them. I'd like to keep it in, and maybe expand it to other diseases -- there are a lot of good Canadian government and other reports in the footnotes, but it's a lot of work to read through them.
Here's a peer-reviewed article that has a table comparing the cancer outcomes in 5 countries, including the U.S. and Canada. You could use the data for a new table, and quote their conclusions. Or you could expand it from cancer, and give the conclusions for all diseases.
Health Affairs, 23, no. 3 (2004): 89-99
Quality: How Does The Quality Of Care Compare In Five Countries? [6]
Australia, Canada, New Zealand, England, and the United States, studying five-year cancer relative survival rates, thirty-day case-fatality rates after acute myocardial infarction and stroke, breast cancer screening rates, and asthma mortality rates. "No country scores consistently the best or worst overall. Each country has at least one area of care where it could learn from international experiences and one area where its experiences could teach others."
Another one is:
Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007 [7]
Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.
I do think that cancer section is ready for drastic surgery, though. Nbauman 22:17, 7 July 2007 (UTC)
The Commonwealth Fund study is already cited in the article, although the cite is incomplete -- see footnote #30. -- Sfmammamia 03:47, 8 July 2007 (UTC)


I can compute the motions and binding states for many of the chemical systems involved in disease, and I do so regularly for the systems of prostate cancer and androgen insensitivity syndromes, but I will defer to your knowledge of the statistics. However, there is no good reason to remove the table. Perhaps consideration should be given to removing the division operation, but it is not original research as defined by wiki. It is not a new theory or method, it is not an original idea, it does not define or re-define terms, it does not make an argument without providing a reputable source, it does not introduce a synthesis in a way the that builds a case favored by me and it does not use neologisms. It presumes incidence/mortality is a good proxy for cancer survival rates. We should mention the "fuzziness" inherent in these figures. I assumed the reader would know that.JoeCarson 10:13, 8 July 2007 (UTC)
I saw a presentation of binding states for androgen receptors at the American Chemical Society meeting, and I loved it, but clinical medicine operates on a different scale.
The main thing I learned about statistics is my own ignorance. That's a job for experts, and even the experts have trouble. (The classic example is [Simpson's paradox]). All I do is quote from reports and from statisticians.
If a medical statistician compiled the incidence and mortality rate for, say, breast cancer, and confirmed that they were diagnosing breast cancer the same way in Canada and the U.S., and that they were reporting the same kind of cancers, and they used the same diagnostic criteria, and they published them together in a peer-reviewed journal as comparative statistics -- O.K. But this table got the Canadian statistics from one report, and the U.S. statistics from another report, and lined them up as if they were equivalent -- which they're not. That's innacurate, misleading and original research. Just read the caveats in the Canadian Cancer Statistics 2007 report, which explains why cancer statistics may not be compatible from region to region (let alone country to country).
Take breast cancer. The raw incidence figures have to be adjusted, and the 2 government reports adjust them in different ways. Canadian doctors examine more of the population for breast cancer, so that would inflate Canadian figures. The U.S. tends to diagnose ductal carcinoma in situ as breast cancer. Does Canada? Are the ages equivalent? If a woman with breast cancer dies of heart failure as a result of the chemotherapy, do they record that as a death from breast cancer or from heart failure?
The first thing I did when I saw incidence and mortality statistics in a textbook was to divide them. But the incidence/mortality is not a proxy for survival rates -- or anything meaningful. If it was, the incidence/mortality for lung cancer would be 1.0. But it's not.
You can't assume that the readers will understand the "fuzziness". Doctors and PhD-level statistician co-author articles with mistakes (like the Simpson paradox study). If doctors who have studied medical statistics don't understand these things, how can the general reader understand them?
And there's no reason to use these numbers. If you want a table comparing Canadian and U.S. cancer survival, there are peer-reviewed, published data in the Health Affairs article. Nbauman 21:20, 8 July 2007 (UTC)

I just found a Wikipedia policy that's exactly on pont in Wikipedia:No original research

The cancer section violates WP:SYN: "Editors often make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to advance position C. However, this would be an example of a new synthesis of published material serving to advance a position, and as such it would constitute original research.[2] "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article."

The cancer section is synthesizing 2 studies, and drawing conclusions from them, in exactly the way that WP:SYN defines as original research. It has to come out. Nbauman 16:04, 10 July 2007 (UTC)

How about just presenting the data without drawing any conclusions then? --Rotten 16:12, 10 July 2007 (UTC)
If you take data on, say, prostate cancer incidence from a Canadian study, and line it up with prostate cancer incidence from an American study, that would be new synthesis in violation of WP:NOR.
It's also wrong in medical terms, because prostate cancer statistics from Canada are not compatible with prostate cancer statistics from the U.S. (Prostate cancer statistics from 1990 aren't even compatible with prostate cancer statistics from 1995.) If you want to compare prostate cancer statistics, find a reliable source that has compared them, such as the Health Affairs article. I can't even check the conclusions that have sources because the footnotes don't link to the original articles (and some of those data go back to 1993 or earlier). I read cancer statistics every week, and I've written about them. You can't combine numbers like that. This section is just wrong. I don't see how we could justify it, in WP terms or medical terms. Nbauman 16:37, 10 July 2007 (UTC)
No need to justify just presenting data, as long as you note that the two statistics aren't compatible. Why do you want to suppress the data so bad?--Rotten 18:47, 10 July 2007 (UTC)
The reason I want to suppress the data "so bad" is that it's meaningless and misleading. Anyone who divides those 2 numbers doesn't understand the statistics. If people want to understand medicine, they have to understand the statistics, and comparisons like that are miseducating them. It's junk data. I was trained to look out for misleading comparisions like that. That's the kind of comparisons drug companies used to make, until the FDA made them stop. They used false comparisons like that because it made it possible to make their drugs look good, even when they were actually harmful. This kind of statistics has caused lots of harm.
Or to put it in terms that everybody here can understand: it violates WP:OR and WP:SYN. Nbauman 04:59, 12 July 2007 (UTC)


