Earlier this month, the U.S. Preventive Services Task Force (USPSTF) recommended against the routine use of the prostate-specific antigen (PSA) test for most men. A couple of years ago, the same federal agency concluded that routine mammography for most women in their 40s and 50s was counterproductive.
Both declarations incited passionate arguments on both sides of the issues.
So who are these fearless people whose job is to articulate health protocols with the potential to roil the waters of any medical specialty?
As readers will see from the list at the end of this piece, the members are distinguished doctors and other caregivers from around the country. Nary a faceless bureaucrat among them, contrary to what you hear from critics on the right.
Established in 1984, the USPSTF, according to its website, “was convened to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations and preventive medications.”
Anyone can look at the wide range of topics the agency addresses by linking to the site, and see whether a given recommendation is active, inactive or in progress.
As described in the Los Angeles Times, “If the world of primary-care physicians had a supreme wizarding council that only weighed in on screening tests and pills promising to head off disease, it would be called the U.S. Preventive Services Task Force.”
Wizardry is certainly one way to cultivate order within the chaos that is health care in America, a thick, perpetually simmering stew of commerce, politics, perpetual motion and consumerism. Wizards can ferret out the influence of a Big Pharma “task force” of physicians paid to hawk their product. They can disarm grass-roots movements that have declared otherwise worthy medical treatments suspect because of coincidence instead of science.
USPSTF wizards are obliged to filter out the noise and focus on the scientific evidence about screening tests, preventive medications, counseling and anything else that holds promise to treat symptoms or disease.
As the L.A. Times notes, the USPSTF has opined about “medications that promise to prevent heart attack or stroke, cancer screening tests that claim early detection means better chances of survival, HIV/AIDS screening in which privacy concerns are paramount.”
Sixteen people compose the USPSTF, representing physicians, nurses, health psychologists, epidemiologists and statisticians with expertise in primary care and preventive medicine. Their backgrounds include clinical practice, organizations and academic institutions outside of the federal government. They are nominated by institutions or individuals for four-year terms that can be extended by one or two years. They have no financial or professional conflicts-of-interest that could color their assessment of a preventive measure’s value, and anyone under consideration for the task force gig may be asked to provide detailed professional and financial information to ensure objective judgment. The U.S. Public Health Service ultimately grants membership.
As The Times says, the work is not glamorous, “but it is remarkably influential. Once a measure has been accepted for study (a decision made by the Health & Human Services Department’s Agency for Healthcare Research & Quality), task force members review the findings of an entire body of published studies on that measure. Then, they issue grades that not only recommend for or against the measure’s widespread use, but bluntly grade the quality of research that has been done.”
Most USPSPF decisions are aimed toward primary care physicians who need advice on which screening tests or preventive medications are worth ordering and prescribing to their healthy patients. But its sphere of influence has grown. If a health plan or an insurer is uncertain about whether to cover a screening or diagnostic test, or wants to shift the cost of a preventive medication to a patient, the recommendation of the task force is often the deciding factor. Professional societies see this small, but influential agency as a standard-of-care bearer.
Everybody, even a Godlike doctor, needs a mentor.
Here are the current members of the US Preventive Services Task Force. The list is courtesy of Healthnewsreview.org.
Virginia A. Moyer, M.D., M.P.H. (Chair) Professor, Pediatrics Baylor College of Medicine, Houston, TX Chief, Academic Medicine Service, Texas Children’s Hospital
Michael L. LeFevre, M.D., M.S.P.H. (Co-Vice Chair)
Professor, Department of Family and Community Medicine University of Missouri School of Medicine, Columbia, MO
Albert L. Siu, M.D., M.S.P.H. (Co-Vice Chair)
Professor, Geriatrics and Palliative Medicine Mount Sinai School of Medicine, New York, NY
Kirsten Bibbins-Domingo, Ph.D., M.D.
Associate Professor, Medicine, Epidemiology, and Biostatistics University of California, San Francisco, CA Co-director, UCSF Center for Vulnerable Populations San Francisco General Hospital
Adelita Gonzales Cantu, Ph.D., R.N.
Assistant Professor, Family and Community Health Systems University of Texas Health Science Center, San Antonio, TX
Susan J. Curry, Ph.D.
Dean, College of Public Health Distinguished Professor, Health Management and Policy University of Iowa, Iowa City, IA
Glenn Flores, M.D.
Professor, Pediatrics and Public Health University of Texas Southwestern, Dallas, TX Director, Division of General Pediatrics UT Southwestern Medical Center and Children’s Medical Center of Dallas
David C. Grossman, M.D., M.P.H.
Medical Director, Preventive Care and Senior Investigator, Center for Health Studies, Group Health Cooperative Professor of Health Services and Adjunct Professor of Pediatrics University of Washington, Seattle, WA
George J. Isham, M.D., M.S.
Medical Director and Chief Health Officer HealthPartners, Minneapolis, MN
Rosanne M. Leipzig, M.D., Ph.D Professor, Geriatrics and Adult Development, Medicine, Health Policy Mount Sinai School of Medicine, New York, NY
Joy Melnikow, M.D., M.P.H.
Professor, Department of Family and Community Medicine Director, Center for Healthcare Policy and Research University of California Davis, Sacramento, CA
Bernadette Melnyk, Ph.D., R.N., C.P.N.P./P.M.H.N.P.
Associate Vice President for Health Promotion, Chief Wellness Officer, and Dean College of Nursing Ohio State University, Columbus, OH
Wanda K. Nicholson, M.D., M.P.H., M.B.A.
Associate Professor, Obstetrics and Gynecology Director, Diabetes and Obesity Core Center for Women’s Health Research University of North Carolina School of Medicine, Chapel Hill, NC
Carolina Reyes, M.D., M.P.H.
Medical Director, Maternal and Fetal Medicine Virginia Hospital Center, Arlington, VA
J. Sanford (Sandy) Schwartz, M.D., M.B.A.
Leon Hess Professor of Medicine, Health Management, and Economics University of Pennsylvania School of Medicine and Wharton School, Philadelphia, PA
Timothy J. Wilt, M.D., M.P.H.
Professor, Department of Medicine, Minneapolis VA Medical Center University of Minnesota, Minneapolis, MN