Another email, in response to my last two posts on this subject:

Ramesh, you’re outside the lines on the PC (prostate cancer) issue. I’ve unfortunate up close and personal experience with this, in my family and close friends, and ‘statistical artifact’ is a ridiculous overreach, unworthy of your usual careful thinking.
There is a fierce and honest difference of opinion among medical professionals on the utility of aggressive screening. Most urologists feel that the risk of overtreating indolent disease is worth it, especially as there is *no* reliable way of determining which early stage prostate cancer is going to grow like wildfire, and which is going to just – sit there. What is certain is that PC that spreads beyond the prostate capsule is ultimately a game over scenario. If you catch it early, through aggressive screening, a cure is possible (some would say likely); later, the options are far fewer.
On the contra side, a small but growing number of urologists are more concerned with morbidity, not just mortality. They want to save lives, but are equally concerned with the tens of thousands of men treated annually for PC, who experience impotence, incontinence, and other radio/surgical side effects. A significant number of these men were *never* going to die from PC – but due to aggressive screening, they incur serious, lifelong medical consequences from the treatments.
My point is – there are legitimate arguments for both positions, but it is indisputable that there is a point with many (not all) prostate cancers, where they cross the lines from curable, to treatable, to terminal disease. Asserting that *all* disparity between US and UK survival is a time-from-discovery ‘artifact’, is essentially stating that testing is irrelevant; “ either your number is up, or it’s not”. That’s a valid position as well – but its philosophy, not science.

I think to some extent you’re reading more into my comment than I put there, and to some extent we have a difference of opinion. I’m not against aggressive screening. But remember that Giuliani’s claim was that prostate cancer survival rates here are double what they are in England, and that this reflects poorly on socialized medicine. If some large percentage of this difference is the result of the fact that we catch and treat a lot of cases that would not have been fatal, then Giuliani’s inference is at best an exaggeration. The fact that the same percentage of Britishers and Americans die of prostate cancer suggests that the difference is almost entirely, yes, a statistical artifact.