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 skilful 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 Medcine (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?

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