Time to cut the cord between Obamacare and the USPSTF?

In an important editorial, just published in the Annals of Internal Medicine, three former senior members of the U.S. Preventive Services Task Force (USPSTF) argue that it may be time for de-linkage of the recommendations of the Task Force from  decisions about whether specific types of preventive care should be covered under the Affordable Care Act. This is an argument that The “New” Prostate Cancer InfoLink would concur with.

Clearly, some group of people do need to be empowered to make decisions about what tests and what forms of care get covered under insurance plans that meet the stipulations of the ACA, but what is happening now is that the USPSTF is being seen as a target for lobbying because its recommendations can profoundly impact whether this or that test or form of care is covered under the ACA (or “Obamacare” as it has become popularly or unpopularly known, depending on one’s point of view). This makes it increasingly difficult for the USPSTF to issue scientifically unbiased opinions about whether this or that test should or shouldn’t get an A or B rating from the USPSTF that would ensure coverage of the costs under the ACA.

Whether one agrees with the USPSTF or not about some of their decisions, we need a body that tries to make recommendations on such issues that are based on the medical and scientific evidence alone, and not on the effectiveness of the lobbying by some company or advocacy group or whatever. There is an important distinction to be made here between the medical and scientific recommendation and the social and financial implications of each specific recommendation.

In recent years the USPSTF has come under enormous pressure from multiple organizations that didn’t like the decisions it made. And sometimes that pressure has been driven by the financial implications of their decision. Organizations will still “fight back” when the USPSTF comes to conclusions that they do not agree with. The upcoming recommendation about PSA screening (due some time within the next 18 months or so) is a potential example … because many in the prostate cancer community will be angry if the USPSTF does not alter its current D-level recommendation.

However, there are clear benefits to de-linking the USPSTF recommendation from decisions about coverage for care under the ACA.

The editorial in question addresses a specific example of a manufac turer seeking to persuade the USPSTF that having an form of treatment for acute allergic reactions is a form of “preventive care” that they should be endorsing. But the form of treatment in question is not preventive care; it is therapeutic care for a person who is having certain types of allergic response to specific types of stimulus. The actions of the manufacturer are a clear example of a company trying to “game the system” to make sure that “the government” (i.e., you and I) are paying for immediate access to treatment for every person who might possible need it. Do we think that every patient who might need this form of treatment should have it available “just in case”? Yes, we do. But we don’t think that makes this form of treatment a form of preventive medicine, and we consider that the manufacturer’s widely publicized behaviors in driving up the cost of this form of treatment for all those who need them over the past few years has been deplorable enough already. This is just another example of this type of corporate profiteering … and the USPSTF is entirely right in resisting such lobbying, but it would be better if their decisions were de-linked from the whole issue of coverage.

2 Responses

  1. Faulty Make-up of USPSTF Renders It Unfit for Its Purpose

    There is surely a hot place in hell reserved for the greedy, sociopathic executives of Mylan! Of course they have no shame, so why not aggressively lobby the USPSTF.

    But whether or not the USPSTF’s recommendations should be decoupled from the ACA because of lobbying pressure, the USPSTF is still arguably incompetent to fulfill its mission because it sometimes lacks expertise in tackling certain medical issues. Most of us would agree that is the case with prostate cancer, as not a single oncologist or urologist was on the voting board, and as the USPSTF committed a number of rather basic blunders stemming from evident deficiencies in understanding the disease, treatments, the state of play, trends, etc. in publishing its last recommendation on prostate cancer.

    I am convinced the USPSTF should not make recommendations on issues in which it lacks competence. A better solution would be to legally reconstitute the board to include ad hoc members so that it would have competence and could make informed recommendations. It would also help to have public hearings on its draft recommendations, as is done with FDA advisory committees, such as the Oncologic Drugs Advisory Committee.

    Of course, the lobbying aspect is another important, separate issue.

  2. Dear Jim:

    With the very greatest respect, I am not sure that you really appreciate what the USPSTF’s mission is. The fact that I don’t agree with its recommendation about the use of the PSA test (and neither do you) doesn’t mean that I think that its makeup “renders it unfit for its purpose”. Indeed, I suspect that very few passionate advocates about any specific disease for which screening is a possibility agree completely with the USPSTF’s recommendations about their specific disease of interest. That sdoesn’t make the USPSTF “unfit for its purpose” either. What it means is that there is a difference of opinion between people like you and the members of the USPSTF about what its purpose is!


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