Independent reviews support diagnoses by CARD doctors

To the Editor:

Regarding the Libby asbestos disease patients, there have been undocumented claims in the media that the doctors at the Center for Asbestos Related Disease (CARD) Clinic in Libby have been "overdiagnosing" patients with asbestos disease. The claim is that there is a diagnosis of asbestos disease in some patients when none is present. Not so.

There have been independent reviews of the findings by the doctors n Libby. Both local and federal physicians who have conducted extensive reviews agree with the CARD Clinic doctors, Dr. Whitehouse and Dr. Black.

Controversy appeared back in September 2005, when the W.R. Grace and Co. Libby Medical Program issued 172 letters to patients stating that they had no asbestos disease. The 172 were about 25 percent of the total 700 patients who got letters. Grace acknowledged that the other 75 percent do have asbestos disease.

In regard to claims that the CARD Clinic doctors were "overdiagnosing" asbestos disease, the clinic analyzed chest x-ray readings on the 70 patients who brought in letters of denial from Grace. Out of these 70, 48 had had chest x-rays read during the federal screening programs in Libby in 2000 and 2001. On 47 of these 48 patients, the doctors in Denver hired by the federal government to read the screening chest x-rays agreed with Dr. Whitehouse and Dr. Black and disagreed with the doctors from the East Coast hired by W.R. Grace. That is a 98 percent level of agreement with the CARD Clinic doctors, and a 2 percent level of agreement with Grace's doctors.

Locally, Dr. Becker, the radiologist at St. John's Hospital in Libby, had read chest x-rays on 69 of the 70 patients with denial letters from Grace. In 55 of the 69 cases he concurred in finding evidence of asbestos disease. This is an 80 percent level of concurrence with Dr. Whitehouse and Dr. Black. It is said that if you can get 80 percent agreement on chest x-ray readings, that is a high level. Moreover, in 13 of the 14 cases where Dr. Becker did not concur, the CARD diagnosis of asbestos disease was confirmed later on by other doctors through CT scans and the like.

Furthermore, among the 70 patients where Grace's hired doctors on the East Coast found no disease, the CARD Clinic findings were confirmed by Dr. Gordon Teel, a pulmonary radiologist in Spokane, on five out of five cases that he read. The CARD findings were also confirmed by Dr. Lynch or Dr. Newell, radiologists in Denver, on six out of six they read.

In short, the CARD Clinic diagnoses have high degree of support from independent sources. The CARD Clinic did not hire these independent doctors to perform their work. In contrast, the Grace doctors were hired by Grace for this purpose. Grace hires include doctors who regularly testify for asbestos companies.

Locally, claims of "over diagnosis" have come from Dr. Obermiller and Dr. Pistorese in Kalispell. What was not mentioned in the media reports was that these doctors do work for Grace, and have accompanied Grace Medical Plan officials to Libby. Dr. Pistorese has testified twice for Grace before the Workers' Compensation Court. In neither case did the judge rely on his testimony. Instead Dr. Whitehouse was believed. Dr. Pistorese has acknowledged that he has not seen enough patients to draw scientific conclusions on the Libby disease population.

We hope that in the future doctors who have questions about Libby tremolite asbestos disease will contact the doctors at the CARD Clinic directly, in a professional manner, rather than raising issues in the media.

Jon L. Heberling

Attorney for 600 Libby patients