Friday, May 24, 2013

How not to de-politicize the USPSTF

Disease Management Care Blog has a good post on the politicization of the USPSTF and of science generally:
That's the bigger issue in this just-published article by Steven Wolf and Doug Campos-Outcalt. They're focusing on the political pressure that is being brought to bear on US Preventive Services Task Force (USPSTF). As readers may recall, the Affordable Care Act requires health insurers to fully cover screening services that are deemed effective by the USPSTF. Drs. Wolf and Campos-Outcalt point out that politics rudely intruded on the USPSTF's determination that the evidence supporting mammography for women under age 50 years was lacking. The resulting firestorm not only prompted Congress to not only waive the USPHSTF recommendation, but led some of its members to question the Task Force's integrity.

As academics writing in peer-reviewed journals are wont to do, the authors suggest that this can be remedied by another layer of bureaucracy. They want a new "firewall" committee to be inserted between the "pure" evidence-based USPHSTF and the "political" fisticuffs of the public square.  It'd be the job of this a new entity to insulate USPHSTF by reconciling the proof and the politics prior to the upload of the final recommendations to the mandarins that are running CMS.

"Another committee?" asks the dismayed DMCB. While that would end the Obamacare fiction that health reform was ever going to be truly "based on science," the real Achilles heel of the JAMA proposal is that it literally doubles the opportunity for political meddling. The smartest political operatives will see this as a target-rich environment and naturally seek to influence all of the committees with any jurisdiction over the medical-industrial complex of laboratory medicine, radiological imaging and medical devices.
DMCB suggests de-centralizing scientific decision-making, which I'm not convinced is a superior solution.  It might reduce the influence of special interests in many cases, but it probably also reduces the quality of the decision-makers.

Unfortunately, I think this is one area where centralized decision-making might be the lesser of two evils.  I've lived in DC long enough to know that there are no bodies of wise men with access to better knowledge than the rest of us.  But there is a lot of bad science out there and there is something to be said for having talented people reviewing literature and making these decisions.  Decentralizing decision-making can be a good way to reduce the influence of special interests, but I'm not sure that it would lead to better science here.  There is already a thriving pseudoscience industry in the health care sector, and I worry that this would only increase the opportunities for homeopaths, nutritionists and pharmaceutical company lobbyists to gain legitimacy through lobbying (rather than science).  This might be one instance where flawed wise-men might be wiser than a decentralized group of even more flawed wise-men.

1 comment:

  1. No because there are folks with an ideological interest in the viability of government health care, and they want to "prove" that we don't need to spend money on our patients, who just happen to be the taxpayers paying for all of this "free" health care.

    They are on a mission to reduce the cost of the standard-of-care because the current standard of care is too expensive for the American taxpayer, and that missionary attitude is anti-science.