In a Wall Street Journal op-ed, Betsy McCaughey misrepresented remarks by Dr. Jeffrey Borer to suggest that he is opposed to treatment guidelines when, in fact, he stated that guidelines are “needed” and “very valuable” while noting that “they have important limitations.” McCaughey further advanced the claim that White House health care adviser Ezekiel Emanuel supports rationing of health care and attributed the claim to a doctor who belongs to a conservative-leaning group that holds several controversial views and has promoted the right-wing conspiracy theory that Vince Foster didn't commit suicide.
Rehashing debunked falsehoods, McCaughey claimed “Government-Imposed Treatment Guidelines” are included in health reform plans
From McCaughey's October 29 Wall Street Journal op-ed:
Doctors from across the country were invited to the White House on Oct. 5, but the president did most of the talking. Medical professionals are being ignored or vilified more often than consulted in the current health-care reform debate. To broaden the discussion, the Committee to Reduce Infection Deaths invited 16 highly regarded physicians to convene at the Grand Hyatt in New York City on Oct. 19 to reflect on the current legislative proposals. Here's what they had to say on four key issues.
Government-Imposed Treatment Guidelines
Dr. Jeffrey Borer, cardiologist, named to Castle Connolly's “America's Top Doctors”: “What's the impact of guidelines on the doctor-patient relationship? Guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing. There really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem.”
McCaughey repeated false claims about stimulus bill, Blumenthal article to suggest government will mandate “adher[ence] to the guidelines” for treatment. During the October 19 forum from which McCaughey drew the content of her Journal op-ed, McCaughey introduced the discussion of treatment guidelines by stating:
MCCAUGHEY: The topics you'll see on your agenda were suggested by you, be we don't have to stick to them. This can be as free-ranging a discussion as you want it to be. Tonight, the physicians are in charge. The first topic you'll see on the agenda is the impact of guidelines on the doctor patient relationship. When the Stimulus legislation was signed into law last February 17th it provided in part that protocols would be delivered to doctors electronically via computer on what the government deems appropriate and cost-effective care, and beginning in 2014 doctors who are not meaningful users of this new system will face penalties from Medicare and Medicaid.
In March, Dr. David Blumenthal was appointed National Coordinator of Health Information Technology and on April 9th in the New England Journal of Medicine he expanded a bit on what these protocols would mean. He explained in that article that “embedded clinical-decision support”, his phrase for computer guiding doctors, would be employed to persuade physicians to practice in a way that the government deems appropriate and cost-effective and the doctors who feel a loss of autonomy, he predicted some might rebel and petition Congress to change the law or simply reconcile themselves to penalties rather than adhering to the guidelines.
So, all of the current legislative proposals, address the issue of guidelines in some very broad language. I've asked Dr. Jeffrey Borer to open up the discussion on the issue of guidelines and their impact on the doctor-patient relationship and we'll take it from there.
McCaughey rehashed stimulus falsehood from which she previously backtracked. During a February 10 appearance on CNN's Lou Dobbs Tonight, McCaughey advanced the false claim that information technology provisions in the economic recovery act would permit the government to eliminate "[w]hatever the federal government deems unnecessary care." CNN senior medical correspondent Elizabeth Cohen reported during the February 11 edition of CNN Newsroom, “I had a PDF of the bill up on my computer. I said, 'Show me where in the bill it says that this bill is going to have the government telling your doctor what to do.' And she directed me to language -- it didn't actually say that. But she said that it was vague enough that it would allow for that to happen in the future.” Cohen added, “Now when we asked the folks who wrote this bill, 'Hey, is this bill going to allow the government to tell doctors what to do?” they used words like, 'preposterous' and 'completely and wildly untrue.' " FactCheck.org similarly concluded that “the idea that this will lead to federally mandated treatment guidelines is her supposition. The fact remains that law does not impose any federal treatment guidelines or require that the government do so.” McCaughey's claim is one of a series of instances in which she was caught making an outright false claim about health care reform and backtracked, but nonetheless continued to attack and distort progressives' policies without acknowledging her backtrack from her prior falsehood.
