In an excellent diary today, mcjoan quotes Inhofe:
When you tell people that the mortality rate in Canada is 25% higher for breast cancer, 18% higher for prostate cancer, you know, they say why in the world would we emulate a system like that?
He does not understand mortality and survival.
Follow me, and you will.
Mortailty refers to death rate (usually quoted as deaths per 100,000 population per year, age-adjusted).
Survival refers to how long people live after diagnosis of disease. (Usually survival rate at five years, but variable.
Now imagine a disease called "breast cancer." We will suppose that it is a single disease (it is not, nor are any of my other assumptions anything but cartoonishly over-simplified).
"Breast cancer" occurs in our imaginary population of 100,000 people and each year 20 people die of breast cancer. This is the mortality rate.
Now suppose that there is no good way to diagnose "breast cancer" early, and it is only diagnosed when the patient is nearly dead. Everybody who is diagnosed with breast cancer is dead within five years of diagnosis. The five-year survival rate is 0%.
Now suppose there is no effective treatment.
Suppose now that there is a new diagnostic test that will diagnose breast cancer when the lesion is 1mm diameter, ten years before it will eventually kill the patient. If you apply the diagnostic tool to the population, you will move the population from a 0% five-year survival to 100% five-year survival, but you will not help one single patient survive one moment longer. You have just discovered what we call Lead-time bias.
Now suppose that there are two forms of "breast cancer" that look exactly the same under the microscope, but one is highly aggressive and will kill the patient within a month of inception, and the other form is indolent and will take fifty years to kill the patient. Suppose you have a population that gets each kind of cancer in equal numbers, and you screen once a year. Your screening test the first year will result in an apparent 600-fold improvement in survival, since you will diagnose only 1/12 of the aggressive cancers that developed in the last year, and you will diagnose all the indolent cancers that accumulated before you started screening. It will appear to the unsophisticated that you have saved countless lives, but not one person will live one bit longer. And you have discovered Length-time bias.
Now consider mortality and survival from real-world breast cancer.
You will see that the mortality rate from breast cancer is slightly higher in the U.S. than in Canada, but that 20% more U.S. women are diagnosed with breast cancer each year. This may be due to any number of factors, such as improved screening (with lead-time and length-time biases), over-diagnosis, and so on. We just cannot know. And neither can Inhofe. But I'd rather have the lower mortality rate; maybe he would not.
BTW, Cuba has a better breast-cancer survival rate than does the U.S. Inhofe neglected that.