Friday, November 20, 2009

Pettiti and Asses

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

When I read stories such as this from guys like Michael Collins I have to wonder aloud how far we've really gotten from the fake panels and ignorant civilians that always seemed to be employed by the Bush administration.

True, HHS Secretary Kathleen Sibelius did the right thing and swiftly denounced a report from an HHS-sponsored U.S. Preventive Services Task Force panel claiming that breast examinations weren't all that important for women aged 40-49. Secretary Sibelius said in her official response,
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... 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.

Yes, you read that right. In fact, they even recommended against regular mammography screenings for women in that risky demographic.

The panel of 16 members, including two nurses and a researcher (but she had a PhD!) had not one single oncologist or anyone with a recorded history of treating cancer. Huh? How could this be, since the thrust of the panel was preventive medicine.

So who was one of the voices of this panel? None other than the ironically-named Dr. Diane Pettiti, M.D. Who is Dr. Diane Pettiti, MD? She is, to quote Michael Collins' simple description, "a health policy and medical advisor for Kaiser Permanente of Southern California." Kaiser Permanente? The people mentioned often in Michael Moore's SiCKO, the largest health insurer in the country, the one that routinely shoves uninsured patients into cabs and leaves them wandering the streets of LA in the general vicinity of free clinics with the IV's still in their arms?

The Kaiser Permanente who, under Richard Nixon in 1971, began to change the way HMO's would cover their policy-holders, the one that became the soulless juggernaut prizing profits over the health of their policy-holders, the model for other HMOs to emulate over the next four decades?

That Kaiser Permanente?

WUSA did an in-depth report and found out that three of the panel members had ties to the health care industry, not including Pettiti. The furor stated when NPR's Diane Rehm had Dr. Pettiti on her show and asked her point blank how many oncologists were on the panel and she couldn't answer. Among others, Dr. Rebecca Zurrbier, MD was listening to Rehm's show and became enraged by what she'd heard. Dr. Zurrbier is the Chief of Breast imaging at Sibley Memorial Hospital in DC and when she went public with her own outrage, Secretary Sibelius had no choice but to denounce the report the day after it came out.

Question: How could this happen under Sibelius' nose and why were oncologists and breast cancer specialists seemingly deliberately omitted from a 16 member panel supposedly dedicated to preventive medicine such as mammograms? Why were so many of them affiliated with a health care racket and a notorious HMO like Kaiser Permanente that would love nothing more than for people to stop getting sick and to squander their bottom line on frivolous things such as cancer screenings?

And how come it was up to NPR, WUSA and a breast imaging chief of staff to turn up this obviously tilted panel?

We had enough of this shit under the Bush years. Under Bush, we had a 24 year-old college dropout determining what NASA scientists could or couldn't say about the Big Bang. We had religious fundmentalists in the FDA spreading the wrong ideas about womens' health and birth control and others who owned stocks in the food and medical device industry they were supposed to regulate. We saw the same suppression of information in the EPA, the Surgeon General's office and other places. Under Bush, there was an all out Cold War against science that poo-pooed global warming, the plight of the polar bear, evolution, stem cell research, even the origins of the universe.

But at least it can be said that the shills and ideological rodeo clowns of the pathetic dumb show that was the Bush administration earnestly believed through some tragic misguidance the positions they took.

This panel of preventive medicine was acting largely, if not solely, in the interests of health care profits. And that's what makes this HHS-sponsored panel even more despicable.

And this report came out a little over two weeks after Breast Cancer Awareness month.

Believe it or not, there are still many women who die from breast cancer through lack of education. In fact, breast cancer is the second leading cause of cancer death among US women (after lung) . According to, 40,170 women (and 440 men) are expected to die of the disease this year. stated late last September that 192,370 women will be diagnosed with the disease in 2009. So how important is screening, in reality?

Early last year, the British National Health Service released a finding that was hardly startling but one that stands in stark contrast to the "findings" of the voodoo panel that briefly had the HHS seal of approval written all over it: The NHS determined that merely getting screened halves cancer deaths. If that goes for the UK, why shouldn't it go for the US?

Molly Ivins, liberal icon and one of the greatest political journalists of our time, said just before her own death of breast cancer, "Get. The. Damned. Test. Done."

