Thursday, March 31, 2011

Idealist

I told the whole prostate cancer story to a class at Georgetown University this morning, from the scientific evidence through last November's politically-motivated U.S. Preventive Services Task Force meeting cancellation that prompted my resignation from the federal government. When I was done, the instructor asked me why no present or past USPSTF members have yet come forward to confirm my story. It's understandable that my former AHRQ colleagues would remain quiet - unlike me, most of them don't have the option of leaving their jobs in the middle of an economic recession - but individual Task Force members aren't employed or paid by the government. Why haven't any of them spoken out about these insults to their independence and evidence-based medicine?

I don't know the answer, of course, but I have two theories. The first is that the government and former TF Chairman Ned Calonge (who has steadfastly maintained the "scheduling conflicts" story despite the easily verifiable fact that virtually everyone who was invited to the November 2010 meeting was, in fact, able to attend, and had already made travel arrangements) managed to convince the rest of the Task Force that I have a political axe to grind and simply invented the tale of the White House's involvement. In other words, they think I lied. The second explanation is that the Task Force believes my story, but have rationalized that preservation of the group's existence is a greater good compared to drawing attention to a controversial guideline that will inevitably be portrayed by political opponents as health care rationing - especially if more "D" grade ("don't do it") recommendations are in the works.

In the immediate aftermath of my blog post, my then-boss called me into his office and, after expressing his deep disappointment, called me an "idealist," as if it was a dirty word. (I hasten to add that after emotions cooled a bit, he was supportive of my decision and even helped to repair some strained relationships with my colleagues.) But that label - "idealist" - sticks with me now. Am I an idealist for believing that when the health of millions of men are at stake, science should come first, and politics second? Am I an idealist for wanting to be completely truthful to a group of respected scientists whom I spent 4 years of my life serving, and whom I considered colleagues and even friends? Am I an idealist for thinking that some means are never justified by the ends? Very well, then, I accept that label. And if being an idealist ultimately made me a pariah in government service, what is the opposite of idealist?

I hoped at the time, and still do, that by making the reasons for my resignation public, I would ultimately help to preserve the scientific independence of the USPSTF and their decisions to only recommend clinical preventive services of proven net benefit, politics be damned. The new leadership of the Task Force, empowered by the 2010 health reform law, now has an unprecedented opportunity to support and improve the health of all Americans - even if that means telling them that there are some tests they just don't need. I pray that they seize it, and wish them all the best.

3 comments:

  1. Wow..power post. It take a strong and principled person to stand up and risk it all for what they believe. Your patients are lucky to have you!

    Illegitimi non carborundum.

    Steve Wilkins

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  2. Good to hear more from you on this topic. I expect the "D" on PSA screening soon from the USPSTF even without your expertise, and dread now having to tell men that there is just nothing we can do to prevent death from prostate cancer, but at least we can prevent unnecessary and potentially harmful testing and treatment.

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