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HHS Task Force Mammogram Recs Slammed

Written by Michael Collins World News Nov 19, 2009

Cancer doc (left) tops bureaucrat (right) on cancer recs (WUSA).

HHS Head Sibelius Says, Ignore Panel, Get Checked

Michael Collins

“The (task force) recommends against routine screening mammography in women aged
40 to 49 years.” U.S. Preventative Services Task Force, Nov. 17, 2009

“My message to women is simple. Mammograms have always been an important life-
saving tool in the fight against breast cancer and they still are today. Keep doing what
you have been doing for years – talk to your doctor about your individual history, ask
questions, and make the decision that is right for you.” Kathleen Sebelius, Health and
Human Services Secretary, Nov. 18.

Talk about a short news cycle. A Department of Health and Human Services (HHS)
appointed “best practices” task force dismissed the value of “routine” mammograms as a
cancer prevention technique for women 40 to 49 years on Tuesday, November 17.

A day later, Wednesday, Nov. 18, HHS Secretary Kathleen Sebelius issued a statement
dismissing the committee recommendations.
‘The U.S. Preventive Task Force is an outside independent panel of doctors and scientists
who make recommendations.

“They do not set federal policy and they don’t determine what services are covered by the
federal government.” Kathleen Sebelius, Nov. 18.

The committee is made up of independent practitioners but operates under the

sponsorship of the Agency for Healthcare Research and Quality, HHS. The agency
states that their task force “recommendations have formed the basis of the clinical
standards for many professional societies, health organizations, and medical quality
review groups.”

Sebelius didn’t care. Amidst Republican outcries that this was the way Democratic
sponsored health reform would operate, she issued her terse statement dismissing the
dismissal of mammography for women 40 to 49.

The DC flap started when Diane Rehm had task force member Dr. Diane Pettiti, MD on
her show yesterday, Nov. 18. She asked the doctor for the name of one cancer specialist
on the task force. Petitti was unable to answer (video 1:53). The doctor also told Rehm
that “Cost effectiveness was not a part of the discussion. Cost was not uttered in the
room.”

Dr. Rebecca Zurrbier, MD, Chief of Breast Imaging at Sibley Memorial Hospital in
Washington, DC was listening to the Rehm show and became incensed. She pointed out
that no one on the committee had either a clinical specialty or indicated any direct
experience in treating cancer in a WUSA, Channel 9 special news feature (video).
Zurrbier’s WUSA critique was a devastating counterpoint to Rehm’s skillful questioning
on her radio show earlier in the day.

The HHS sponsored task force had 16 members. These members issued a statement on
cancer treatment. There is not one oncologist on the panel nor is there a radiologist. The
specialties of task force physicians consist of: Family Medicine (4 members); Pediatrics
(2); Obstetrics and Gynecology (2); Internal Medicine (2); Geriatrics (1); Epidemiology
(1); Primary Care (1). The non MD’s had these specialties: Nurse Practitioner –
Psychiatry (1); Nurse Practitioner – Family Medicine (1); and, PhD researcher (1).

If you were seeking treatment for cancer or consultation on current treatment, would you
consult anyone with the specialties listed? Not if you’re concerned about your health.
Cancer is not what these doctors treat. Dr. Zurrbier’s point was so obvious, she seemed
amazed that this kind of finding could even occur. So should we.

WUSA’s did an on-the-spot review of task force member affiliations. They came up with
three members tied to HMO’s or health insurance companies. Dr. George Isham, MD is
the Chief Health Officer for a major health care provider, Health Partners. Dr. David
Grossman, MD, is an investigator a research division of the Group Health Cooperative
health care network in the Seattle area. Dr. J. Sanford Schwartz, MD, is the past
executive director of the Leonard Davis Institute of Health Economics at the University
of Pennsylvania. He’s also on the Blue Shield Medical Advisory Panel.

There are three other affiliations that deserve note.

Task force Chairman, Bruce Nedrow Calonge, MD, is a Colorado physician who is the
Chairman of the Colorado Foundation for Medical Care, a major advisor on “quality
improvement” in care for the state and other health care organizations. Dr. Pettiti, who
said the recommendations would have no influence on insurance coverage, is a health
policy and medical advisor for Kaiser Permanente of Southern California. Joy
Melnikow, MD is the associate medical advisers for Healthwise, a medical
knowledgebase company serving health providers, insurance companies, and government
entities. The firm also provides software for patient information.

Thanks to the incisive questioning of NPR syndicated radio host Diane Rehm and the
quick and clear response of cancer specialist, Dr. Zurrbier on WUSA, the issue hit the
public airwaves and was quickly resolved with the rapid response of HHS Secretary
Sebelius.

Now it’s time to find out how this HHS research organization could impanel a group of
experts to recommend cancer treatment protocols when none of the physicians on the
panel were oncologists and none had any identified clinical experience treating cancer.
It’s also a good time for those on the task force to examine why they chose to issue this
guideline without cancer researchers and clinicians on the committee?

Why were the deficiencies in this process, so obvious to us, too difficult for the HHS
administrators to grasp?

END

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