David Gratzer

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David Gratzer is a practising psychiatrist and senior fellow at the Manhattan Institute where he specializes in medical topics such as medical reform, prescription drug policy, and insuring the medically uninsured.

He is an author of two books Code Blue: Reviving Canada's Health Care System (ECW Press, 1999), which was awarded the $25,000 Donner Prize for best Canadian public policy book in 2000 and The Cure: How Capitalism Can Save American Health Care (Encounter Books, October 2006).

He is often quoted on health matters across North America, including The Wall Street Journal, The Washington Post, The Los Angeles Times, and The Weekly Standard.

For his essays, Dr. Gratzer won the 2000 Felix A. Morley Journalism Competition, sponsored by George Mason University’s Institute for the Humane Studies.

Dr. Gratzer is a peer reviewer for numerous publications and organizations: the Journal of Health Politics, Policy, and Law, the Canadian Medical Association Journal, the American Journal of Medicine, the Max Bell Foundation, the Pacific Research Institute, and the National Center for Policy Analysis.

He also testified before the U.S. House of Representatives in favor of the Health Care Choice Act of 2005.

1 Notoriety
2 Books
3 References
4 Footnotes

[edit] Notoriety

Gratzer achieved international notoriety when Rudy Giuliani in his 2008 presidential campaign claimed

My chance of surviving prostate cancer — and thank God I was cured of it — in the United States? 82%. My chances of surviving prostate cancer in England? Only 44%, under socialized medicine.

A City Journal article^[1] written by Gratzer was the source for the claim, in which Gratzer had written

....if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out....The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England — a striking variation.

The claim was immediately denounced as wrong by the UK Health Secretary ^[2] who by tradition would not normally intervene in a US political matter. The statistics were then examined in more detail and found to be misleading.

According to cancer experts cited in fact check articles by the Annenberg Public Policy Center's FactCheck.org, the St. Petersburg Times and its PolitiFact.com, The New York Times, The Washington Post, and The Times, Giuliani's statistics were "false" and very "misleading" and his conclusions were complete "nonsense".^[3]^[4]^[5]^[6]^[7]^[8]^[9]
The St. Petersburg Times and Congressional Quarterly's PolitiFact.com said: "Rudy Giuliani used cancer statistics from a conservative journal to compare the U.S. and the U.K. but the stats are wrong and the underlying comparison is faulty at best."

The ad caused a stir in medical circles after the group that did the research issued a statement^[10] condemning the misuse of its numbers.

“I find it personally distasteful to have Mr. Giuliani exploiting cancer patients to make a political statement,” said Andrew Vickers, associate attending research methodologist at New York’s Memorial Sloan-Kettering Cancer Center.
Vickers, who moved here from Britain several years ago, said Giuliani’s ad was irresponsible. “As a prominent individual who is a cancer survivor, I would think it’s more incumbent on him to be accurate in the way he uses cancer statistics,” he said.^[6]

The Washington Post said: "The former New York mayor has had personal experience battling prostate cancer, but he's confused about the stats, according to several experts we consulted."

"When you introduce screening and early detection into the equation, the survival statistics become meaningless," said Howard Parnes, chief of the Prostate Cancer Research Group at the National Cancer Institute. "You are identifying many people who would not otherwise be diagnosed."
"You can't say that it's better to have prostate cancer here or in some other country," with a developed health care system, said Brantley Thrasher, chairman of the Department of Urology at the University of Kansas, who also serves as a spokesman for the American Urological Association.^[11]

Princeton University economist Paul Krugman said that Giuliani's statistics were "just wrong" and "scare tactics," and accused Giuliani of "simply lying" by calling Democratic presidential candidates' health care proposals "socialized medicine."^[12]

An unrepentant Gratzer later defended the claim: "The mayor is right."

Krugman and others have compared statistical apples to oranges. My 44% figure, replicated by economist John Goodman and others, looks at a snapshot in time, based on decade-old OECD data; Krugman's 74% is a five-year relative survival rate from government sources today.^[13]

Annenberg's FactCheck.org found no merit in Gratzer's response:

Marie Diener-West, professor of biostatistics at Johns Hopkins Bloomberg School of Public Health, said Gratzer's attempts to calculate cancer survival rates were “inappropriate” and “very misleading."
Peter Albertsen, professor and chief of urology at the University of Connecticut Health Center, called Gratzer's calculations a “very dangerous thing to do” and “complete nonsense.”^[4]

Nor did The Washington Post, which awarded Giuliani and Gratzer's response the same "Four Pinocchios" rating (reserved for "whoppers")^[14] it awarded Giuliani and Gratzer's original claim:

"You would get an F in epidemiology at Johns Hopkins if you did that calculation," said Johns Hopkins professor Gerard Anderson, whose 2000 study "Multinational Comparisons of Health Systems Data"^[15] has been cited by Gratzer as a source for his statistics.
Five-year prostate cancer survival rates are higher in the United States than in Britain but, according to Howard Parnes of the National Cancer Institute, this is largely a statistical illusion.
Both Anderson and Parnes say that it is impossible, on the basis of the available data, to conclude that Americans have a significantly better chance of surviving prostate cancer than Britons.
We have invited the Giuliani campaign to name a reputable prostate cancer researcher or epidemiologist who will publicly endorse the candidate's claim. They have not so far responded.^[16]

In December 2007, The New York Times public editor wrote, "Fact-checking the candidates has long been an important part of campaign coverage," but that:

To be most useful, fact-checking needs to be timely. In October, Giuliani incorrectly claimed that the prostate cancer survival rate in England, under the “socialized medicine” he falsely implied Democrats favor, was only 44 percent, compared with 82 percent in the United States. The Times initially said the number for England was “in dispute,” though it provided all the necessary information for a reader to conclude it was wrong. It wasn’t until Friday that the newspaper declared the statistic a “false statement.”^[7]

At the end of 2007, Giuliani and Gratzer's claims won awards from The Washington Post as one of "the top ten fibs of the year" and from The Times as one of "the worst junk stats of 2007," with the Post noting Giuliani's "campaign has been unable to produce a single prostate cancer researcher who agrees with him," and the Times describing Giuliani and Gratzer's claims as "innumerate."^[8]^[9]

[edit] Books

Gratzer, David (September 1999). Code blue : reviving Canada's health care system. Toronto: ECW Press. ISBN 1550223933.
Gratzer, David (ed.) (April 2002). Better medicine : reforming Canadian health care. Toronto: ECW Press. ISBN 1550225057.
Gratzer, David (October 2006). The cure : how capitalism can save American health care. New York: Encounter Books. ISBN 1594031533.