Wednesday, October 5, 2011

The meeting that wasn't, revisited

A New York Times Magazine story published on the newspaper's website this morning details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF's scientific activities on a wide range of topics.

I commend science journalists Shannon Brownlee and Jeanne Lenzer for their tireless reporting efforts and dogged persistence in pursuing the real reason for the meeting's cancellation, despite repeated and vigorous denials of senior government officials. Former USPSTF Chairman Ned Calonge confirms in the Times story that politics played a role: "In November 2010, just before midterm elections, the task force was again set to review its [prostate screening] recommendation when Calonge canceled the meeting. He says that word leaked out that if the November meeting was held, it could jeopardize the task force’s financing." It's true that several members of Congress had threatened to cut off funding for the Task Force after it recommended against routine mammography for women in their 40s. To the best of my knowledge, however, the order to cancel the meeting came directly from the White House, not Congress. And according to my superiors at the time, Dr. Calonge had no choice in the matter.

In a 2007 commentary in BMJ, former Assistant Surgeon General (and current Georgetown University colleague) Doug Kamerow, reflecting on the George W. Bush administration's attempts to censor government health officials' statements on controversial scientific issues, wrote:

Clearly a presidential administration should be allowed to attempt to set its agenda, to focus on what it thinks are important issues, and to prioritize. It also, of course, has a right to tout its accomplishments and take credit for even the serendipitous achievements that have taken place during its tenure. When, however, administration officials ... bend the rules of science or evidence in pursuit of a political agenda or policy, it is a different matter entirely. That is the time for honorable government employees - whether career status or political appointees - who are unable to persuade the administration to desist from such distortions to call attention to them in the only way they can: resignation.

During my tenure at AHRQ, there were in fact heated disagreements between the USPSTF and other Bush-era health agencies on politically charged recommendations such as screening for HIV and illicit drug use. But whatever the Bush Administration did to interfere with science, it did not go so far as to unilaterally cancel any scheduled meetings of the USPSTF. That distinction, unfortunately, belongs to the Obama Administration. I hope that the New York Times story sheds some much-needed light on the shadowy politics surrounding prostate cancer screening, and in so doing, allows the current Task Force to re-assert its recently curtailed independence and unfettered ability to make science-based recommendations for the good of the public, rather than the agenda of any politician or political party.

1 comment:

  1. There is a question on our competency evaluation for residents that says: "Patient care supersedes own interests." Unfortunately, we often don't model that, especially on that big-picture level of public health advocacy.

    Thanks, Kenny, for sacrificing for the principle of the true doctor - doing whats right not to be right but to best serve the patient or community. And for reminding us to recognize evidence-based decision-making vs. intuition vs. politics and be transparent about that. And to you and Shannon and a few vocal others for reminding us that modern medicine has a lot of harms that we try to ignore.

    We can do this better. But we have to be honest and courageous.