What is the main duty of the Preventive Service Task Force?

W: When you go to the doctor’s office for a checkup, how do you know that every procedure is actually necessary? Nearly three decades ago, the U.S. Department of Health and Human Services created a panel to answer this very question: the Preventive Services Task Force. I spoke with Elliot Marshall about recent controversies involving the Task Force and some proposed changes in how they make assessments. Welcome, Eliot.
M: Thank you. There’s an interesting contrast between the way this group of experts sees themselves, and how they’re perceived as working by the public. They deal with issues that affect public health, and everyone’s encountered the issues that they deal with when they go to the doctor. So it’s an interesting mix of politics and science.
W: So Eliot,(1)what does the U.S. need a Preventive Service Task Force for? What do they do?
M;(l)We spend a great deal of money on checking our health and trying to prevent disease and looking for early signs of disease. And it turns out, when you investigate it carefully, as they do, a lot of it is unnecessary. Not only is it unnecessary, but it’s also—it can be—detrimental. So it’s good to have somebody looking over these decisions that we make to see if we’re on a sound course, whether we’ve got evidence for the things that we do when we visit the doctor.
W: So how does this task force go about deciding what preventative measures to review? What do they use as their indicators?
M: They take a very academic and very labor-intensive look at everything that’s been published on the subject, and they try to find the best evidence for whether a procedure that you may be invited to undergo by your doctor really has solid evidence supporting a conclusion that it will do some good—that is, they look for evidence of efficacy.
W: Does the task force take into consideration the costs that come into play when they’re advising on what things are effective?
M: Well, when I asked Virginia Moyer—the chair of the task force—this question, she said no.(2)I mean, they are explicitly told not to look at cost. And this is one of the points of controversy in their work. People think they do, but they do not. The main task of this group is to look at whether medical procedures work—whether screening procedures work. And they do consider the cost to a patient in an informal way, but not in the same way they consider other evidence.(2)So it’s something that sort of weighs in the balance, but they don’t investigate cost as a primary issue.
W: This task force has been in the news recently because there’s been some controversy lately surrounding some of their recommendations. Can you talk about some of these?
M: Well, I’ll just mention the one that got them the most attention, which was in 2009. They took a look at the use of mammography, a kind of X-ray, to detect breast cancer early, with an idea that you could intercept it and treat it and prevent death from breast cancer by having mammography.(3)What was controversial was that they were looking at a specific age group—women in their 40s. And this was hugely controversial, because there are many groups that promote early screening for breast cancer. And there are also medical groups who have advocated that screening in this age group is proper and early enough. So it was a controversial decision.
W: So in essence, the mammography study was simply telling women to use their best judgment before getting a possibly unnecessary treatment. Why was this so controversial?
M:(4)Some people have described what happened with the mammography screening decision as a perfect storm. For example, Mike McGinnis, who’s at the Institute of Medicine, called it that because he said it came at a time when national elections were occurring. There was a large and very vehement debate going on about the reform of the health insurance. And since then, they’ve been trying to get a better handle on how to communicate how they do their analyses.
W: So the task force recently made a decision about prostate exams. Can you tell me what was different about that?
M: Actually, they came to a more negative conclusion, which was that the evidence actually shows that you should not recommend that procedure for anyone, that no healthy person should undergo that test. It should be reserved for people who are at risk of cancer for some other reason.
W: That sounds like a big change.
M: So anyway, the second case of reviewing prostate cancer screening also led to objections from those who treat people with prostate cancer. A bill has been introduced in Congress that would overhaul the task force by mandate from Congress, changing the makeup of the task force.
W: So were these recommendations made by the government followed?
M; Well, one of the consequences over the mammography decision was that the task force sort of changed the way it communicates information. They tried to make it much more comprehensible, easy to understand, clearer.(5)But they also changed their procedures for getting input from the outside. And they now invite the public to comment before they review a new issue, and after they’ve issued their draft decision. So they didn’t use to do that; they used to just consult with some educated peers, experienced peers, about what they should do. Now they’ve opened up their procedures a bit. So that’s one major change.
W: Well, Eliot Marshall, thanks for talking with me.
M: Well, thank you very much.