Lack of transparency re public “input” to USPSTF is rather sad

According to a new article by Andy Pollack on the New York Times Health blog just before 1:00 p.m. EST today, the U.S. Preventive Services Task Force (USPSTF) has managed to add to public confusion about its process for what was originally described as public “comment” on current draft recommendations (regarding screening tests for prostate and ovarian cancer and other disorders).

In the on-line material seeking community opinion and feedback on the draft recommendation of a “D” grade for the use of the PSA test in the screening of healthy males for risk of prostate cancer, the USPSTF clearly states that it is “sharing drafts of its Recommendation Statements on clinical preventive services for public comment.”

In the article by Mr. Pollack, our good friend Jan Manarite of the Prostate Cancer Research Institute is quoted as saying, “It’s public comment; it should be public.’’

This certainly sounds right to us. Unfortunately, however, the USPSTF is not intending to make the comments submitted “public” at all. They are now describing “public comment” as more properly thought of as “public input.”

This has placed Dr. Virgina Moyer, the chair of the USPSTF group that put together the PSA screening recommendation, in the embarrassing position of having to try to “re-manage perceptions” post hoc. To quote Mr. Pollack:

“This is very new for us,’’ Dr. Moyer said. She said the transparency initiative was still “a work in progress’’ and that at some future time the task force might allow the public to read, as well as write, comments.

Such re-management of perceptions is rarely a good idea. It fuels the fears of “conspiracy theorists.”

“Public comment” and “public input” are two very different animals. There is a long history in this country of “public comment” implying a form of public input that is available for all to see and to read. Assurances that all comments submitted by the public “would be read and appropriately considered” just doesn’t cut the mustard.

Whatever one may feel about the accuracy of the actual recommendation of the USPSTF, it is clear that managing perceptions is a skill set that the USPSTF still needs to work on if it wishes to be recognized as a reliable and credible organization in the eyes of the general public. This is a pity, because the USPSTF is made up of a group of very smart people who are trying hard to offer the best guidance they can to the primary care community about appropriate screening for many disorders … but they do seem to have a talent for misreading the ways in which the media, the general public, and the special interest communities are going to respond to their efforts. A greater degree of foresight and transparency would be helpful for all concerned.

8 Responses

  1. Just read the article. I agree with you wholly on this, Mike. It’s really foolish to try to keep public information from being public.

    I have already sent Michael LaFevre (USPSTF member from our campus) a message to that effect.

  2. How important definitions are :-)

    Just what is meant by “sex” in the phrase “I did not have sex with that woman”?

    Is there truly an agreed definition difference between “public input” and “public comment” or is this just a stick to beat on someone with views that are not popular?

  3. Another example of “your government working for you”. It appears their recommendation is made and they just want to go through the required process of “public comment” before finalizing the recommendations. I wonder who reads our comment. An unpaid intern with a circular file?

  4. Dear Terry:

    As noted in the article above, at least here in America … ‘There is a long history in this country of “public comment” implying a form of public input that is available for all to see and to read.’

  5. Not surprised. Had this niggly feeling from the get-go. We had better not learn that the volumes of comments that were likely sent in were set aside and generally ignored.

  6. Chuck:

    Well … Unless comments sent in offered some scientific rationale to support them, I think we can be sure that they will be largely ignored, becuase the USPSTF (rightly) makes decisions on the basis of scientific data. So …

    Comments that just say things like “This is a ******* awful decision” are not going to have a loit of time spent on them.

    On the other hand, I am aware that some comments sent in to USPSTF have received responses asking for additional suppporting evidence and clarifciation, so most certainly some commenmts are being taken very seriously.

  7. Dear Sitemaster,

    I am sure there is also a long history in the US of “sex” implying many of the activities undertaken in the Oval Office.

    I still think this is a storm in a teacup; an argument about what specific words mean; like an argument about how many angels can dance on the head of a pin. All designed to divert attetion from the main issues.

    Arnon used the word Orwellian and I found that amusing, thinking of that pig in Animal Farm (can’t recall his name) who was always dancing with his amazing tail whenever a difficult question was raised. A good distraction.

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