Monday, July 16, 2007

Sicko's Critique By Dr. Sanjay Gupta, CNN Is Entirely Misplaced

Funny how a little conflict of interest can show up a person who's so well thought of for years. I've avidly watched Dr. Sanjay Gupta on CNN and affiliated stations, and found him to be very informative, articulate, engaging and interesting. He is all that, but I also ascribed honesty and sincerity to his earnest doctor's persona.

Then I saw Dr. Gupta's 4 minute "fact check" report on "Sicko." Some aspects of the report struck me as strange and unbalanced even the first time. But I paid more attention to it after seeing Sicko creator Michael Moore's outburst on Wolf Blitzer's CNN show, followed by Moore's rebuttal on his website. Subsequently, I saw the Moore-Gupta exchange on Larry King Live, then the actual movie "Sicko," and finally Moore's second rebuttal, this time of Gupta's statements made on Larry King Live.

In these situations you normally expect both sides to be at least partly right. But here's the thing - none of Gupta's substantive corrections or criticisms was valid. Worse, when the facts were starkly laid out in Moore's first rebuttal Gupta only acknowledged one mistake and managed to cover himself on Larry King with his debating skills, glibness, and "running out the clock" in the limited air time.

You can follow the successive links to see the whole story, but here are Gupta's key distortions:

  • He accuses Moore of cherry-picking numbers from several data sources. I can see that Moore used the most authentic sources and the latest data where available, and going to other sources on a sliding scale when the ones higher up on the list did not have the information.
  • Gupta said that Moore "did indeed fudge his numbers." You call it fudging or "cherry-picking" when the numbers you choose are more favorable to the case you're trying to make. In the main example Gupta gave, it was just the opposite. Moore says US healthcare at $7,000 per capita is much more expensive than Cuban healthcare at $251. Gupta says Moore cherry picked and fudged by taking this number of $251 instead of the BBC figure of $229. This is (a) a trivial difference, (b) Moore had picked the more authentic data source, and worst of all (c) the $229 number was making Moore's case even stronger, so he actually gave detractors the benefit of doubt by quoting the higher figure.
  • Gupta quibbled with Moore's statement of US per capita healthcare expenses of nearly $7000 , claiming it was "actually $6,098." Well, Gupta's figures are for 2004, while Moore used the more current 2006 estimates from the US Dept. of Health Services. Gupta made the ridiculous point that the 2006 number was a "forecast." If you haven't noticed, 2006 is already gone, so while it's an estimate that may land up, say, a hundred dollars higher or lower than this estimate, the $7,000 figure is a lot more valid than the $6,098 Gupta touted. I want to ask Gupta, if the US authorities said they were really really sure only about numbers of 30 years ago, would he have espoused using those 1977 numbers for comparison, or the current official estimates?
  • Gupta pointed out that Canada scored lower than the US in wait times to see the doctor. Talk of focusing on a glass being 20% empty. That same source said that New Zealand, UK, Germany and Australia (all with universal coverage) scored higher than the US in this six-nation study.
  • Gupta showed that industry expert Paul Keckley (whose links and Repub affiliations weren't disclosed) dissing the Europeans because 15-20% of people will purchase services outside of the government system. He exaggerates the numbers, but even so this means that 80-85% of the people are happy enough not to look outside the government system, even for any supplemental care.
  • Gupta made a big deal of Cuba at 39th place being behind the US in 37th place in WHO rankings. But the film clearly showed this, and irony of the point being made was clear - even a miserable place like Cuba coming anywhere near the US in healthcare comparisons is a shame.
  • Gupta also deliberately mis-ascribes the claim to Moore that healthcare in the other countries is "free." Anyone can see Moore means that patients don't get billed so they are not inhibited from going to the hospital/doctor. The film spent several minutes addressing the issue and claim about "drowning in taxes" and Gupta wrongly implied that the film glossed over this aspect.

The list goes on. Did Sicko have any notable omissions? Sure it did, and I'll mention them in a subsequent post. But even here, Moore may have wanted to concentrate on the two issues that most bothered him, without the distraction of the other things that are wrong with US healthcare.