McCaughey has previously mischaracterized Blumenthal to claim he backed up her stimulus falsehood. In an October 5 op-ed, McCaughey wrote that Blumenthal “settled that debate” about health information technology and that Blumenthal “confirmed that 'embedded clinical-decision support' (his term for computers telling doctors what to do) would be used to reduce costs, and he predicted that some doctors might rebel against tight controls.” In fact, contrary to McCaughey's claim that Blumenthal “predicted that some doctors might rebel against” the stimulus bill's provision because “computers” would be “telling” them “what to do,” in his March 25 New England Journal of Medicine article, Blumenthal actually wrote that “many physicians and hospitals may rebel” if “the requirements” for receiving the stimulus bill's incentives for adopting electronic health records (EHRs) are “set too high.”
Flashback: McCaughey fear-mongered about treatment guidelines to attack reform in the 90s. The New York Times reported on February 6, 1994, “Ms. McCaughey raises fears another notch when she cites 'mandatory' practice guidelines that would 'compel doctors to uniformly practice low-budget medicine.' What she doesn't say is that treatment guidelines would not be compulsory. They would merely be recommended procedures that, if followed, could serve as a backstop against malpractice suits. Health plans would still decide how to treat patients. Mandatory is her word, not Mr. Clinton's.”
McCaughey suggested doctor generally opposes treatment guidelines, when in fact he said they are “needed”
McCaughey spliced Borer's quote, eliminating positive comments about treatment guidelines. McCaughey asserted that Borer said of treatment guidelines: “Guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing. There really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem.” However, this quote was taken from two different parts of Borer's response. McCaughey gave no indication in her op-ed that she had spliced the quote.
Borer also stated that treatment guidelines are “needed” and “very valuable” while noting “there are some limitations.” During the forum, Borer stated that non-mandated treatment guidelines are “very valuable, especially if a doctor is faced with a patient who has a problem that isn't totally familiar to him or her because guidelines provide a very reasonable starting point and sometimes much more than starting point for evaluating and managing a patient, but there are some limitations and we have to be aware of what the limitations are.” He further stated that "[g]uidelines are needed and these discussions and consensus documents are created because definitive data on which to unerringly base management strategy seldom exist. If they did, then guidelines committees wouldn't be necessary." Borer added that “I think that guidelines are very valuable, very useful, very important, but they have important limitations and ultimately in the worst case scenario they stand between the doctor and the patient.”
From the transcript of McCaughey's October 19 forum (portions quoted by McCaughey in bold)
McCAUGHEY: I've asked Dr. Jeffrey Borer to open up the discussion on the issue of guidelines and their impact on the doctor-patient relationship and we'll take it from there. As each of you chooses to join the conversation for the first time, please identify yourself and it's up to you what you want to tell us about yourself. The opinions and insights expressed tonight are your own, not necessarily those of your institution. So, Dr. Borer -- and please use the microphones even though it's a small room because then we can easily make this usable on YouTube.
DR. JEFFREY BORER: Thank you, Betsy. You've asked me to make some comments about the impact of guidelines on the doctor-patient relationship. I think before I can do that in a meaningful way, I need to talk about what guidelines are because these can be misunderstood. Guidelines are consensus documents. They're created by a committee and they're meant to provide opinions about how to evaluate and manage the average patient. They're very valuable, especially if a doctor is faced with a patient who has a problem that isn't totally familiar to him or her because guidelines provide a very reasonable starting point and sometimes much more than starting point for evaluating and managing a patient, but there are some limitations and we have to be aware of what the limitations are.
First of all, there really isn't an average patient. Every person that you see with a medical problem has some unusual or unique characteristic and this often has to be considered in dealing with the problem. A second limitation is that these guidelines are constructed by committees of eight, ten, fifteen people who are experienced but who seldom fully agree on anything. So in the construction of guidelines there is a fair amount of horse trading that goes on until a result is reached that no one may be totally happy with but everybody can sort of live with. Guidelines are needed and these discussions and consensus documents are created because definitive data on which to unerringly base management strategy seldom exist. If they did, then guidelines committees wouldn't be necessary. I'll give you an example.
