HHS could eliminate the U.S. Preventive Services Task Force (USPSTF) completely or outlaw the independent agency similar to the CDC’s Advisory Committee on Immunization Practices (ACIP), two former members of the USPSTF have warned.
“The USPSTF, an organization created by the Reagan administration to bring scientific rigor to prevention policy, is now under threat from the Trump administration, particularly Secretary of Health and Human Services Robert F. Kennedy Jr.,” Robert Lawrence, MD, PhD, the task force’s first chair, and Stephen Wolf, MD, MPH, its first scientific advisor, argued in the paper when the task force was created more than 40 years ago. Annual report of internal medicineOpens in new tab or window Explanation.
The task force has been in existence since 1984 and is comprised of volunteer experts who review evidence and provide evidence-based recommendations for screening and other preventive care. Recommendations to earn an A or B grade by law — etc. colorectalOpens in new tab or window or chestOpens in new tab or window Cancer screening — insurance companies must cover the cost at no cost to the patient.
Lawrence and Wolff warned that even if the USPSTF begins to make sweeping recommendations based on weak evidence, current law requires coverage of care, and that “all of this is at risk.”
“Purchasers and insureds may end up paying for questionable screening tests and patient counseling about vaccine risks and unconventional diets,” the researchers wrote. “As happened with ACIP, the medical and public health communities may lose confidence in the USPSTF and turn to specialized agencies for guidance on preventive services.”
“I was concerned last summer when, with two days’ notice, we found out: HHS canceled regular meetingOpens in new tab or window of the task force. It appeared following ACIP DisbandingOpens in new tab or window and replacedOpens in new tab or window by ideologically motivated groups [vaccine skeptics]. Dr. Wolf and I were worried that we would face the same situation at the task force. ”
For now, The schedule for a new task force meeting has not been announced.Opens in new tab or window. Additionally, no plans for their replacements have been announced, even though the terms of five members of the 16-member task force expire on December 31 and four draft guidelines are scheduled to be finalized. Those guidelines are: According to new york timesOpens in new tab or windowaddress Testing adults for unhealthy alcohol useOpens in new tab or windowfor self-swab Cervical cancer screeningOpens in new tab or windowcounseling for women at high risk for perinatal depression, and vitamin d supplementsOpens in new tab or window To prevent fractures and falls in the elderly.
But the task force’s future is uncertain, warns Lawrence and Wolff, director emeritus of the Center for Society and Health at Virginia Commonwealth University in Richmond.
“Although it cannot be abolished without Congressional approval, Secretary Kennedy could eliminate the USPSTF by tightening its budget and personnel,” they wrote in an editorial. “President Trump could replace members and discard rules of evidence to revise or rescind USPSTF recommendations that touch on topics ideologically sensitive to the administration, such as drug use, sexually transmitted infections, HIV infection, and mental health. Recommendations that prioritize services for high-risk groups, such as minorities and the LGBTQ+ population, could disappear.”
“The situation is alarming,” Lawrence said. “I hope this piece gets enough attention in the health community that people can advocate for a rules-based order in the public health world, because it certainly has been beaten down by previous acts.”
The authors noted that in the past few years, patient advocacy groups such as the American Cancer Society have supported screening tests, but evidence that screening tests improve health outcomes is limited, and insurance companies have been reluctant to cover them, making “preventive services a luxury available only to those who can pay out-of-pocket costs. In what was then known as ‘reverse targeting,’ preventive services were made least available to high-risk patients who were most likely to benefit.”
Before the rise of evidence-based medicine, “experts tended to recommend what they were taught in training or observed in clinical practice, often citing selective research that confirmed their biases,” Lawrence and Wolfe write. “The guideline development process was opaque, generally closed to the public, and vulnerable to bias as well as conflicts of interest. There was no expectation that all relevant evidence would be collected and accounted for.”
The arrival of the evidence-based medicine movement in the 1980s prompted researchers to “shed their old ways, adopt a more rigorous approach to critical appraisal of research, and make recommendations based on data-backed evidence,” the researchers continued. “The USPSTF was a pioneer in this movement. Inspired by a similar task force in Canada, the USPSTF introduced Rules of Evidence, a systematic search method to ensure a comprehensive review of all relevant research, a scoring system to evaluate research, and a letter grade that ties recommendations to the quality of the science.”
However, access to preventive services remains a barrier due to out-of-pocket costs, especially for high-risk patients. This all changed in 2009 with the passage of the Affordable Care Act. The law stipulated that A or B grade insurance, as recommended by the USPSTF, must be insured at no cost to patients.
Today, 17 years later, “a generation of insured Americans is accustomed to free mammograms, colonoscopies, oral contraceptives, and other USPSTF-recommended preventive services,” they write.
Lawrence said in an interview that he has heard that some task force members, who are typically generalists such as family physicians, internists and pediatricians, will be replaced by specialists. “If you have a cardiologist or a nephrologist instead of a general internist, you’re likely to encounter someone who sees things differently, and their expert opinion will be determined by their own narrower view of what the population’s health needs are,” he said.
One of the early task force members was a medical sociologist. “Many of the recommendations, particularly around things like behavior change to reduce risk, are in the realm of social science…and that would be hampered if they were replaced by groups of people, each with a particular professional orientation,” Lawrence said.
Lawrence and Wolf noted that doctors’ confidence in the USPSTF’s recommendations did not happen overnight.
“It has taken decades of effort to build the advisory body’s reputation, strengthen its analytical methods for critically appraising evidence, and refine its process for making evidence-based recommendations,” they write in their conclusion. “Current efforts to ignore this progress in pursuit of political or ideological ends are destroying the infrastructure that has taken decades to build. This is an existential threat to clinical practice and the health of our population, and we are ignoring it at our peril.”