And while we're renewing the battle to have women (and men) screened for breast cancer (and to examine themselves once a month), let's also renew calls to screen out industry ideologues and shills who will try to get away with saying anything even though it could result in the deaths of close to 200,000 women just so they could keep their employers and their shareholders fat and happy.


At November 20, 2009 at 9:16 PM, Blogger daveawayfromhome said...

I figured there was an insurance connection here, but I didnt know what it was. Thanks for the info.

At November 21, 2009 at 8:39 AM, Anonymous Susie from Philly said...

This isn't new; it's been an ongoing debate in the public health community for at least two decades. The fact remains that regular exposure to radiation increases your chances of developing breast cancer.

Scientists also know (but don't know why) that the more biopsies a woman has, the more likely it is that she'll develop breast cancer. This is one of the reasons they're trying to avoid unnecessary tests.

And if you read the entire article to which you link, you'll find grounds to question the study and the rather astonishing news that mammograms often lead to cancer treatments for cancer that would never have progressed anyway.

It's well known that radiation and chemotherapy increase your chances of getting cancer at a later date. I don't know about you, but I'm not willing to risk that unless it's absolutely necessary.

It's not as cut and dried as you're making it. And it's not as simple as blaming it on insurance company shills, not this time.

At November 21, 2009 at 8:48 AM, Anonymous Anonymous said...

excellent report! my wife has kaiser.we are watching them very closely.

At November 21, 2009 at 8:59 AM, Anonymous shaw said...

What susie says. I despise insurance companies as much as the next gal, and I don't put anything past them when they're trying to save a few bucks. However, I don't have breast cancer in my family, so I never thought smashing my boobs and zapping them with radiation would be a healthy activity. Nor would getting freaked out by a false positive (1 in 6) and going through more possibly disfiguring tests and procedures.

At November 21, 2009 at 9:07 AM, Blogger MosesZD said...

Your outrage misses some vital points. The United States has the highest first-world breast-cancer rate in the world. We also know, by independent, non-industry-affiliated experts the following:

1. Radiation causes cancer. It's about a 2% chance for each mammogram. (British Journal of Cancer, 2005)

2. Biopsies, as Susie pointed out, can stimulate non-cancerous growths into cancerous growths. Nobody knows why, exactly, but the NIH does fund a lot of studies to figure this out.

3. Every year the radiation exposure from Mammograms kills one in 2000 women via cancer. (Ibid)

4. Mammograms save one in 1900 through early detection.

Just looking at 3 and 4, we can see mammograms are almost as fatal to women, in a population, as the cancer.

This is why the Europeans, with their science (instead of profit or ideology) driven medicine perform so much better than the United States. Here in America, we are way to driven by the extremes on both sides. For example, ideologues, such as yourself, rant on in a fact-challenged, lop-sided, obviously ideological (instead of fact and science based) manner on one side of an issue and greedy doctors who pretend to care on the other.

That doesn't make good medicine. It makes the charlie foxtrot we currently have.

In short, you've just become part of the problem. Not the solution.

OTOH, the panel makes sense. IF we stop causing cancer in low-risk populations where the harm outweighs the good, we cut the rate. IF we stop causing cancer by testing too often, we cut the rate. IF we stop all this unnecessary and wasteful medical expenditures (that do more harm than good overall in large swaths of the population) we cut the rate.

But people whining because there wasn't an oncologist on the panel? How stupid is that? An oncologist is not an epidemiologist or a nuclear medicine specials and his opinion on these manners is NOT EXPERT.

At November 21, 2009 at 9:35 AM, Anonymous Anonymous said...


While your information is important to consider; it's also important to point out the health insurance industry connections on this panel. Dr. Pettiti is not an honest broker in this.

Insurance companies are acting out of a desire to maximize their profits not a desire to save lives.

At November 21, 2009 at 10:21 AM, Blogger Unknown said...

I am a social worker for Kaiser Permanente. As an organization, it is certainly far from perfect, but I really disagree with your characterization, and your facts. For one thing, KP is a not for profit organization. For another, you mention isolated, if terrible, incidents as though they were routine occurrences. In my department (psychiatry), we are always trying to find ways to provide quality care in a cost efficient manner. We have to look at the big picture when we do that --- saving money in the short term by not prescribing a needed but expensive medication may mean spending more money with a very expensive hospitalization ---- so our doctors aren't prevented from prescribing the medications or treatments they believe to be the most appropriate. That goes for mammogram screening as well.