An area in which I'm very active is the evaluation and management of patients with heart valve diseases. In 1996 a set of guidelines was published from the American Heart Association/American College of Cardiology that suggested that patients with a leaking heart valve, specifically a leaking aortic valve, should be treated with vasodilating drugs -- drugs that lower blood pressure -- and that the predominant drug should be an angiotensin converting enzyme inhibitor, a special kind of drug that's used commonly in patients with heart failure and with high blood pressure. That was 1996 and the recommendation was made at the level 1A, which means: “Yes, we believe this is right and we have some evidence.”
When the second set of guidelines came out in 2006, this recommendation had been denoted to 2B which means: “Well, you could do it but we're not really sure and in fact we really don't have any evidence.” What had happened between 1996 and 2006, what had happened was that two studies came out. One suggested that vasodilators and specifically angiotensin converting enzyme inhibitors were bad for patients with leaking aortic valves and the other suggested the same thing. Neither of these studies was definitive. That's the problem, you see. The kinds of definitive evidence that we'd like to have seldom exist. Those kinds of studies are expensive, they're difficult to do, they take many years, but what we had was very little evidence in 1996, two studies that were much more to the point by 2006, totally changing the guidelines. That's not an uncommon scenario.
The point is that guidelines are very useful. They represent a reasonable approach to the average patients and to many patients a good starting point, but they are not definitive. So in answer to the question that's been raised: “What's the impact of guidelines on the doctor-patient relationship” guidelines step in between the doctor and the patient. If it's necessary to respond to guidelines rather than what you see, feel and hear when you're evaluating a person, then perhaps you're going to do something that isn't really the right thing to do because the guidelines aren't perfect. If they were, if the data to support them existed, we wouldn't need them.
So I think that guidelines are very valuable, very useful, very important, but they have important limitations and ultimately in the worst case scenario they stand between the doctor and the patient.
McCaughey again advanced smear that Ezekiel Emanuel seeks to deny care to the elderly
From McCaughey's October 29 Wall Street Journal op-ed:
Dr. Borer: “One of the more common problems that people have as they get older is a disease called aortic stenosis. ... [W]e can relieve that aortic stenosis with an operation with really very acceptable safety, low mortality rates ... if that 85-year-old cannot walk down the street because he or she is too breathless to do so ... or feels light-headed or could faint and break a hip ... then there is really a very good justification for offering the therapy.”
Dr. Richard Amerling, nephrologist, Beth Israel Medical Center, New York: “The example that you give of valve surgery in an 85-year-old is just not going to happen under [White House health care adviser] Ezekiel Emanuel. He's going to just say that that's a nonstarter. That person has outlived their useful years, no matter how long they could live beyond that.”
McCaughey previously distorted Emanuel's writings to smear him as “Rationer-in-chief.” McCaughey, who The New York Times reported has “largely quot[ed]” Emanuel's “past writings out of context this summer,” did so again -- and at length -- in an August 27 Wall Street Journal op-ed. Indeed, she distorted various passages of Emanuel's writings and interviews by cropping and misrepresenting his remarks -- some of which the Times had described in context only days earlier -- to smear him as “Obama's Health Rationer-in-Chief.”
McCaughey hosts doctors belonging to controversial group Association of American Physicians and Surgeons
AAPS has promoted numerous controversial views. McCaughey attributed the quote about Emanuel to Dr. Richard Amerling. Amerling is a director at the Association of American Physicians and Surgeons, a conservative-leaning group that has promoted and endorsed controversial views on medicine and health, including urging doctors not to serve as Medicare providers and supporting a “moratorium on vaccine mandates.” AAPS also filed an amicus brief pressing for the public release of photos of former Clinton deputy counsel Vince Foster -- whom AAPS described as “the attorney assigned by Hillary Clinton to 'fix' the AAPS lawsuit against the Health Care Task Force” -- taken following his 1993 death, which numerous investigations have determined a suicide. The group also published an article falsely claiming that “in the past three years America has more than 7,000 cases of leprosy” and tying the increase to illegal immigration. Dr. David Fields, who is quoted by McCaughey in the Journal op-ed, is also affiliated with AAPS. According to an AAPS newsletter, Fields joined the association in 1993. He also spoke at the AAPS annual meeting in 2007.