The point is, Gupta's original piece unfairly criticized "Sicko" on nearly all counts, and this does not stem from honest mistakes. He seems to have ended up defending his healthcare industry as a partisan while in the garb of an impartial journalist. CNN deserves credit for at least giving Moore's outburst coverage in their subsequent shows, and some additional time on Larry King Live to make his case. But while the casual watcher may be taken in, the errors in Gupta's initial report and his subsequent stance should be clear to those looking at it in some depth.

Dr. Sanjay Gupta may refuse to retract his story and unconditionally apologize. CNN should then do so on his behalf. That'll be the right thing to do, though I doubt it'll happen.


Anonymous said...

"""Gupta showed that industry expert Paul Keckley (whose links and Repub affiliations weren't disclosed) dissing the Europeans because 15-20% of people will purchase services outside of the government system. He exaggerates the numbers, but even so this means that 80-85% of the people are happy enough not to look outside the government system, even for any supplemental care."""

Actually, up here in Canada anyway, we have a hybrid system. Core medical services are covered by the government, but other goods and services (drugs, dental, optical) are covered by private insurers. A lot of US commentators seem to be caught up in Manichean "us vs. them", "red vs. blue", "good vs. evil", "freedom vs. communism" binary thinking. The fact that we buy supplementary insurance is not a comment on the failings of our system. It is part of our system. Right-wing ideologues in this debate are being extremely childish and simplistic with their black-and-white thinking. Anything to protect their prejudices from the inconvenient truths, I suppose.

Sandip Madan said...

Well said, Anonymous! :-) I also appreciate your inputs and clarifications about the Canadian system, from someone who lives there.

Rene said...

Apparently the Registered Nurses Association of Ontario will be inviting politicians here to see "Sicko", because they're really committed to protecting Canada's Universal Health Care System.


Sandip Madan said...

Thanks for the news, Rene. I'm thinking the nurses are kind of preaching to the choir. Universal healthcare is a sound concept and well entrenched in Canada, so I doubt it faces any real threats. May be it's just an occasion for Canadians to look across the border and then pat themselves on their backs. :-)

Anonymous said...

Just stumbled across this, while doing research for a paper. You may want to update your post, as it seems Dr Gupta was actually right on every point. He accused MM of using numbers from different sources. That makes an unfair comparison and violates rule #1 of statistics. And, yes the 2006 numbers are still not out. It usually takes 12 - 18 months for the states to submit their data and for it all to be analyzed. There is not some magic formulation that is suddenly created on Dec 31st. And, here is the kicker, it lookes like the 2006 numbers that wer forecasted were off by at least 25%, which is why Gupta says he prefers not to use them. Please update your clearly biased and misinformed post.

Sandip Madan said...

Anonymous, I've no idea about this "rule #1 of statistics" that you quote, or the sources behind your "facts." It is standard practice to use multiple sources(as you undoubtedly are doing in your own research) when one source doesn't have all the information. There's no evidence Moore cherry-picked numbers as Gupta falsely alleged. If you have such evidence you're welcome to cite it so we can have an honest discussion.

Where did you get this "kicker" about 2006 figures being off by at least 25%? As far as I know the official estimates (that Moore used) closely track the actual stats that subsequently come in. And Gupta "right on every count?" I haven't found even one among those cited in the post.

I gain nothing from dissing Dr. Gupta. Till I saw his true colors in this Sicko report, I liked and trusted him. I also felt a measure of pride in him as an ethnic Indian. Now all that's changed.

Anonymous said...

Sandib Madan, since you don't know "rule #1 of statistics, maybe you shouldn't be attempting to blog about it. No, you don't take sources from different sources. That is all you need to know. I am also Indian and my pride in Sanjay Gupta has nothing to do with his ethnicity, it is his ethics. Perhaps you should take a lesson. You're a disgrace who criticizes without the facts, the most dangerous of all.

Sandip Madan said...

I'm not surprised you choose to remain anonymous. No further comments necessary.