By Liz Szabo, USA TODAY
Nobody loves a party pooper. And it seems nobody these days loves the U.S. Preventive Services Task Force.
Few Americans had even heard of it until three years ago, when the advisory board with the 10-syllable name challenged convention by saying women under 50 might not benefit from mammograms, just as the debate over health care was coming to a boil.
The task force was accused of trying to ration care, even though its members never
consider cost, says group chairwoman Virginia Moyer, a professor of pediatrics at Baylor College of Medicine in Houston. Critics repeated those accusations in May, when the task force suggested that healthy men would be better off skipping PSA tests for prostate cancer, concluding that men are more likely to be harmed than helped.
"Everyone has a right to ask who these people are and how they conduct their business," says Deepak Kapoor, a urologist in Melville, N.Y. who takes issues with the task force's PSA decision. "They are completely unaccountable."
Some in Congress even want to change how the group operates.
Last month, Rep. Marsha Blackburn, R-Tenn., and Rep. John Barrow, D-Ga., introduced legislation that would require the task force to consult more closely with patients and specialists in relevant medical fields, such as the urologists who treat prostate cancer. Barrow, a prostate cancer survivor, credits the PSA with saving his life. In an interview, Blackburn says she wants to see applications for the task force vetted publicly to prevent "cronyism." The bill is supported by the American Urological Association, which opposed the task force's stance on PSA tests.
David Meyers, the task force's acting scientific director, says there's nothing to prevent urologists or other specialists from applying to join the task force.
Otis Brawley, chief medical officer of the American Cancer Society, says the primary care providers and screening experts on the task force are perfectly positioned to be impartial. Because primary care doctors don't earn money by performing imaging tests or by diagnosing and treating cancer, they don't have a financial stake in the screening debate, he says.
Critics "ar trying to kill the messenger," Brawley says. "This is a scientific and medical issue that they are politicizing, and truthfully informing the patient may be the victim."
Though the task force went further than most by advising against the PSA, Brawley says none of the major medical groups tells men to get one. Instead, both the American Cancer Society and American Urological Association take a more nuanced position, advocating for "informed decision making."
Looking back, the task force's position on mammograms wasn't all that different from the American Cancer Society's advice, Brawley says. "The real problem with the breast cancer statement three years ago was a communication and public relations one," Brawley says. When it comes to mammograms, "we're not the same, but we're very close."
Yet because the task force often overturns conventional wisdom, it "is always in the eye of the storm," says Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice. "They haven't always been so great at getting their message out."
Woloshin says there are several reasons why the task force often takes a contrarian stance.
Doctors often adopt promising new technologies immediately because they hope to save lives, Woloshin says. The technology may take off and become a part of standard practice while patients see the procedures almost as a right. It can take years or even decades for clinical trials to show whether that technology really helps people. "It may seem that the task force is conservative," Woloshin says. "But really, it may be that the practitioners are more aggressive." Once study results are finally available, Woloshin says, "that's where the task force comes in" to make recommendations on the evidence.
In the case of PSA, doctors used the tests for 20 years, even without any rigorous clinical studies showing whether they saved lives, Brawley says. When the trials were completed, the results showed the PSA carried significant risks and saved few, if any, lives. In the best case, the tests might save one in 1,000 men from dying of prostate cancer, Moyer says. But the tests also cause many men to undergo unnecessary treatments, which can cause serious and even deadly complications of their own.
Last month, the task force sought to curb the public's enthusiasm for calcium and vitamin D pills. Even though doctors have advised women to take calcium for decades, studies have failed to find that taking the tablets actually prevent women from fracturing bones. The task force announced last month that there's no evidence that postmenopausal women should take either type of pill.
Yet doctors who've been practicing one way for decades may not be eager to change, even if evidence shows the technology they've been using has no benefit - and may in fact cause harm, Brawley says. Patients may not be happy to hear experts suddenly change their minds, either. "The history of medicine is filled with doctors having opinions about things and starting to do things," Brawley says, "and then years later we finally get around to doing the science, and finding out that their opinion was wrong."
In some cases, Moyer says, doctors have more questions than science can answer.
Though professional groups may feel compelled to answer members' questions, even in the absence of definitive clinical studies, the task force's mandate says it isn't permitted to do that. That can lead to differing standards, Moyer says. Gynecologists or pediatricians make recommendations based on the experiences of their best experts, while the task force remains on the sidelines, refusing to weigh in.
The American Cancer Society has adopted some of the task force's methods of writing screening guidelines, Brawley says. Recommendations will be written by generalists and experts in screening, as opposed to radiologists, who interpret tests such as mammograms, or oncologists, who treat people who have cancer.
Moyer says she understands why consumers would find it confusing to read conflicting advice from two medical groups.
So this year, the task force teamed up with the American Cancer Society and two other gynecological groups to release cervical cancer guidelines on the same day. The guidelines are nearly identical, Moyer says. "We worked very hard with the other organizations to be consistent," Moyer says. "We don't want to confuse people."