"Politics trumped science": the stories behind the sound bite

Last November, when I publicly announced my resignation from the support staff of the U.S. Preventive Services Task Force after 4 years as a medical officer at the Agency for Healthcare Research and Quality, media reports suggested that I had done so in protest of the government's decision to cancel the USPSTF's regularly scheduled scientific meeting on the day of the midterm elections, thus delaying a critical vote on new prostate cancer recommendations. That interpretation was essentially correct, but unfortunately, it was only part of a much larger and more painful story.

Since November 2009, when the USPSTF released its updated recommendations on screening for breast cancer at the peak of this country's impassioned health reform debate, there was rarely a day on my job when politics did not "trump" science in some way. An administration that prides itself on transparency decided to protect its reform legislation by repeatedly interfering with the work of a highly respected group of scientists whose carefully considered decisions about the value of clinical preventive services are, in my opinion, one of the things that make health reform worth the cost. It did so by misleading not only the public and the press about its motives, but eventually major primary care organizations who depend on Task Force recommendations and the Task Force itself. This post is the first in a series that will tell this story from my perspective, drawing on my experiences working behind the scenes of federal government with the USPSTF. Later this week, my next post will discuss the USPSTF's updated recommendation statement on screening for osteoporosis, which was published online earlier today in the Annals of Internal Medicine.

A few caveats are in order. First, although I am now a private citizen, out of respect for the scientific process, I will not discuss the content of any recommendation statements until they are made available to the general public. Nor will I attempt to describe or interpret political decisions that were made outside of my presence, unless I have good reason to believe that the content of those decisions was accurately communicated to me by another person who was there at the time. Finally, it is important that you understand that my motivation for sharing these "behind the scenes" stories is not to malign former colleagues or current or former members of the Task Force (who were, and are continuing to do, the very best they can in a difficult environment), but rather to shed light on factors that were generally outside of their control, and, mostly, should have had nothing to do with the scientific process in the first place.