Monday, January 18, 2016

This is 40: evidence-based vs politically mandated care

Ironically, my Viewpoint on public health and screening mammography appears in JAMA the day after I turned 40. Written with Georgetown law professor Lawrence Gostin, it articulates the reservations I expressed last week about Congress preemptively overruling the recently finalized U.S. Preventive Services Task Force breast cancer screening recommendations. Make no mistake: like the members of the USPSTF, I don't have a problem with ensuring that women who make informed decisions after considering the potential benefits and harms can undergo screening mammography at any time after age 40. What troubled me was the process that legislators chose to do this: rather than adding a coverage benefit on top of the Affordable Care Act's evidence-based preventive care mandate, Congress undermined the Task Force's scientific credibility by claiming that 14 year-old clinical guidance (the USPSTF's 2002 recommendations on breast cancer screening) is still relevant to women's health today.

Professor Gostin and I conclude: "The ACA improved the public's health by guaranteeing that insurers provide uniform, cost-free access to preventive services based on modern evidence of effectiveness. The public's health is best served when women's personal decisions about screening are informed by evidence rather than political considerations. Congress's paternalistic response to USPSTF mammography screening recommendations vividly illuminates the social costs of politically mandated care. Rather than benefiting women, political interference with science can discourage shared decision making, increase harms from screening, and foster public doubt about the value and integrity of science."