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Mammography as Politics

They came from Colorado and Arizona, the two leaders of the U.S. Preventive Services Task Force, summoned to Washington Wednesday to explain the panel’s contentious new recommendations on breast cancer screenings. But Chairman Ned Calonge and Vice Chair Diana Petitti might have been surprised to discover that lawmakers were much more interested in grandstanding on health reform than they were in examining the mammography guidelines themselves.

The first sign came when Rep. John Shimkus (R-Ill.) announced in his opening statement that the breast cancer screening guidelines “will not be taken outside of the context of the H.R. 3962,” the Democrats’ health reform bill.

It happened again when Rep. Michael Burgess (R-Texas), also during opening statements, made reference to “the 2,000-page gorilla in the room.” (He wasn’t talking about the mammography guidelines.)

Any doubts on whether the hearing was political were put to rest when Rep. Frank Pallone (D-N.J.), chairman of the Energy and Commerce health subcommittee, cut off Petitti’s opening statement at the seven-minute mark.

“Doctor,” Pallone said, “I didn’t want to stop you, because it’s so important. But you’re two minutes over.”

That was after Petitti and Calonge had endured more than 90 minutes of opening statements from lawmakers.

But the charade didn’t stop there.

Instead, many lawmakers used their question-and-answer time to try to get the task force leaders to weigh in, not on how they arrived at their recommendations, but how the reform legislation would absorb them — a topic of legal interpretation that they, as medical experts, knew nothing about.

“That is not my role here,” said Petitti, one of many times. “My role is to speak to the mammography guidelines.”

But that message didn’t sink in very quickly among the lawmakers. At one point, Rep. John Dingell (D-Mich.) asked if the recommendations were to be used as a coverage ceiling or a coverage floor.

“It’s outside of the scope of our recommendations how they’re used by other entities,” Calonge said.

In another exchange, after Calonge declined to answer a question based on his lack of familiarity with the bill, Rep. Henry Waxman (D-Calif.) decided to fill him in. “You’re not an expert on the bill,” he said, “but let me explain what the new bill will do.” Waxman then explained what the new bill will do.

Rep. Marsha Blackburn (R-Tenn.) also inquired about the influence of the task force recommendations under the Democrats’ bill. Petitti’s response is a good reminder to those on Capitol Hill that life goes on outside the Beltway.

“As unbelievable as it may seem to those who are so caught up in Washington,” Petitti said, “I was writing my bio-statistics lectures, and have been actually woefully and naively oblivious of what’s been going on in health care reform arena.

“From the point of view of specific statutory language,” she added, “I know nothing.”

That statement brought a smile to the face of Pallone, who conceded that lawmakers on Capitol Hill tend to think of themselves as so influential that the world follows their every move.

“We all think we’re so important and everyone’s paying so much attention to everything we do,” Pallone said. “It’s kind of refreshing to know that you were not.”

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