The United States Preventive Services Task Force (USPSTF) is a federal committee composed of private sector experts in prevention and primary care. Its mandate is to make recommendations as to which preventive services are beneficial, which are usesless and which are harmful. Disconcertingly, there is a small but vocal oppostition to the USPSTF as embodied by an op-ed piece in the Wall Street Journal last week by Dr. Scott Gottleib.
Dr. Gottleib’s main argument against the USPSTF is that it sets too high a bar for evidence to demonstrate that a particular test or intervention is beneficial and that it is out of sync with conventional medical practice. At the same time, because its recommendations for preventive services must be covered by insurance companies, it represents an insidious power grab by the Obama administration.
This smear against the USPSTF is baseless for a number of reasons. First, the USPSTF recommendations are valuable precisely because the bar for the evidence is high. Primary care physicians know that these recommendations are built on a solid foundation of evidence and so when services are recommended, those graded A or B, we know that we should offer them to our patients to improve their health. Requiring that insurance companies cover these services at no cost to patients ensures that money is not a barrier to getting beneficial preventive services.
Second, ‘conventional medical practice’ is not synonymous with quality medical care. A study in the Annals of Internal Medicine published this month shows that 28% of physicians would screen women at low risk for ovarian cancer. This is despite the fact that no professional society recommends ovarian cancer screening and that the USPSTF finds that the potential harms outweigh the benefits. In general, some conventional practices not grounded in evidence are later found to be beneficial while others are later found to be useless or harmful. This uncertainty may not sit well with many but it is the reality of how medical knowledge unfolds.
Third, there is nothing wrong with health plans dropping coverage for services that don’t have an A or B from the USPSTF. Insurance companies would be wise to not cover services that don’t provide benefit to their patients or worse, have the potential to harm them. To further scaremonger this point, Dr. Gottleib warns that the USPSTF will at some point recommend against services that people now take for granted. I too am sure this will happen but I’m not sure why it’s a bad thing. If new evidence reveals that what we’re doing is useless or harmful, wouldn’t we want to stop what we’re doing?
Lastly, Dr. Gottlieb’s solution for the ‘problem’ of the USPSTF’s structure is to open it up to political considerations. The USPSTF recommendations are respected precisely because they are perceived as being based on solid evidence and not on political considerations. The panel members are private sector experts, not political appointees or government employees. While politics may influence ultimate decisions on health insurance coverage, they have no place in a careful assessment of medical best practices.
The USPSTF is a well respected body whose recommendations form the basis of preventive care services in the United States. Casting a sinister shadow on the actions of the USPSTF may serve to further his political agenda but it has no place in the practice of good medicine.