Friday, April 27, 2018

Don't Know Much About Health Care and Public Health, and Don't Care Much About Their Missions - but in Leadership Positions in US Government Health Agencies

Here we go again.  As we  We have frequently discussed how health care leadership is often ill-informed ( look here).  More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research.  Obviously health care and health policy decisions made by ill-informed people could have detrimental effects on patients' and the public's health.

Through 2016, our examples of ill-informed leadership in health care tended to be executives of hospital systems (e..g.,in 2014, here, on the mishandling of a patient with Ebola in a hospital system led by generic managers; and in 2013, here, on a luxurious hospital led by a former hotel executive).  Others were top executives of pharmaceutical corporations (e.g., in 2011, here, on previous Pfizer CEOs).

Now, however, the most ill-informed people in health care leadership seem to be running US government health related agencies.  Worse, the latest examples we have found also appear to be mission-hostile leaders.

Ximena Barreto, Deputy Director Of Communications, Office Of The Assistant Secretary For Public Affairs,, Department of Health and Human Services (DHHS)

Ms Barreto's new position was first discussed in an article in Media Matters on April 9, 2018.  The article described her background:

Barreto (who also goes by the surname Barreto-Rice) was a right-wing pundit who used the screen name 'RepublicanChick' on her personal website and social media. She regularly posted commentary on Periscope and briefly co-hosted a YouTube show called The Right View by Deplorable Latinas. She also said she helped Trump’s California efforts during the 2016 election.

I can find nothing to indicate she has any background or expertise in biomedical science, health care, or public health.

Note that the mission of DHHS currently is:

to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.

Yet according to Media Matters, Ms Barreto did not appear to be committed to the health and well-being of all Americans.

As a fringe right-wing political commentator, Ximena Barreto claimed that 'African-Americans are way more racist than white people,' labeled Islam 'a f*** cult' that has 'no place' in the United States,... and attacked the 'retarded' 2017 Women’s March.

In particular,

In her November 30, 2016, Periscope video (starts roughly 8:00 into the video), during a discussion about 'f*** reverse racism,' Barreto said: 'African-Americans are way more racist than white people.'

She continued shortly after: 'I’ve been attacked by more African-Americans on Twitter than white people, in all honesty. … They’re the most racist people I ever met.' She then said that she’s been insulted and called slurs by African-Americans.


During her November 30, 2016, Periscope, Barreto said (starts roughly 7:26 into the video) that Islam advocates for 'killing other people and abusing women; that’s not a religion, that’s a f*** cult. Like, I’m serious. Like, that’s not religion.' She also said during a June 12 video that Islam is 'just a cult. All the practices are cult-like, all that they do.'

In a May 25 post on the now-defunct website Borderland Alternative Media, she suggested that practicing Islam should not be allowed in the United States.

She also expressed sentiments that suggested she was not comfortable with the reality-based approach of the "sciences underlying medicine, public health, and social services."

Barreto has repeatedly pushed the false Pizzagate conspiracy theory that claimed prominent political figures were trafficking children through a Washington, D.C., pizza restaurant. She tweeted in November 2016 that efforts by supporters of former Democratic presidential candidate Hillary Clinton to trigger a recount were 'a hoax so we get distracted from #PizzaGate.'

She appeared in a November 30, 2016, Periscope video in which she also said (starts roughly 1:45 into the video) the presidential recount effort is an attempt to distract people 'from Pizzagate.' She later claimed that former Republican presidential candidate Mitt Romney is also tied to Pizzagate. 'A lot of people are connected to it,' she remarked.

Near the end of the video, Barreto told viewers: 'Don’t listen to the recount and relax. We’ve got to use all of our efforts into Pizzagate and not let that one die because that’s what the mainstream media is trying to get distracted from. So check all the Pizzagate stuff.'

Furthermore, additional investigations by CNN revealed

In May of 2017, Barreto retweeted an image saying the 'our forefathers would have hung' Clinton and Obama for treason. In August of 2017 Barreto retweeted an image of a statue of Obama labeling him 'a Muslim terrorist.' In January of 2017, Barreto wrote in a tweet that Obama was a 'pansy and a traitor.'

The Hill reported on  April 9, 2018, that Ms Barreto was placed on leave.  Her online comments have apparently been erased.

So while Ms Barreto was hired in a top communications role for DHHS, which is supposed to improve the health of all Americans, she previously displayed virulent prejudice against African-Americans and Muslims.  Also, DHHS is supposed to uphold evidence- and science-based health care, public health and social services, but Ms Barreto has promoted grossly false conspiracy theories.

She seems to be uniquely unqualified for her leadership position in DHHS.  In fact, she seems like one of the last people one should consider for such a position.  Worse, since she also appears to have no background or experience in communications, public relations, or journalism, it appears that there was no obvious reason to hire her other than her reputation for taking extreme positions on social media. 

Roger Severino, Director, Office for Civil Rights (OCR), DHHS

Shannon Royce,  Director of the Center for Faith-based and Neighborhood Partnerships at the U.S. Department of Health and Human Services

Mr Severino and Ms Royce work together (see below) and so will be discussed together

According to his official DHHS biography,

Mr. Severino served as Director of the DeVos Center for Religion and Civil Society in the Institute for Family, Community, and Opportunity at The Heritage Foundation.

Before joining Heritage in 2015, Mr. Severino was a trial attorney for seven years in the Department of Justice’s Civil Rights Division....

Mr. Severino was previously chief operations officer and legal counsel for the Becket Fund for Religious Liberty.

Mr. Severino holds a J.D. from Harvard Law School, received a master’s degree in public policy, with highest distinction, from Carnegie Mellon University, and has a bachelor’s degree in business from the University of Southern California.

