U.S. Preventative Services Task Force Confronts Critics
Alan Stolier M.D.
It comes as no secret that the recent changes in breast screening recommendations, have been the subject of condemnation particularly by breast radiologist and surgeons. It is with this background that a recent article grabbed my attention. The article by Charlie Smith, “The U.S. Preventative Task Force Confronts Critics” appears in a recent edition of the Journal of the National Cancer Institute. The article presented information regarding the USPSTF that I had not previously known. Whereas many of you may be quite well informed about the USPSTF, I thought that I might summarize the information that was new to me in hopes that it may be helpful to at least some.
The membership of the task force is intentionally limited to primary-care experts whose mandate is to focus only on the strength of the evidence under review. In many instances, such as breast screening, this pits the task force against specialists as well as companies with an economic stake in the final recommendations. Because the Affordable Care Act mandates screening that is approved by the task force, “drug companies, device makers, professional medical societies and even investment firms…lobby the task force, hoping to sway its recommendations”. Due to the A.C.A., the task force now has a powerful influence on healthcare economics.
Interestingly, Tom Price M.D. (Ex-Secretary Health and Human Services), as a Republican representative from Georgia, fought against implementing the task force’s recommendation against screening mammography for women younger than 50. This of course has also been the position of many specialty societies in surgery, radiology and OB-GYN. This has lead for a call for inclusion of specialists on the task force.Interviewed in the article is Gilbert Welch M.D., professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice who said, “that adding specialists to the task force would lead to what economists call regulatory capture, wherein a few parties with high-stake interests in a regulatory agency’s decision, work for the recommendations they prefer”. Furthermore, he noted that “a mass screening test amounts to a huge market, and while most people won’t develop the target disease, everyone gets exposed to the test and to the risk of false-positive results, over-diagnosis, and unnecessary interventions”.
The task force, created in 1984, consists of 16 volunteer experts in primary care including pediatrics, family medicine, internal medicine, women’s health and nursing? According to the chairman David Grossman M.D., benefits and harms are the only variables used in evaluation and that costs are never a factor used by the task force in arriving at decisions. All members must have expertise in prevention and primary care. Furthermore, he noted that “the task force welcomes input from disease specialists and has procedures for involving them at every stage of the recommendation development process”. They are not however, allowed a vote on the final recommendations.
Currently those entities with vested interests in task force recommendations are supporting a bill introduced earlier this year by Rep. Marsha Blackburn (R-TN) “seeking to augment the task force with specialists and disease-specific patient advocacy groups”. However, with the currently political atmosphere in D.C., it’s anyone’s guess as to what happens next in this politico-economic-medical saga.