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MASSA participants receiving excellent healthcare

| April 22, 2005 12:00 AM

To the Editor:

I, as you are most likely aware, retired as the chief medical officer for the Montana Department of Public Health and Human Services and the director of MASSA on Dec. 31, 2004. Although I had previously planned to retire on Jan. 16, 2004, requests from my bosses Maggie Bullock and Gail Gray resulted in me delaying the timing until their retirements in August and December, respectively.

I am thoroughly enjoying my retirement and doing many of the things that I have only dreamed about for the last several years. I recommend retirement very highly. However, I have to admit that I have found the occasion to return to Helena from time to time to serve as a consultant to the governor's staff, Dr. Wynia and the new division director Jane Smilie. Although I have been asked to consider returning to work, my response is only to smile and say, no thank you.

During the time that I was employed by DPHHS I had the opportunity to visit Libby not only for the asbestos issues but for several other public health reasons. It resulted in my meeting many individuals and establishing friendships that I continue to cherish. This has also resulted in me keeping in touch with people in Libby and following the various local activities. To that end I have recently had the opportunity to review the minutes of the February ARDNet meeting in which Aubrey Miller was in attendance and would like to provide some input. The reason that I want to do this is that I know that many of the people with an interest in ARDNet constitute some of your readership and some of Aubrey's points need to be expanded upon and clarified.

Aubrey is quite knowledgeable about B-reading of X-rays and when he, Brad Black, Jeff Lybarger and I were working with national experts in developing the protocols for the ATSDR screening program for the 2000 and 2001 screening activities it was at Aubrey's insistence and the concurrence of Drs. Black, Lybarger and myself that B-reads became a major part of the screening protocols. Aubrey rightfully pointed out that B-reads are the international as well as the gold standard for screening for pneumoconiosis (lung diseases that are caused by industrial dusts such as coal, silica and asbestos).

I was not in attendance at the meeting so I do not know the exact verbiage that Aubrey used but I would like to discuss International Labor Organization radiographic interpretations also known as B-reader reviews of X-rays. Aubrey correctly stated that any medical doctor could apply for and receive the training. The training program is one week in duration but consists of 8 plus hours a day of classroom exercises and reviewing of X-rays plus a fair share of homework. In essence the individual in B-reader training eats, drinks, breathes, sleeps, dreams and basically lives X-ray evaluations of chests for the week of training. At the end of the training the program participants have to pass a very difficult examination to be certified. The failure rate for the examination is 70 percent for non-radiologists and 30 percent for radiologists.

As many of you are probably aware, Dr. Brad Black's assistant in the CARD clinic, Dr. Alan Whitehouse, took the training in the 1990's but was not certified because he did not pass the examination. That may give you some idea of the difficultness of the examination. MASSA, as I am sure everyone knows, has continued to use B-reader evaluations in the screening process and I am happy to inform you that on numerous occasions over the past several months Brad Black indicated to me how happy he was with Dr. David Lynch's group of B-readers at National Jewish Hospital in Denver and how he felt they were doing a great job. The MASSA team has also been very happy with the Denver group's support.

I feel that the people in Libby that are participating in the screening are receiving a very high quality care. It is also my understanding that the MASSA is planning to conduct a quality assurance review of the B-reads and the spirometry to further insure that only the best of care is provided.

Dr. Mike Spence

Lakeside