I just returned from a hearing of the House Energy and Commerce Committee's health subcommittee on the U.S. Preventive Services Task Force (USPSTF) breast cancer screening guidelines. Donna Sweet, MD, MACP, a general internist and HIV/AIDS specialist from Wichita, Kansas, testified on ACP's behalf. Dr. Sweet is a past chair of the ACP Board of Regents and a member of the College's Clinical Efficacy Assessment Subcommittee (CEAS), which has responsibility for developing the ACP's evidence-based clinical guidelines.
The first several hours of the hearing--and much of the grilling from the subcommittee members--were concentrated at chair and vice chair of the U.S. Preventive Task Force. The Task Force witnesses agreed that they could have done a better job in communicating the revised screening recommendations to the public but stood their ground on the evidence behind the recommendations. The USPSTF witnesses also made the point that breast cancer screening recommendations were voted on and approved late last year, before the Obama administration took office, so the politics of health reform had no role in their deliberations.
This didn't stop the politicians, though, from introducing politics into the USPSTF's recommendations. The headline from Reuter's says it all: "U.S. debate over mammograms splits along party lines."
Who knew that there was a Republican and Democratic view on the value of breast cancer screening? But in today's hyper-partisan and polarized politics, there is no issue that won't be used to divide the voters. Republicans argued that the USPSTF's recommendations were driven by a desire to cut costs - a charge that the USPSTF's witnesses steadfastly denied. (Fact check: the Agency for Health Care Research and Quality website specifically states that "economic costs" are never a consideration in the USPSTF's recommendations.) Republicans also argued that the House and Senate health reform bills would prohibit health insurers from offering prevention benefits that have not received an A or B evidence rating from the USPSTF, ultimately leading to U.K-style rationing. Democrats argued that the recommendations from the USPSTF would set a floor - not a limit - on the preventive services that insurers would have to cover. Both sides accused the other of mis-representing the truth.
ACP's own reading of the bills is that the Task Force's recommendations would improve access to evidence-based preventive services by establishing a floor, not a ceiling on benefits. On this point, ACP, the American Cancer Society, the National Breast Cancer Coalition, and the Susan Susan G. Komen for the Cure Advocacy Alliance all were in agreement.
Why did ACP wade into this fight? Well, for one thing, the USPSTF recommendations were published in our own Annals of Internal Medicine website. For another, in 2007, ACP issued its own guideline on screening mammography for women between the ages of 40 and 49, which recommended that clinicians and patients conduct an individualized risk assessment, discuss the risks and benefits of mammograms for this age group, and make their own judgment. But the biggest reason is that ACP believes that the politicization of evidence-based medicine is not in the public's interest.
This is what Dr. Sweet had to say:
"One lesson is that the public is ill-served when assessments of clinical effectiveness are politicized. For clinicians and patients alike to have confidence in the evidence, we need to know that it has been developed through a process that is independent of political pressure.
...Politicization [of evidence-based assessments], if left unchallenged ... could result in politically-driven changes so that future evaluations are influenced by political or stakeholder interests - instead of science."
Harold Pollack, writing in The New Republic blog, gives ACP high marks for its advocacy. Calling ACP "one of America's most respected medical organizations," he goes on to say this about ACP's stand against the politicization of evidence-based research:
"In its own wonky way, within an often-disheartening health policy debate, that's Change We Can Believe In."
Today's question: What do you think about the ACP's stand on the politicization of evidence-based clinical research?