American College of Physicians blasts "politicization of evidence-based clinical research"

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The American College of Physicians - the largest medical specialty organization and the second-largest physician group in the United States - has issued this statement:

The U.S. Preventive Services Task Force (USPSTF) recommendations on mammography, which were published in ACP's flagship journal, the Annals of Internal Medicine, have regrettably been used by some critics of the health reform bills being considered by Congress to make baseless charges that the bills would lead to rationing of care. Other critics have made unfair and unsubstantiated attacks on the expertise, motivations, and independence of the scientists and clinician experts on the USPSTF.

ACP believes that it is essential that clinicians and patients be able to make their own decisions on diagnosis and treatment informed by the best available scientific evidence on the effectiveness of different treatments and diagnostic interventions. The USPSTF is a highly regarded, credible and independent group of experts that performs this role, on a purely advisory basis, to the Department of Health and Human Services, as it relates to interventions to prevent or detect diseases. As is often the case with evidence-based reviews, the USPTF's recommendations will not always be consistent with the guidelines established by other experts in the field, by professional medical societies, and by patient advocacy groups. Such differences of opinion, expressed in a constructive and transparent manner so that patients and their clinicians can make their own best judgment, are important and welcome. It is not constructive to make ill-founded attacks on the integrity, credibility, motivations, and expertise of the clinicians and scientists on the USPSTF.

Some critics have erroneously charged that the USPSTF's recommendations were motivated by a desire to control costs. According to the Agency for Health Care Research and Quality, "the USPSTF does not consider economic costs in making recommendations." The Agency continues, "it realizes that these costs are important in the decision to implement preventive services. Thus, in situations where there is likely to be some effectiveness of the service, the Task Force searches for evidence of the costs and cost-effectiveness of implementation, presenting this information separately from its recommendation" and the "recommendations are not modified to accommodate concerns about insurance coverage of preventive services, medicolegal liability, or legislation, but users of the recommendations may need to do so." [emphasis added in bold]

Under the bills being considered by Congress, the USPSTF will have an important role in making evidence-based recommendations on preventive services that insurers will be required to cover, but the bills do not give the Task Force -- or the federal government itself -- any authority to put limitations on coverage, ration care, or require that insurers deny coverage. Specifically, the House and Senate bills would require health plans to cover preventive services based in large part on the evidence-based reviews by the USPSTF, but no limits are placed on health plans' ability to offer additional preventive benefits, or in considering advice from sources other than the USPSTF in making such coverage determinations. Accordingly, patients will benefit by having a floor - not a limit - on essential preventive services that would be covered by all health insurers, usually with no out-of-pocket cost to them. Patients will also benefit from having independent research on the comparative effectiveness of different treatments, as proposed in the bills before Congress. The bills specifically prohibit use of comparative effectiveness research to limit coverage or deny care based on cost.

The controversy over the mammography guidelines illustrates the importance of communicating information on evidence-based reviews to the public in a way that facilitates an understanding of how such reviews are conducted and how they are intended to support, not supplant, individual decision-making by patients and their clinicians.

ACP urges Congress, the administration, and patient and physician advocacy groups to respect and support the importance of protecting evidence-based research by respected scientists and clinicians from being used to score political points that do not serve the public's interest.

3 Comments

http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4194&blogid=140

Here's our take on the issue http://cli.gs/vj18PT
Best,
Drs. B

I totally agree with your sentiments. We cannot sink to the level of conspiracy theories and accusations of hidden agendas when undergoing scientific debate. That will not help us make our point or earn the respect of the public.

I certainly acknowledge the integrity and honesty of the members of the USPSTF. Nonetheless, I do not understand their recommendations at all. According to ACOG, about 7,000 lives a year are saved by screening mammography in women ages 40-50. Considering the impact this has on those women, their families, friends, businesses, and so on, I can hardly understand how the risks outweigh the benefits. Even though it is true that many unnecessary procedures may be avoided, how risky is an unnecessary breast biopsy anyway? How much damage does the extra radiation exposure cause? I'm truly baffled.

Furthermore, even according to the USPSTF, "biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms"

What does that mean? Which risk factors would make it worthwhile to start screening a 40 year old woman? What about smokers? What about women who drink alcohol? What about women who are obese? What about women who never breastfed? What about women who never were pregnant? These are all risk factors for breast cancer, so who should we screen? I am both confused and astounded by these recommendations.

Saul Weinreb M.D.

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This page contains a single entry by Gary Schwitzer published on November 24, 2009 2:49 PM.

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