Members of the Task Force

[Margerie]

I looked it up here (http://www.ahrq.gov/clinic/3rduspstf/breastCancer/brcanrr.htm)
Members of the Task Force***

Members of the U.S. Preventive Services Task Force are Alfred O. Berg, M.D., M.P.H., Chair, USPSTF (Professor and Chair, Department of Family Medicine, University of Washington, Seattle, WA); Janet D. Allan, Ph.D., R.N., C.S., Vice-chair, USPSTF (Dean and Professor, School of Nursing, University of Texas Health Science Center, San Antonio, TX); Paul S. Frame, M.D. (Tri-County Family Medicine, Cohocton, NY, and Clinical Professor of Family Medicine, University of Rochester, Rochester, NY); Charles J. Homer, M.D., M.P.H. (Executive Director, National Initiative for Children's Healthcare Quality, Boston, MA); Mark S. Johnson, M.D., M.P.H. (Associate Professor of Clinical Family Medicine and Chairman Department of Family Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ); Jonathan D. Klein, M.D., M.P.H. (Associate Professor of Pediatrics and of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY), Tracy A. Lieu, M.D., M.P.H. (Associate Professor, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, MA); Cynthia D. Mulrow, M.D., M.Sc. (Professor of Medicine, University of Texas Health Science Center, Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX); C. Tracy Orleans, Ph.D. (Senior Scientist, The Robert Wood Johnson Foundation, Princeton, NJ); Jeffrey F. Peipert, M.D., M.P.H (Director of Research, Women and Infants' Hospital, Providence, RI); Nola J. Pender, Ph.D., R.N. (Professor and Associate Dean for Research, School of Nursing, University of Michigan, Ann Arbor, MI); Albert L. Siu, M.D., M.S.P.H (Professor of Medicine, Chief of Division of General Internal Medicine, and Medical Director of the Primary Care and Medical Services Care Center, Mount Sinai School of Medicine and The Mount Sinai Medical Center, New York, NY); Steven M. Teutsch, M.D., M.P.H. (Senior Director, Outcomes Research and Management, Merck & Company, Inc., West Point, PA); Carolyn Westhoff, M.D., M.Sc. (Associate Professor of Obstetrics, Gynecology and Public Health, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY); and Steven H. Woolf, M.D., M.P.H. (Professor of Family Medicine, Department of Family Practice, Virginia Commonwealth University, Richmond, VA).

If anyone is keeping score that is:

oncologist- 0
radiologists- 0
breast cancer surgeons- 0
breast cancer specialist of any kind- 0
anyone that has treated cancer (any cancer) -0

family medicine physicians- 4
pediatricians- 2
ob/gyns- 2
internal medicine physicians- 2
geriatrics- 1
epidemiologists- 1
primary care physicians- 1
nurse practicioner (psychiatry)- 1
nurse practioner (family medicine)- 1
PhD researcher (focus is tobacco use) - 1
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Sorry folks this report card and task force listed above is for the 2002 panel. The current panel is in my correction post below and the rest of this post is a review of the CURRENT panel members, the list above was mistakenly copied from the 2002 panel. Don't worry yourselves, LOL, the current panel scorecard is almost exactly the same. 0 breast cancer, oncology, radiology, you get the idea and sorry for the interruption.......
************************************************** *********************************

I always say if something stinks, check your shoe. What stinkbomb I found is that numerous members of this 16-member panel are currently or have been directly involved with the HMO or health care industry.

This information came directly from USPSTF (http://www.ahrq.gov/clinic/uspstbio.htm)

Dr. George Isham, MD is the Chief Health Officer for a major health care provider, Health Partners (http://www.healthpartners.com/portal/27h.html). "Dr. Isham is responsible for quality, utilization management, health promotion and disease management, research, and health professionals' education at HealthPartners. He is active in strategic planning and policy issues. He is an experienced primary care clinician and was chair of the Institute of Medicine committee that produced the report, Priority Areas for National Action: Transforming Health Care Quality." (quote from the Health Partners website)

J. Sanford Schwartz, MD, is the past executive director of the Leonard Davis Institute of Health Economics (http://www.upenn.edu/ldi/about.html) at the University of Pennsylvania. He's also on the Blue Cross and Blue Shield Medical Advisory Panel. He was also formerly the Editor of the American Journal of Managed Care (http://www.ajmc.com/)

Diana B. Petitti, MD (the Vice Chair of this panel who said that these recommendation would have no effect on health insurance coverage) was a Senior Scientific Advisor for Health Policy and Medicine at Kaiser Permanente of Southern CA.

Joy Melnikow, M.D is a contributing member of the California Health Benefits Program Task Force (http://www.chbrp.org/)for the University of California's Office of the President and associate medical director of Healthwise, Inc (http://www.healthwise.org/).



Hmmmmm... I know I am not open-minded nor devoid of paranoia, but if you were to assemble a health care/action committee to review and possibly revise breast cancer screening guidelines for the good citizens of the U.S.A., would you not want SOMEONE on this panel that has treated a breast cancer patient? Would you consult any of these people if you had, or suspected you had breast cancer?? Is it not a conflict of interest, or at least VERY bad taste, to have the health care industry represented (by some means) by at least 25% of this panel and breast cancer specialists make up 0%? And we are supposed to believe there is no motivation here except to better the health of American women overall?