Perhaps you should think this through more deeply. You may have a case for SYN, but certainly not OR as it relates to the data itself. Leave the data and remove the conclusions of the editor. However, a belief that mortality/incidence is not a good proxy for (1-survival rate) in these systems must be based on poor reasoning. Imagine a section of pipe with a slowly changing flow rate and several sinks between one end and the other. Using mortality/incidence is equivalent to using 1-(outflow rate/inflow rate) to measure the amount lost to the sinks. If you are comparing two pipes and the technique used to measure flow differs, you should mention that, but it is unscientific to reject the comparison unless at least one of the techniques is highly flawed. If that technique leads to bad data. The data in this scenario is outflow and inflow rate, not outflow/inflow. To make a case against outflow/inflow as a proxy you must either show that the change in flow rate is not negligible (problem with method, not data) or that the underlying data is not reliable, in which case you must reject the outflow and inflow measurements completely.JoeCarson 13:03, 12 July 2007 (UTC)
Medical statistics is a separate specialty because medical models are unusually complicated, and they have lots of experience with people using simple models that seem reasonable and turned out to be wrong. It seemed reasonable that the earlier you operate on cancer, the more likely the operation will cure the patient, but when doctors looked at the actual results of real cancers, it didn't work. Doctors come up with statistics like yours all the time, but they have to be validated to see if they do anything useful. That's the experimental method of science. You're ignoring the experimental method.
I understand sinks and pipes with inflow and outflow. Chemical engineers deal with that all the time. That's not a valid model for cancer incidence and mortality. If you use the scientific method, you have to test things, and when you test this model to see if it predicts anything useful, it does't work. The most obvious problem is that cancer patients have multiple diseases, especially cardiovascular (which is worsened by chemotherapy and radiation), and when they die, you don't know what they died of.
So the comparison is highly flawed. You're not comparing people who died of breast cancer in the U.S. to people who died of breast cancer in Canada, you're comparing people who died with breast cancer and heart disease who were recorded as breast cancer deaths in the U.S. with people who may have the identical disease who were recorded as heart disease deaths in Canada, and vice versa. When somebody writes an article on treatments for breast cancer in a medical journal, one of the basic things they do is correct for that. You're not correcting for that.
You're adding noise. The false Canadian/U.S. comparision is bad enough. When you divide deaths by incidence, you magnify the error. You get a number with a large random component. Canadian health care administrators rigorously monitor valid indicators, like 30-day mortality for different operations, and waiting times, so they can see where things are working well and poorly. But they would never divide mortality by incidence, because it doesn't show anything valid.
It's only useful for generating random statistics, which can then be used by people who cherry-pick statistics to justify a political position about private versus public health care. And that's what the Fraser Institute is doing. Nbauman 17:29, 12 July 2007 (UTC)


You'll have to forgive me, I'm not familiar with the Fraser institute. However, your insinuation that I am trying to lead the reader to believe that private is better than public by presenting this data is way off. I am not convinced that the American system is really more private than the Canadian system. The structure of government restrictionism just takes a different form in the American market. Government spending on x is an imperfect proxy for the extent of government control over x. Nazi Germany had many companies that were nominally private, but those companies were no more free than the government-run operations of the USSR.
Now do you have any reason to believe this "noise" is biased in any direction? If not, then you are only making a case for including a statement about the fuzziness of the statistics, something we have already agreed on. <(x+randn(0))/(y+randn(0)> = <x/y>. <--See any magnification of randn(0) there? JoeCarson 18:59, 12 July 2007 (UTC)
I have never thought that you were using this data to prove that private is better than public, nor was I insinuating that. I believe that these statistics produce numbers that are chaotic and not related to anything meaningful. Very often in medicine you get a lot of data that doesn't meet statistical confidence. I've talked to medical device manufacturers who tried to use their non-valid data to prove to me their products were actually useful. (You haven't heard of anybody getting laser angioplasty lately, have you?) When you calculate data this way, you get meaningless numbers. People in the Fraser Institute, and the Manhattan Institute, who are trying to prove that private is better, cherry-pick among those meaningless numbers and use it to sell their arguments to statistically ignorant people. That's why I don't want to use those numbers in the entry.
I don't understand that formula. But suppose the cancer rates in Canada were 100 ± 1%, and the cancer rates in the US were 100 ± 1%, in arbitrary units. If you divide one by the other, you get 1.00 ± 2%. That's what I meant. But it's not central to my point. Nbauman 22:39, 12 July 2007 (UTC)


The formula isn't really important. It just shows that if the error is normally distributed around 0, it is not expected to change the value of the measured average. Any error symmetric about 0 should have this property. I changed the table and removed the operation because it may be SYN.JoeCarson 00:37, 13 July 2007 (UTC)

This cancer survival table commits the ecological fallacy. I just came across that term in another article. I am giving notice that it should be deleted, because it's misleading, WP:OR, WP:SYN, etc. Nbauman 23:05, 18 October 2007 (UTC)

It does not meet the necessary conditions for the ecological fallacy. I suggest you read through that and think carefully about the requirements. You are making an assumption. JoeCarson 14:36, 19 October 2007 (UTC)

Comparison of wait times

Do the cited resources have a way of including people who have been denied treatment in the U.S? Someone who is denied treatment theoretically has an infinite wait time. And obviously, systems that do deny treatment to people are going to perform better in this respect. It's like comparing delivery times but discounting lost items. Or failing that is there a statistic about how much treatment is denied at least. Macgruder 11:28, 14 October 2007 (UTC)