Unmasking the McCaughey mischaracterizations - Part Five

September 1, 1:50 PMLiberal ExaminerJenny Kakasuleff

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Wheelchair bound Jen Halbert attends a rally supporting the passage of health care bills championed by the late Senator Ted Kennedy, Saturday, Aug. 29, 2009 in Times Square in New York. The event near Times Square began shortly after the funeral for U.S. Sen. Edward Kennedy, and took on the feel of a tribute to the liberal leader. (AP Photo/Stephen Chernin)

The previous article exposed Betsy McCaughey’s misleading claims with respect to comparative effectiveness research, and elaborated on some of the recommendations by the Congressional Budget Office (CBO) for bending the health care cost curve, including health information technology and larger risk-pooling.

Read: Part One

Read: Part Two

Read: Part Three

Read: Part Four

This article will focus on McCaughey’s absurd contention that preventive care is ineffective. I would say that Dr. McCaughey should stick to the constitution, since her doctorate is not in the medical field; however, she has proved arguably more defunct at interpreting legislation than understanding the breadth of literature confirming the health benefits of preventive care. McCaughey states in an op-ed:

Driving these cuts [to Medicare] is the misconception that preventative care can eliminate sickness. As President Obama said in a speech to the American Medical Association: ‘We have to avoid illness and disease in the first place.’ That would make sense if most diseases were preventable. But the two most prevalent diseases of aging—cancer and heart disease—are largely caused by genetics and their occurrence increases with age. Your risk of being diagnosed with cancer doubles from age 50 to 60, according to the National Cancer Institute.”

The president’s broad statement could be interpreted to mean that he believes we have the ability to prevent all illnesses; as McCaughey suggests. It could also – and more likely does– mean that there are some illnesses, which are preventable, and we should reward physicians who encourage their patients to make healthy choices in order to avoid them.

McCaughey references the two leading causes of death – but misleadingly terms them “diseases of aging,” as if these conditions only affect the elderly. In fact, they are the overall leading causes of death in the U.S.; claiming well over a million of the 2.5 million lost in 2006.

One factor that each of these diseases has in common is that at least some of their causes were preventable. Indeed, not all, but at least some were caused less by genetics and more because of a personal choice. According to the American Cancer Society:

…in 2009 about 169,000 cancer deaths are expected to be caused by tobacco use. Scientific evidence suggests that about one-third of the 562,340 cancer deaths expected to occur in 2009 will be related to overweight or obesity, physical inactivity, and poor nutrition and thus could also be prevented. Certain cancers are related to infectious agents, such as hepatitis B virus (HBV), human papillomavirus (HPV), human immunodeficiency virus (HIV), Helicobacter pylori (H. pylori), and others, and could be prevented through behavioral changes, vaccines, or antibiotics. In addition, many of the more than 1 million skin cancers that are expected to be diagnosed in 2009 could be prevented by protection from the sun’s rays and avoiding indoor tanning.”

The same National Cancer Institute that provides McCaughey’s proof that Cancer is not preventable based on the non-causal connection that its incidence increases with age, agrees with the American Cancer Society: “Scientists estimate that as many as 50–75 percent of cancer deaths in the United States are caused by human behaviors such as smoking, physical inactivity, and poor dietary choices.” Clearly, genetics plays a role, but it is certainly no larger than that of personal choice and is at least substantial enough to warrant our attention.

Similar to her cancer claims, McCaughey gives genetics far too much responsibility as the unavoidable cause of heart disease. According to the Mayo Clinic: “Atherosclerosis is the most common cause of cardiovascular disease, and it's caused by an unhealthy diet, lack of exercise, being overweight and smoking. All of these are major risk factors for developing atherosclerosis and, in turn, cardiovascular disease” Again, all personal choices that are preventable.

Some deaths attributed to chronic lower respiratory disease are caused by smoking – another preventable behavior. While genetics largely predisposes an individual to diabetes (70K deaths/year), there are health care choices that can be made – to eat healthy, exercise regularly, and better manage the disease – that eases the costs of say, amputating a foot. According to the Mayo Clinic:

When it comes to type 2 diabetes — the most common type of diabetes — prevention is a big deal. It's especially important to make diabetes prevention a priority if you're at increased risk of diabetes, for example, if you're overweight or have a family history of the disease… Diabetes prevention is as basic as losing extra weight and eating more healthfully.”

McCaughey’s claim that there is little benefit to be derived by focusing on prevention – which includes processes designed to target genetic links earlier to ensure early prevention and treatment – is as asinine as her claim that House Bill 3200 is a death bill for seniors.

There is a reasonable debate to engage in over the cost-benefit of encouraging sweeping preventive health care measures. While preventive care clearly works on an individual level, and implementing it at a macro-level will make us all healthier, it may not save money. This is primarily because certain preventive efforts implemented across the entire population to pre-empt a disease that afflicts only a small number will eventually cost more than they will save over the long-term. According to the New England Journal of Medicine:

Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs. For example, screening costs will exceed the savings from avoided treatment in cases in which only a very small fraction of the population would have become ill in the absence of preventive measures. Preventive measures that do not save money may or may not represent cost-effective care (i.e., good value for the resources expended). Whether any preventive measure saves money or is a reasonable investment despite adding to costs depends entirely on the particular intervention and the specific population in question.”

The NEJM reserves judgment on whether the increased costs of preventive care are justified through the lives they will save, but rather point out that saving these lives will come at a cost, and thus, should not be touted as the primary means for cutting health care costs. For these reasons, the CBO does not estimate large cost savings as a result of preventive care, but does cite a study that recognizes the possible health benefits of a system that encourages it. The authors, examining cardiovascular disease prevention:

…estimated the effects of achieving widespread use of several highly recommended preventive measures aimed at cardiovascular disease — such as monitoring blood pressure levels for diabetics and cholesterol levels for individuals at high risk of heart disease and using medications to reduce those levels. The researchers found that those steps would substantially reduce the projected number of heart attacks and strokes that occurred but would also increase total spending on medical care because the ultimate savings would offset only about 10 percent of the costs of the preventive services, on average."

The question is not whether preventive care works, but rather, do the costs justify the health benefits? Extending that argument further, what are we willing to pay to save lives? It is clear why the woman who has managed to convince the ideologically faithful that democrats are trying to kill grandma would not want to talk about the real reason she is opposed to preventive care. We know which side of the debate McCaughey would align herself, and it’s likely not the one that favors spending lots of money to save a few lives.

The next article will conclude this series – though I have not ruled out the possibility of adding a second volume if it is warranted – and discusses the final mischaracterizations offered by McCaughey, as well as ending remarks on the current health care debate.

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Copyright ©2009 Jenny Kakasuleff