I think this smells like &$#@! (and I am not ranting, just presenting information to share, OK a minor rant at the end here, please forgive my hysteria)

[Laurel]

Very, very interesting, Margerie. Thanks for the detective work and you have presented us all with some information to chew on. Well done.

[alicem]

Thanks for all your hard work in researching this. Very interesting indeed!!

[ElaineM]

Thanks for doing all the research !!

[Margerie]

I can take no credit for research, it was all in plain sight on the USPSTF site. But getting all the links in and not have the page timeout was stressful, and the reason I had to edit.

[hutchibk]

FANTASTIC work Margerie! Well done. I need to take it all in, but it definitely reveals a deeper truth, no?

[Margerie]

I must apologize for screwing up the top part of my original post (too much copy, pasting and linking) Believe it or not, but the government's website can be confusing. The LIST at the top was actually the 2002 task force. Everything below the scorecard IS the current panel member's bio information.

The Current 2009 Members of the Task Force

Bruce Nedrow (Ned) Calonge, M.D., M.P.H. (Chair)- Associate Professor of Family Medicine and of Preventive Medicine and Biometrics at the University of Colorado Health Sciences Center

Diana B. Petitti, M.D., M.P.H. (Vice Chair)- Professor of Biomedical Informatics at the Fulton School of Engineering, at Arizona State University

Susan Curry, Ph.D- dean of the College of Public Health and distinguished professor of health management and policy at the University of Iowa

Allen J. Dietrich, M.D.- board-certified family physician, is a professor of community and family medicine at Dartmouth Medical School

Thomas G. DeWitt, M.D.- Professor of Pediatrics

Kimberly D. Gregory, M.D., M.P.H.- Director of Maternal-Fetal Medicine and Director of Women's Health Services Research at Cedars-Sinai Medical Center, Los Angeles, CA

David Grossman, M.D., M.P.H.- board-certified pediatrician

George Isham, M.D., M.S.- Medical Director and Chief Health Officer for HealthPartners, a large health care organization in Minnesota

Michael L. LeFevre, M.D., M.S.P.H.- Professor in the Department of Family and Community Medicine at the University of Missouri School of Medicine

Rosanne Leipzig, M.D., Ph.D.- board-certified internist and geriatrician


Lucy N. Marion, Ph.D., R.N.- family medicine/psychiatric nurse practioner


Joy Melnikow, M.D., M.P.H.- professor in the Department of Family and Community Medicine and associate director of the Center for Healthcare Policy and Research at the University of California Davis. She is currently a deputy editor of Medical Care, standing member of the health services organization and delivery study section at the National Institutes of Health


Bernadette Melnyk, Ph.D., R.N., C.P.N.P/N.P.P.- pediatric and psychiatric nurse practioner


Wanda Nicholson, M.D., M.P.H., M.B.A.- board-certified obstetrician-gynecologist and a perinatal epidemiologist

J. Sanford (Sandy) Schwartz, M.D.- board-certified internal medicine specialist

Timothy Wilt, M.D., M.P.H.- board-certified internal medicine specialist

and folks this score card is not much different:

family medicine- 5
biomed informatics- 1
health management and policy (PhD)- 1
pediatrics- 2
ob/gyns- 2
internal medicine- 3
nurse pracitioners (family medicine/psychiatry/peds)- 2

but most importantly (IMHO) the score is STILL:

oncologists- 0
radiologists- 0
breast cancer surgeons/specialsists- 0

sorry for the inconvenience, I will make a note at my original post to hopefully prevent the whiplash

also the quote in my original bio of Dr. Isham was from the USPSTF site itself and not his health care organization's website

[Debbie L.]

Margerie and all,

It's not an accident that the task force does not include oncologists and radiation oncologists. The task force's job was to provide an unbiased review of the evidence, which is best done by those who have expertise in epidemiology but not in the field being reviewed. They want people evaluting the evidence with open minds, not people who already think they know the answer. IOW, they didn't just sit down and say "well, what do YOU think?". They evaluated the evidence from many different perspectives (directly, and with various computer modeling strategies). First, they evaluate the quality of the studies that are available, and then they use the good quality studies to put together the guidelines. The evidence itself was amassed by breast cancer experts. Does that make sense?

And btw, I'm not sure it's been mentioned here - but the guidelines that they came up with are essentially the same guidelines that are used in Europe and Canada.

I don't know if anyone has access to "The Cancer Letter" but I heard that this question about the panel's composition is nicely addressed there.

Debbie Laxague

[Laurel]

Why would we wish to be Canada and Europe, especially the U.K.?