According to her official biography, Ms Royce

worked for over seven years on Capitol Hill, including serving as Counsel to Senator Chuck Grassley (now Chairman of Senate Judiciary Committee).

In the private sector, Shannon worked in several faith-based non-profits. Early on, she led the D.C. office of the Ethics & Religious Liberty Commission (ERLC), a group focused on issues such as sex trafficking, global hunger, and protecting religious liberty. Most recently, Shannon served as Chief of Staff and C.O.O. at the Family Research Council (FRC)....

Again, neither Mr Severino or Ms Royce have any background or expertise in biomedical science, health care, or public health.

According to a Politico article from January, 2018, they are

politically prominent religious activists inside the Department of Health and Human Services have spent months quietly planning how to weaken federal protections for abortion and transgender care....

Mr Severino in his capacity with the OCR

laid out new protections allowing health care workers with religious or moral objections to abortion and other procedures to opt out. Shannon Royce, the agency's key liaison with religious and grass-roots organizations, has also emerged as a pivotal player.

As we discussed in January, 2018, the OCR is part of an effort officially aimed at protecting doctors, nurses and other health-care workers who decline to participate in care that goes against their moral or religious convictions.  At that time we raised the probably naive hope that this would particularly help health professionals who felt pushed to participate in unethical and illegal activities like conflicts of interest, outright crime, such as fraud, bribery or kickbacks, or other criminal or corrupt practices to which they had moral objections.  That was not to be.

Instead, as Politico suggested in January, the aim was to support people who believe abortion, favorable treatment of LGBT people, even contraception are morally wrong.  In particular, Mr Severino and Ms Royce have
- "selectively post[ed] public comments that were overwhelmingly anti-abortion"
- started a "vast outreach to religious groups," apparently limited to those who agree with the moral positions above
- kept secret "decisions about controversial issues like abortion, contraception and transgender care"

At one point, speaking to a sympathetic religious audience, Ms Royce acknowledged the purpose of their actions,

Royce said last Thursday, appearing at the anti-abortion conference. 'We have such an amazing team at HHS that is absolutely a pro-life team across the spectrum.'


'You will see exciting things in the coming days, and that's all I can say right now. But good stuff is coming,' Royce promised attendees at last Thursday's anti-abortion conference.

Politico noted that people and groups who have religous beliefs compatible with those of Severino and Royce voiced their approval of these policies.

'To have leaders like Roger, like Shannon, it’s so important," said Deanna Wallace of Americans United for Life, an anti-abortion group that was frequently at odds with the Obama administration. 'It’s extremely encouraging to have HHS on our side this time.'


'You're over at HHS, a true bright spot in this administration when it comes to protection of life and protection of conscience,' a moderator at the Evangelicals for Life conference said when introducing Royce last Thursday. 'It's no exaggeration to say that you guys have just had a monster year over at HHS.'

Again, note that the purpose of the OCR on paper was to allow health care professionals to avoid being forced to take actions which they found morally objectionable for whatever reasons, not just to cater to people who are against abortion for religious reasons. 

However, Politico quoted a variety of experts who underlined that the work by Severino and Royce amounted to favoring particular religious beliefs and the people who hold them.

'It’s supposed to be the faith-based partnership center, not the Christian-based partnership center,' said a longtime HHS staffer, referencing the HHS Center for Faith-Based and Neighborhood Partnerships led by Royce.


'This administration is focused on recognizing one set of religious beliefs,' said Gretchen Borchelt of the National Women’s Law Center. 'It’s going to do whatever it can to reshape or violate the law to do that.'

A follow-up article by Kaiser Health News in March emphasized how fundamentally hostile the activities of Severino and Royce are to the DHHS mission, quoting

Mary Alice Carter, executive director of a new watchdog group called Equity Forward. 'But the core issue here is we have individuals coming in who fundamentally don’t believe in the very mission they’re serving.'

'They are coming in with the agenda of burning it down,' she said.

Nonetheless, these efforts are gathering momentum and spreading throughout the Trump regime.  An article in Buzzfeed on April 17, reported that an the annual UN Commission on the Status of Women meeting,

Bethany Kozma — a senior adviser for gender equality and women’s empowerment at the US Agency for International Development (USAID) and anti-transgender activist — emphasized that the US was a 'pro-life nation,'


We have noted, most recently here, how the current Trump administration has been appointing many people without any qualifications in biomedical science, health care, or public health to leadership positions in health and public health agencies.  Obviously health care and health policy decisions made by ill-informed people coule have detrimental effects on patients' and the public's health.

Worse, it now seems that some ill-informed appointments have more nefarious purposes, including the subversion of the mission of these health related agencies.  The group of leaders discussed above seem to be hostile to the notion that health care and public health should serve all people, regardless of their religious beliefs, race, ethnicity, or sex.

Furthermore, they seem to be undermining fundamental principles of US government enshrined in the Constitution, including prohibiting the government from establishing a religion or preventing the free expression of any religion, and equal application of the laws and provision of due process to all people, again regardless of their religious beliefs, race, ethnicity or sex.

We have been writing about health care dysfunction since 2003, and publishing this blog since 2004.  A major concern all along has been how threats to health care professionals' core values generate  health care dysfunction.  Up through 2016, these threats came principally from large private health care organizations.  While the US government was not always as good at defending these values as it could have been, at least it rarely presented its own set of active threats.  Under Trump, that situation has been changing for the worse.  This is obviously hugely dangerous, (and made more so by the regime's threats to other core values of US society, to US law, and the US Constitution.)

To prevent the decline and fall of US health care, and maybe the entire US experiment in representative democracy, health care professionals, academics, patients and citizens concerned about health care will have to join up with the larger populace to defend our core values while they still have any force.   

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