When politics creeps into scientific work

Was vote on prostate cancer screening avoided because of proximity to Election Day?

December 02, 2010|By Cedric Dark

A report in The Wall Street Journal raised troubling questions about the recent decision of the U.S. Preventive Services Task Force, a 16-member panel of independent medical experts, to cancel a meeting that had been set for around Election Day.

One of the important items on the agenda was to have been a vote on the utility of prostate cancer screening. The most recent recommendations, from 2008, state that prostate screening should not be conducted for men older than 75. For younger men, the evidence around the preferred screening test (the prostate specific antigen, or PSA, blood test) was inconclusive.

Dr. Kenneth Lin, now a former member of the preventive services panel, implied that the cancellation of the November meeting was more than just a coincidence. Declaring that "politics trumped science," Dr. Lin tendered his resignation from the task force.

But why would the task force avoid voting on the prostate cancer screening issue during the spotlight of Election Day? To answer, we only need to look back to the policy debates surrounding the passage of the Patient Protection and Affordable Care Act. In the new health care reform law, the task force was granted the power to require health insurers to cover any preventive services with a grade "A" or "B" rating.

The leaders of the task force may have anticipated another controversy similar to the one surrounding last year's mammography recommendation. Readers may recall that the task force revised its breast cancer screening recommendations in November 2009. Reflecting scientific evidence, the group recommended against routine screening mammography for women under age 50.

However, in response to constituents upset by that recommendation, an amendment by U.S. Sen. Barbara A. Mikulski of Maryland was added to the Patient Protection and Affordable Care Act. The amendment explicitly forbids using the Preventive Services Task Force's November 2009 breast cancer screening recommendation. The Mikulski amendment flexes its political muscle by directing all health insurers to cover mammography for women under age 50, even though the scientific evidence does not support this coverage decision.

It is no surprise that if the task force anticipated another controversy around prostate cancer screening, the influential panel might postpone its vote to a less conspicuous time.

While the enhanced power granted to the Preventive Services Task Force's recommendations will likely help promote better health in the nation, the formerly obscure expert panel now faces public and political scrutiny over every critical decision it will make.

The health care reform law essentially begins the transformation of the task force into an entity similar to the National Institute for Health and Clinical Excellence, or NICE, the organization tasked with determining coverage decisions for the British health care system. Medicine and therapies recommended by NICE are required to be covered under the British health system. Preventive Services Task Force recommendations now carry similar authority in the United States.

The unfortunate flip-side of the coin is that in cases where the task force cannot make a cogent decision based on the available evidence, insurers might elect to deny coverage altogether.

However, if politics is allowed to trump science, the concept of evidence-based health policy will never become reality.

Dr. Cedric Dark, a resident of Beltsville, is an emergency medicine physician practicing at Saint Agnes Hospital in Baltimore. He is the founder of Policy Prescriptions LLC, a health policy consulting firm. His e-mail is cedric@policyprescriptions.org.

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