March 29, 2008 – Dr. Ward Casscells is assistant secretary of defense for health affairs. A prominent Houston cardiologist with interests ranging from disaster preparedness to bird flu, Casscells shook his life up when he enlisted in the U.S. Army Reserves in 2005, then accepted President Bush’s nomination in 2007 to become the military’s top health officer. Casscells, who was in Houston last week to speak at a nursing conference, talked with Houston Chronicle reporter Todd Ackerman about a wide range of issues, including the neglect scandal at Walter Reed Army Medical Center and his own battle with cancer.
Q: So how do you find Washington compared to Houston?
A: It’s less homogenous, less of a city, doesn’t have that big civic pride. It’s more where the country comes to talk and make decisions.
Q: What’s been the biggest challenge?
A: Walter Reed, Walter Reed, Walter Reed. We’ve made good progress. It’s always better when you get all sorts of people looking over your shoulder. Patient satisfaction is improving, but public perception is lagging. There’s two new polls out — one found 75 percent of our patients think military health care is on the right track. The other found that only 21 percent of the public does.
Q: What’s the underappreciated health issue that soldiers in Iraq face?
A: We talk a lot about concussions and traumatic brain injury, but the biggest challenge is the psyche. Those who feel we’ve done good over there face the least problems. Those who feel our activities there are a mistake and those who feel they let the team down are at higher risk.
Q: Do you have an opinion about Gulf War syndrome, the mysterious illness some veterans think was caused by wartime exposure to biological and chemical toxins. Do you think that link is real?
A: It’s hard to sort out the component that’s psychological. There’s some suggestive evidence, but it’s not very strong. That doesn’t rule it out — the absence of evidence isn’t proof. But what is clear is, whatever triggered it, we owe those veterans care.
Q: We spend something like 10 times more on bioterrorism preparedness than on hurricane preparedness. Is that really justified?
A: Maybe not. It is true that local governments need the authority to make their own plans. In Biloxi, you want money for hurricanes, not the Ebola virus or anthrax.
Q: Was bird flu overhyped?
A: I don’t think so. But of course, I was one of the big hypers. You never prevent a pandemic, which comes every 30, 40 years, but it’s important to be as prepared as possible.
Q: Isn’t there a danger people will start tuning out public health officials when these catastrophes don’t materialize?
A: That’s a concern, certainly. We’re at the point where, when fire alarms go off in buildings, almost no one responds. Are we at that point with bird flu? I don’t think so, but it’s a significant risk. Though you can’t be sure, H5N1, the current bird flu, probably isn’t going to cause a pandemic — it still needs a number of major mutations. But it might be H6N1, or whatever combination of letters and numbers they give the next virus.
Q: People in the Medical Center know you have prostate cancer, but I’ve never heard you talk about it. Can you? I’d heard it was pretty advanced.
A: It was terrible. I was dying. I always had great medical care, but my doctors made a mistake. Even though I was always a cancerphobe, often going in for tests, by the time it was diagnosed, it had spread from head to toe, to my skull and my liver. I was told I probably had three years to live. But an M.D. Anderson doctor told me to disregard such prognoses and put me on constantly changing combinations of drugs that have kept me in good health for almost seven years now. I have chronic prostate cancer — I take 52 pills a day — but I’m still here.
Q: And yet, despite all that, you enlisted in the Army Reserves at 52. What was basic training like at that age?
A: It was hard. I trained for a couple of months before, and I still struggled. I struggled with the heat, the cold, the exercises, the obstacle course, everything.
Q: So why did you do it? You’ve got three kids and a potentially deadly disease. Why take on so much?
A: As I’ve gotten older, I’ve gotten more adventuresome. I want to set an example for the kids, and it keeps me from focusing on my own problems.
Q: What will a change in administration mean for your office?
A: We’ll all submit our letters of resignation Jan. 20, then assist in the transition process. (Barack) Obama and (Hillary) Clinton will be pleased to find the military is more favorable to women and minorities than any institution in the country, that it operates in an objective, non-sexist, non-prejudiced way. (John) McCain will take that for granted. But since he knows the military so well, he’ll reach deeper down in the organization and hand-pick not just, say, the secretary of defense but numerous layers below.