If the world of primary-care physicians had a supreme wizarding council that only weighed in on screening tests and pills promising to head off disease, it would be called the U.S. Preventive Services Task Force.
On Friday, the U.S. Preventive Services Task Force recommended against routine prostate cancer screening for men using the prostate-specific antigen (PSA) test, saying that patients are more likely to be harmed by anxiety and aggressive treatment prompted by ambiguous test results than they are to reap benefits such as better health or longer life.
The practice of medicine in the United States is buffeted daily by a swirling mix of commercial interests, politics, tradition and consumerism. It’s not uncommon, for instance, for a pharmaceutical or biomedical company to stand up a “task force” of well-paid physicians to recommend their product. But since the USPSTF was established by a congressional mandate in 1984, its task has been to disregard those often-competing forces and focus on the scientific evidence for and against measures--screening tests, preventive medications or counseling--that promise to head off or blunt the impact of some disease.
Its members have weighed in on hotly-debated medical interventions where lives and fortunes are at stake, including medications that promise to prevent heart attack or stroke, cancer screening tests that claim early detection means better chances of survival, HIV/AIDS screening in which privacy concerns are paramount.
Their recommendations almost always leave some party fuming. On Friday, it was urological patient groups and many physicians for whom the PSA test has been a standard ritual in a man’s yearly physical (not to mention the private labs that have processed millions of those tests a year since 1986 when the test was first approved by the FDA). In 2009, the mammogram recommendation coverage panel prompted howls of protest from breast cancer activists and left patients and physicians in confusion when it concluded that mammograms for most women in their 40s and 50s were unhelpful. Other decisions, however, have put reluctant insurance companies under pressure to pay for expensive tests and screenings that the USPSTF deemed to be beneficial to patients.
Its members currently number 16, and they are physicians, nurses, health psychologists, epidemiologists and statisticians with expertise in primary care and preventive medicine. They come from clinical practices, organizations, and academic institutions outside of the federal government, and are nominated by institutions or individuals for four-year terms (which can be extended by one or two years). They are expected to have no financial or professional conflicts-of-interest that could color their assessment of a preventive measure’s value. And an individual under consideration may be asked to provide detailed information about his or her contracts, consultancies, financial holdings or research grants before the U.S. Public Health Service will accept him or her as a member.
Once on the Preventive Services Task Force, a member will spend on average four to six hours a week on work related to the task force, and will travel to Washington, D.C. for meetings three times a year for two days.
It’s not glamorous work, but it is remarkably influential. Once a measure has been accepted for study (a decision made by the Health & Human Services Department’s Agency for Healthcare Research & Quality), task force members review the findings of an entire body of published studies on that measure. Then, they issue grades that not only recommend for or against the measure’s widespread use, but bluntly grade the quality of research that has been done.
The task force’s intended audience has principally been primary care physicians who need solid, practical advice on which screening tests or preventive medications are worth ordering and prescribing to their healthy patients. But in recent years, the effect of the task force’s recommendations has grown considerably: When a health plan or an insurer is on the fence about covering a screening or diagnostic test, or is trying to shift the costs of a preventive medication to a patient, the recommendation of the Preventive Services Task Force is often the deciding factor. Professional societies look to the task force’s findings in adopting “clinical guidelines" that their members should follow in everyday practice.