At November 21, 2009 at 10:39 AM, Blogger jurassicpork said...


Kaiser Permanente is not a for-profit organization??? Like they didn't set the heartless, avaricious standard by which all other subsequent HMO's have gleefully followed? Does that go for all the hospitals in CA that they own, the ones that shove indigent, uninsured patients into cabs and kill children with unnecessary delays and red tape?

Non-profit? Are you kidding me? Christ, Sarah, you're no better than your shill Diane Pettiti. Gimme a break!


You bring up some good points but having an annual mammogram does not, to this layman, constitute "regular exposure to radiation" As Moses said, it perhaps will increase your chance of contracting breast cancer by 2%.

Plus, even if if it was just a coincidence, the fact that Kaiser Permanente was represented and not any oncologists or radiologists, that's a coincidence that cannot be ignored. There was a clear conflict of interest just having Pettiti on the panel.

I have to disagree with Moses, however, that early screening only saves one in 1900. That is so divergent from the British NHS findings from 2 years ago that one has to wonder where you got that figure.

At November 21, 2009 at 11:34 AM, Blogger Unknown said...

For some reason, my response to you wasn't posted. I won't repeat everything I said, but it is a fact that KP is a not for profit organization.

At November 21, 2009 at 11:42 AM, Blogger jurassicpork said...

$10.5 billion in the last quarter of 2009, Sarah? That's a lot of non-profit. I wish my life was so unprofitable...

Go troll someone else's blog, will ya? My former family and Hal Turner excepted, we're not all idiots here.

At November 21, 2009 at 12:35 PM, Anonymous Anonymous said...

RE: Cancer and mammograms

I've read elsewhere, recently, that 1 in 2000 women who receive mammograms die from radiation-caused cancer they receive during the procedure. It seems crazy to me that the procedure is even legal.

At November 21, 2009 at 12:49 PM, Blogger Unknown said...

Listen, I'm not trying to be a troll. I'm trying to have a discussion with you. Please don't be like the right wing blogs that demonize a person who has a different perspective.

If you'll give me a chance, I'd like to know something about me and how I form my perspective. You may still not care, but I'm going to try. I'm a 46 year old woman, both a Kaiser employee and patient. I've got a history of breast cancer in my family, and I've been getting regular mammograms since I turned 40. I'm a die hard liberal Democrat, union member, and supporter of universal, single payer health care coverage. I strongly oppose tort reform that limits malpractice awards. I strongly believe that if a health care organization or provider fucks up, there should be consequences and compensation and measures taken to make sure it doesn't happen again.

Now, a couple things about Kaiser. That $10.5 billion figure you point out? That was revenues, not profits, for an organization that operates across the country. Not for profit organizations still have to earn revenues to pay their costs, and invest in the infrastructure and equipment that is predicted to be needed, sometimes many years in the future. It can't operate at a loss, or it goes out of business. The fact is that legally speaking, KP IS not for profit, there are no shareholders to satisfy financially.

One huge difference between KP and other health insurance companies is that treatment services are not decided by a bureaucrat. If I, as an LCSW, or an MD, decide a patient needs a particular treatment, be it a medication, hospitalization, therapy, etc., we don't have to make that request and wait for approval. We can make that decision based on our clinical judgement. Sometimes there is a delay in getting treatment as fast as the patient may want it, because like everything else in the world of economics, there is limited resources to provide for unlimited demands. But we do all we can to make sure that cases are triaged to make sure that urgent needs are met ASAP.

Like I said, I don't think KP is perfect, and I am a vocal critic at times in my clinic when I think there are policies and procedures that are not in the best interest of the patient. My loyalty and concern is always first in the interest of my patients, not KP. But I also think that as health care in the US goes, we do a pretty good job with the resources available. I've tried to make my case without insulting you or anybody else, and I hope you can have some respect for a different perspective even if you still disagree with me.

At November 21, 2009 at 12:54 PM, Blogger Unknown said...