Doctor who circulated witch-doctor photo of Obama is also affiliated with AAPS. David McKalip, the doctor who notoriously emailed a racist image depicting President Obama as a witch doctor to his fellow “tea party” activists is also affiliated with AAPS. AAPS' “Take Back Medicine” website features an "open letter to America's physicians" by McKalip asserting that health care reform will “turn doctors into servants of the state, insurance companies, hospitals, and everyone except who matters most: the patient.” McKalip stated recently that he attended “a meeting of the Association of American Physicians and Surgeons.” McCaughey has previously quoted McKalip in a New York Post op-ed.
Doctors on McCaughey's panel previously appeared on Beck's doctor special. Three of the doctors on McCaughey's panel of “16 highly regarded physicians” -- Amerling, Tracy Pfeiffer, and Marc Siegel -- appeared on Glenn Beck's Fox News program on October 16, when he hosted a panel of doctors to discuss health care reform. Siegel is listed on FoxNews.com as “a Fox News medical contributor.”
McCaughey is a serial health care misinformer
McCaughey exposed as Big Tobacco shill during 1994 health care debate. Rolling Stone recently revealed that in 1994, tobacco giant Philip Morris implemented a “strategy to derail Hillarycare,” which included an “effort to 'work on the development of favorable pieces' with 'friendly contacts in the media' ” -- specifically mentioning the company's collaboration with McCaughey on her 1994 New Republic hit piece on the Clintons' health care reform bill. This disclosure, combined with a previously exposed conflict of interest, should destroy any remaining credibility she has with the media as an expert in health care reform acting in the public interest.
McCaughey returns to CNBC with another false health care attack. On CNBC, McCaughey advanced the false claim that the “legislation that's now in Congress will force everyone under age 65 to buy the same one-size-fits-all government plan” and that “Page 16” of the House bill “says you must be enrolled in a qualified plan.” In fact, McCaughey's claims are false; the provision she referred to does not require anyone to give up their private individual health insurance plan.
Media echo McCaughey's false end-of-life counseling claim. On July 16, McCaughey falsely claimed that the House health care reform bill would “absolutely require” end-of-life counseling for seniors “that will tell them how to end their life sooner.” Since then, numerous media figures have echoed McCaughey's claim -- even after the falsehood was debunked and McCaughey herself backtracked.
McCaughey claimed Senate bill pushes everyone “into an HMO-style plan.” McCaughey repeatedly falsely claimed that the Senate HELP committee's bill “basically” “pushes everyone into an HMO-style plan.” On June 24, McCaughey further asserted on CNN that under the Affordable Health Choices Act most Americans will have to “go through what they call a 'medical home,' which is this decade's term for an HMO gatekeeper.” However, under the proposed legislation, individuals already enrolled in a health care plan or receiving health insurance coverage are able to keep their coverage and are not “pushed” into “an HMO-style plan.”
Media have repeatedly hosted McCaughey to discuss health reform. The Atlantic's James Fallows has pointed to McCaughey as an example of someone for whom there “seems to be almost no extremity of being proven wrong which disqualifies” her from being given a platform in the media. Indeed, despite her numerous falsehoods and past conflicts of interest, throughout the health care reform debate in 2009, McCaughey has been an ever-present part of the media discussion. She has been hosted on CNN at least twice and on Fox News repeatedly to weigh in on health care reform. Additionally, according to a search of the Nexis database, The Wall Street Journal and the New York Post have each published four pieces by McCaughey about health reform; Bloomberg News also published a commentary by McCaughey on health care reform provisions in the recovery act.