Talk:David Gratzer

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[edit] Mis-use of statistics

Freedomwarrior: You say that "Gratzer has argued that his critics are arguing against a straw-man" but (a) he does not say that and (b) he actually compounds the error by repeating that his claims are meaningful which they clearly are not**.

I'll leave you to contemplate how you might re-word the summary of his defence otherwise I will do it for you.

Personally I am astounded that he actually continues to defend the statistics and mislead yet again. Whichever way you fall on the argument, the use of the statistics by Gratzer is wholly indefensible. I am totally astounded that he has tried to defend his position and this surely must surely affect his future status as a peer reviewer on journals if he cannot get something as basic as this right.

'**' If one country screens people for slowly lethal diseases such as prostate cancer at age 50 and another does not generally screen and therefore discovers the disease at a very late stage in life then the statistics for 5 year survival rates from the two populations following diagnosis are bound to be high in the country that screens at a low age. It is tempting to think automatically that the British men detected with prostate cancer all died from the disease. That is a wrong assumption. Many will have died of other illnesses of late age because they are likely to be about 20 years older! Worse still Gratzer tempts his audience with the truism "remember the cardinal rule of cancer care: Early detection is critical to treating the disease successfully". But British doctors know that the incidence of prostate cancer in younger men is low and many of the cancers will be non-lethal - these cancers grow very slowly and many men outlive them. Attempting to detect and then treat the detected cancers in the young (i) exposes a high proportion of younger men without the disease to needless worry and costs and uncomfortable procedures and (ii) potentially exposes those detected with the disease to potentially harmful side effects to cure them of a disease that is unlikely to kill them. The death rate from prostate cancer in the UK is exactly the same as in the US.. 25 per 100,000 and as far as I have seen there is no evidence that the disease is more prevalent in the US. That is not to say that some people in the UK who do die from the disease would not have benefited from earlier diagnosis. Its a difficult balance to strike but the end result is that British professionals have taken a different philosophical approach to the American cousins. "Do no harm" over "do some good". One cannot conclude from these statistics that one country's approach is better than the other, but other studies are ongoing to determine this. The thing it does not do is to tells us anything about socialized medicine! --Tom (talk) 09:30, 28 January 2008 (UTC)

Tom, do you know what a straw man is? He didn't say that his opponents were arguing against a straw men, but it follows from what he's asserting...

On the final point, so the socialists penchant for preventative medicine is overstated?Freedomwarrior (talk) 15:55, 28 January 2008 (UTC)

Yes I do know what it is and no he doesn't argue that. He re-asserts that he is right... but he is only right if you accept the data comparisons are valid, and every cancer expert and epidemiologist I have seen that has commented on the claim has said the comparison is not valid. It is misleading to make the comparisons he makes.

On your last remark, I assume that you are saying not detecting cancers is not preventative medicine. Neither actions are preventative. One is detective and invasive and expensive and the other is frankly passive and cheap. No doubt about it. Is it an effective strategy? Frankly we have to wait and see the outcome of the long term study still in progress. As I think I may have said elsewhere, my own father in his seventies had an enlarged prostrate and was told the choices and advised to leave it alone as it probably would not kill him. He took the advice and died several years later of an entirely different disease. I think he did the right thing. He lived his last years quite normally and mostly untroubled by the prostate and was not put through the hardships of years of treatment to no effect. The fact that the NHS was saved expense is not really an issue because he was actually offered the possibility of investigation and I have little doubt that had he taken the offer, they would have offered much the same treatment as Guilliani received. But that would not have prevented the small cell lung cancer that he utimately succombed to and his final years would have been much less tolerable. --Tom (talk) 22:32, 28 January 2008 (UTC)