Oh, btw -- looking at the link you provided. LIke I said, the $10.5 billion was revenue, not profits. Also, please note this from the same source:

"As not-for-profit organizations, KFHP/H also use resources to support a wide range of community benefit programs that provide care for low-income individuals and support community-based health partnerships, research, training, and community health organizations. In the second quarter of 2009, KFHP/H approved more than 700 grants and donations to support the needs of its communities. Last year, KFHP/H provided nearly $1.2 billion in annual support to community benefit programs and services which included grants to 2,414 organizations. Given the recession’s impact on the economically vulnerable, KFHP/H also continued to expand charitable care and coverage programs in the second quarter."

At November 21, 2009 at 4:06 PM, Anonymous Anonymous said...

To Sarah --

I am not a Kaiser employee; never have been. BUT I have been a member of Kaiser, off and on, for 28 years. I love Kaiser. Why haven't I been a member the whole time? Because some jobs I had didn't offer Kaiser. Through my work years, I have had every known insurance plan imaginable, and Kaiser is the best. I have 3 children. How could I, as a mother, have chosen an insurance company I didn't trust?

Now that I am retired, I chose Kaiser, and can finally KEEP it.

At November 21, 2009 at 4:44 PM, Blogger jurassicpork said...

OK, Sarah, let me put this in the bluntest terms imaginable:

Calling Kaiser Permanente a nonprofit organization is like calling our mission in Iraq a humanitarian one. Yeah, once in a while we fix a kid's bike and hand out candy so let's just forget about all the Iraqis we've killed, detained and tortured.

I don't see how anyone could not be struck by the conflicting message of this post which calls KP a non profit organization while in the same sentence mentioning, just 15 days ago, profits of $569 million. That's still a projected profit of over $2.3 billion. Two years ago, they posted profits of $2.5 billion and that was just from the first three quarters.

We both know what the top executives make at Kaiser. As far back as 5 years ago, there was a big flap over what their top earners made, considering their tax exempt status. How much did they make? Let's follow the bouncing ball, Sarah, and say it all at once, with feeling:

$1,200,000 a year, not to mention commuting expenses worth $185,000+ and forgivable loans to eight more executives to the tune of $5.1 million. So who's not profiting from Kaiser Permanente's so-called nonprofit structure? Certainly not their top executives. Those would be some of the poor bastards who are literally, literally tossed into the street by Kaiser, a fact to which you still have not alluded.

Yeah, I could see how anyone like you could mistake Kaiser Permanente as an actual, honest-to-God 501(c) 3 outfit.

And I'm not impressed with some corporation that throws a million or two to charitable causes. People cried when Pablo Escobar was killed because of all the work he underwrote in the community but in the end he was still a murderous drug dealer who still killed people and thumbed his nose at the law... sort of like Kaiser Permanente.

I truly hope, Sarah, that you have the smarts to get away from Kaiser ASAP at the earliest available opportunity. The way HMOs are the way they are now is because Kaiser started the ball rolling in 1971 thanks to Erlichmann and Nixon.

At November 21, 2009 at 7:21 PM, Anonymous Anonymous said...

Dear jurassicpork

OK, just what exactly is your agenda? What is prompting this nasty tone in your comments?

Just because you say they are not a non-profit does not make it so. If Kaiser-Permanente is not a true non-profit, then why hasn't the government taken away their tax exempt status? (They have been investigated by the government along with other non-profits) Where in any of your references is there evidence that they are not a non-profit organization?

Paying high salaries in a highly competitive field (there are many HMO's in the U.S.) is not illegal. Top executives have many places to shop their talent, so yes, non-profit organizations will have to pay top dollar, just as they will pay top dollar to advertising agencies to create impressive ad campaigns, such as the current K-P "Thrive" ads. In return, the non-profit collects new membership fees which go to maintaining and purchasing equipment and facilities, paying competitive salaries to staff, and so forth. What that revenue does not do, is go to stock holders and a huge, outside administrative system (insurance companies).

This from wikipedia on level of care at K-P:
In the California Healthcare Quality Report Card 2009 Edition, Kaiser Permanente's Northern California and Southern California regions led the rankings, with each scoring seven out of eight possible stars. Kaiser's rankings in the 2009 Report Card was the first time an HMO has received 4 out of 4 possible stars in Meeting National Standards of Care. Kaiser North and South also received 3 out of 4 stars in How Members Rate their HMO.[39

My family In Southern California has been with K-P for forty years. Our daughter was born in a K-P hospital, and now that she has moved away from home, she has her own K-P plan. Are we 100% satisfied with K-P? No, but there are so many good things about the plan, that they outweigh the bad.