[v-ness]

excellent point, laurel. -valerie

[Margerie]

Well, call me naive, but if at least one-quarter of the panel have been directly involved in the business of healthcare (as in paying for screening tests), this is NOT an UNBIASED panel. If they had consulted an actual breast cancer radiologists they would have discovered:


The analysis was based on older mammography techniques, meaning the researchers mostly looked at results from film mammograms instead of digital mammograms.
The analysis was based on some inaccurate assumptions about optimal treatment after breast cancer is diagnosed. For example, it assumed that women diagnosed with hormone-receptor-positive, early-stage breast cancer would receive and benefit from hormonal therapy but not chemotherapy, even though we know that many of these women do receive and benefit from chemotherapy after surgery. Inaccurate assumptions like this may have caused the researchers to underestimate the number of lives that would be lost should the proposed changes in screening be adopted.
The analysis did not adequately consider the combined benefit of early detection (with current screening guidelines) and new treatments that have resulted in steadily improving survival rates in recent years. Screening cannot be looked at in isolation as a snapshot. Screening happens as we continue to improve both diagnosis and treatment. But we can’t treat what isn’t diagnosed.
The proposed guideline changes would mean that many breast cancers would be diagnosed at a later stage, making it harder to become cancer-free. Later-stage diagnoses result in more women with metastatic disease (that has spread to other parts of the body) and more women with large or multiple cancers requiring mastectomy (too late for breast-conserving treatments).
The proposed guideline changes would mean that younger women would be diagnosed later. Breast cancer in younger women tends to be more aggressive, so early diagnosis and treatment is more critical for them. It is the lives and futures of younger women that would be lost if the proposed changes are adopted.
Expressed as nameless, faceless numbers, the 3% decrease in breast cancer survival might seem like an acceptable trade-off when compared to the economic benefits of changing breast cancer screening policies. But breast cancer affects a very large number of women, so 3% of that number is not insignificant. The reality is that more women -- mothers, daughters, sisters, grandmothers, and aunts -- will die each year from breast cancer, which is neither reasonable nor acceptable.


The above information came from three renowned breast radiation oncologists (http://www.breastcancer.org/opinion/mamm_guidelines/letter.jsp). You know, the people who treat breast cancer.

I don't see how anyone can say this was an unbiased panel.

[StephN]

Here is the list of other health issues this panel is working on. I don't know if the members change or how often, but they are just numbers crunchers, and I wish I knew who feeds them the data that they use to crunch on. This so-called "expert" panel can't know what is involved in treating all these conditions!

You Are Here: AHRQ Home (http://www.ahrq.gov/) > Clinical Information (http://www.ahrq.gov/clinic/) > U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/uspstfix.htm) > Topics in Progress

U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/uspstfab.htm)

Topics in Progress

These topics are being reviewed by the U.S. Preventive Services Task Force:

- Aspirin Use to Prevent Preeclampsia
- Cervical Cancer Screening
- Depression in Adults
- Falls in Older Adults
- Hearing Impairment, Older Adults
- Oral Cancer Screening
- Osteoporosis Screening
- Osteoporosis Preventive Medicine
- Ovarian Cancer
- Skin Cancer Counseling
- Vitamin Supplements to Prevent Cancer and CHD

Current as of November 2009

[Carolyns]

Thank you for this list and the breakdown of participants in the panel.

Excluding members with actual experience in the trenches seems like the Ivory Tower mentality to me. I mean look behind the curtain of numbers and excel spreadsheets and there is always another story to be told. God help us if accounting practices are going to rule the world and we chose to ignore the folks with boots on the ground. Certainly both perspectives should be considered before making such a broad recommendation with such heavy consequences.

I wondered why they didn't consider looking at the African American population of breast cancer patients. I met some advocates who work in the African American population at a recent conference and I learned that a large number of African American Women are diagnosed at Stage III. According to the advocacy groups this population is largely lacking in access and information and as a result they are routinely diagnosed at Stage III. Also, due to a lack of coverage they are more likely to ignore a lump afraid of the financial implications of having breast cancer and being under insured or uninsured. They also die of the disease at a much higher rate. Why not consider the results of this group of women who are already not getting mamos or doing self exams.

How can it be that there isn't on patient or patient advocate on the panel? Breast Cancer is a quite unique disease where personalized medicine has come so far. Unfortunately this fact is known by few outside of the Breast Cancer specialty world. I have heard that in some Countries a person with advanced breast cancer is only allowed two lines of chemo because it is considered to be useless after that. I am on my 14th line on therapy and so far… still responding – working full time and taking care of my son.

I must hope and pray that all of these efforts are well intended but I am also mindful that unintended consequences can result in a lack of access for me because of a lack of knowledge from a panel of “experts”.

[Sandra in GA]

Margerie and Carolyn,
Thanks to both of you. You have posted some very important information and deductions. I feel we all have to keep our eyes, ears and minds open when faced with new information. I personally feel that there should have been oncologists, breast surgeons, and oncology radiologists on the panel. I learned from one of my professors when I was in graduate school to become wary of researchers, they are biased by design and can find evidence to prove what they set out to prove. I know that a report that included a more balanced panel whould have had more validity.
Sandra

[hutchibk]

All I can say is WOW, Margerie. Thank you. Thanks all. This is amazing deductive detective work, and I appreciate it...