Urologists Threaten the Autonomy of the U.S. Preventive Services Task Force

Over at HealthNewsReview.org  Gary Schwitzer has published a disturbing piece that looks at American Urological Association support for a bll that would make “significant changes to the U.S. Preventive Services Task Force.”

The guest post is written by Dr.Richard Hoffman, who is both one of HealthNewsReivew’s reviewers, and an editor at the Informed Medical Decisions Foundation a group that promotes “shared decision making.”   The Foundation, which was co-founded by Dr.Jack Wennber, the father of the Dartmouth Reserach,uses medical evidence to produce outstanding videos, pamphlets and web-based programs that help patients understand the potential risks and benefits of  elective surgeries and tests..  (I have written about “shared decision making” in past posts ). 

Below, an excerpt from Hoffman’s piece:

“Last week, the Supreme Court largely upheld the Affordable Care Act. Two weeks ago, legislation (H.R. 5998) was introduced that threatens the autonomy of the U.S. Preventive Services Task Force.

“The legislation proposes to mandate a more transparent process for guideline development, a greater role for specialists and advocacy groups, and eliminating the Department of Health and Human Services’ secretarial discretion to withhold Medicare funding for interventions that lack convincing evidence for benefit The legislation, which comes on the heels of the Task Force’s controversial D rating against prostate cancer screening, is strongly supported by several prominent urological associations. 


“Unfortunately, Congressional efforts on behalf of groups with financial conflicts of interest are not unprecedented.  In 1994, the North American Spine Society (NASS) was offended by an Agency for Health Care Policy and Research (AHCPR) report recommending against early spinal fusion surgery for back pain (based on data suggesting increased harms and no benefits). NASS successfully lobbied Congress to essentially defund the Agency. 

“…health care reform will succeed only if it improves quality of care and controls health care costs.  When conflicted professional organizations challenge recommendations against providing unnecessary and potentially harmful care, they subvert both quality and cost initiatives. . . . ”   You can read the rest of Dr. Hoffman’s post here

Hoffman serves as interim director for cancer prevention at the University of New Mexico Cancer Center where his areas of interest include prostate and colorectal cancer screening, and prostate cancer treatment outcomes. He holds an MD from the Johns Hopkins University School of Medicine and an MPH from the University of Washington

4 thoughts on “Urologists Threaten the Autonomy of the U.S. Preventive Services Task Force

  1. I am a self serving Urologist, ran for congress, and am , of course appalled by the USPTFS report.
    The bottom line is that deaths from prostate ca are down by 36-42% since unorganized, screening of most of the population since 1990 with PSA and digital rectal exams. We don’t see nearly as many men with advanced disease at presentation as we used to. Prostate ca is the second leading cause of death in men from cancer. The USPTFS says no one dies from prostate ca and it is slow growing.
    If one looks only at randomized prospective studies, and the are NONE, you get one view, If you look at everything, you come up with another.
    I think only a urologist can look at everything in context . I wish they had even ONE onthe USPSTF
    Sincerely,
    Sidney Goldfarb MD FACS Urologist
    Princeton NJ

  2. Sidney–

    First, there are no urologists on the Preventive Services Task Force for a reason. Dr. Otis Brawley, chief medical officer at the American Cancer Society explains:
    “I think their process is exactly where it ought to be. It removes those people who have emotional, ideological, or financial conflicts of interest” from being on the panel. Doctors and hospitals, which get paid for performing follow-up biopsies and treatments that result from screening, have a strong interest in seeing as many men screened with PSA as possible.” Brawley also agrees with the task force.

    I think one can assume that the chief medical officer of the American CAncer Society is as concerned about cancer as you are. It’s also safe to assume that he knows how to read and evaluate cancer reserach.
    There is one difference: he has no vested interested in defending PSA tests.
    It’s not just that urologists have a
    financial interest in the test (and the very expensive treatments that many perform
    after diagnosing a patient with “early stage prostate cancer”); they also have a psychological interest in defending what they have been doing for so many years.
    How could it have no benefit? they sputter. “I have always recommended this test.”

    It is difficult to admit that medicine is still an infant science, always subject to revision. But many doctors are accepting the fact that what they learned in medical school 25 years ago just isn’t true.

    We’ve written about PSA testing many times here on Healthbeat.
    For readers interested in the research showing that risks substantialy outweigh
    potential benefits see :

    What Rudy and Most Americans Don’t Understand About Prostate Cancer
    http://www.healthbeatblog.org/2007/11/what-rudy–and-/

    Should the Preventive Services Task Force Depend on Congress for Funding?
    https://healthbeatblog.com/2011/10/the-future-of-health-care-reform-health-wonk-review-raises-some-provocative-questions/

    American Cancer Society’s Brawley: “Prostate Cancer Clearly Saves Lives”–That’s A Lie https://healthbeatblog.com/2010/10/american-cancer-societys-brawley-prostate-cancer-screening-clearly-saves-lives-thats-a-lie/

    The Doctor Who Discovered PSA Calls PSA Testing a “Profit-Driven Public Health Disaster” https://healthbeatblog.com/2010/03/the-doctor-who-invented-psa-test-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/

  3. If the experts at the USPSTF think the PSA test is unnecessary, at least in asymptomatic patients, then CMS and private insurers should refuse to cover and pay for it. If a patient wants it, the doctor can tell the patient that your insurance won’t cover it but if you want it, you can pay for it yourself at a cost of $75 or $100 or whatever it is in that area. For those who can’t afford to pay for it out-of-pocket, they shouldn’t be getting it in the first place if it’s not cost-effective and doesn’t save lives.

  4. Barry–

    As a practical matter, I agree with you. Medicare and private insurers should not be
    paying for a routine test that medical research shows provides little or no benefit– and substantial risks. (The PSA test may be appropriate for high-risk patients, ethough it’s not a very good test.)

    It’s not just the cost of the test that is a problem, but the often very expernsive
    radiation treatments and surgeries that asymptomatic patients undergo ( with no
    benefit) after being diagnosed.

    But neither insurers nor Medicare are going to refuse to pay for PSA tests– or the subsequent treatments.

    If an insurer tried to refuse to cover PSA testing, it would lose many, many customtres (Headlines & the evening news would alert customers)

    If Medicare decided not to cover PSA testing, Congress would probably try to slash its funding.

    We’re going to have to wait until patients (and younger urologists) begin to
    assimilate the news about PSA testing.

    The one piece of good news: Under the Affordable Care Act, fnsurers cannot charge go-pays for preventive care that recieves an “A” or a “B” from the
    Preventive Services TAsk Force. (And deductibles won’t apply) PSA testing to a “D.” I assume this means that there will be co-pays.

    Many seniors will ask their doctors: Why the co-pay? Primary care physicians (who are often the doctors who recommend PSA testing in the first place) , are llkely to explain why– the risks outweight the benfits. That could begin a process of patient
    education.