A final personal story. My wife and I attended a pre-release screening of the film, "Sicko", where Michael Moore was in attendance. At the end of the film MM took questions from the audience and I stood up and explained that I loved the film, but thought he had painted K-P with a rather broad brush, and related a personal situation where we had a dispute with K-P which involved a procedure which they disallowed, forcing our daughter to go outside the plan and pay out of her own pocket to the tune of eight thousand dollars for relief from pain. When I found out what she had done, I initiated a protest with K-P and explained in a detailed letter what had occurred, and why I felt they had made a mistake and how disappointed I was with their decision.

In a very short time, I received a letter from Kaiser membership services telling me that they had reviewed my complaint and agreed to reimburse my daughter for all her expenses, and then sent me and my daughter a letter of sincere apology for what had transpired.

Michael Moore told me he was happy for me, but that wasn't the movie he was making, and to basically sit down and shut up. I still love the movie.

As we were leaving the theatre afterwards, a woman came up to me and said she wanted to thank me for speaking up, that she was a nurse and had worked for K-P, and felt they were a great health care organization.

Yeah, K-P isn't perfect, and they have made mistakes, but they are pretty damn good at what they do. Consider; K-P doctors are required to continue their education, K-P has been a leader in the area of digital/computer record keeping, as well as "wellness" programs for members, and provides free flu shot clinics for members.

All this and they have wonderful people like Sarah working in their hospitals and clinics.

At November 21, 2009 at 11:36 PM, Blogger Unknown said...

All I can say, JP, is that you apparently know absolutely nothing about accounting or economics, much less health care. Calling our mission in Iraq humanitarian is an opinion. Calling KP non-profit is a legal fact. And KP has to undergo a lot of auditing by the government to keep that status.

Top earners make $1.2 million? Check out the top salaries of these for profit organizations:
Aetna Ronald A. Williams: $23,045,834
Cigna H. Edward Hanway: $25,839,777
Coventry Dale B. Wolf : $14,869,823
Health Net Jay M. Gellert: $3,686,230
Humana Michael McCallister: $10,312,557
U.Health Grp Stephen J. Hemsley: $13,164,529
WellPoint Angela Braly (2007): $9,094,271
L. Glasscock (2006): $23,886,169

2008 Total CEO Compensation
Aetna, Ronald A. Williams: $24,300,112
Cigna, H. Edward Hanway: $12,236,740
Coventry, Dale Wolf: $9,047,469
Health Net, Jay Gellert: $4,425,355
Humana, Michael McCallister: $4,764,309
U. Health Group, Stephen J. Hemsley: $3,241,042
Wellpoint, Angela Braly: $9,844,212

At November 22, 2009 at 10:35 AM, Blogger jurassicpork said...

You're asking me what my agenda is? You're the flak seeking out on Google articles on KP. Since when should an HMO juggernaut like KP give a shit what I have to say about them?

Look, you have your thoughts on KP and, since you work for them, that automatically gives you an agenda and a biased slanted in their favor. I'm not restricted thusly. And all your denunciations of what I know or don't know isn't going to change the facts. KP is an evil, bottom line organization, regardless of what their legal designation is. Please don't ask me to forget what I've already learned about those people.

There are plenty of outfits and organizations that ought to have their tax exempt status taken away (like churches that more than dabble in politics, for example) by the feds but haven't.

At November 22, 2009 at 5:38 PM, Anonymous Anonymous said...

Dear JP
I am the one who said you have an agenda, not Sarah. If you can't get something that simple correct, I think the readers will see you for the name-calling, intellectual lightweight you really are, and give your opinions their proper due.
Have a nice day.
Anonymous (not Sarah)

At November 23, 2009 at 11:05 AM, Blogger jurassicpork said...

I am the one who said you have an agenda, not Sarah. If you can't get something that simple correct, I think the readers will see you for the name-calling, intellectual lightweight you really are, and give your opinions their proper due.

Since I no longer have a home computer and have to share one with an entire town, time is at a premium and sometimes I have to rush what I'm doing.

But when did I ever insult you or call you names, asswipe?


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