In a previous blog note about the recent flap relating to mammography recommendations for women in their 40"s (see: Science-Driven Medicine Bumps Up Against Perception of Risk with Mammography), I made the following statement:
So the question for health and lab professionals is whether this is a general vote in favor of early screening and against EBM and comparative effectiveness as tools and analytic methods for the future. I think that the answer to this question is probably no because of some of the unique aspects of mammography in particular and women's breast health in particular. Breast screening in so ingrained in our culture through long-standing practice that it will be nearly impossible to alter in any substantial fashion. However, any health panel recommendations in the future may need to take the individual wishes and perceptions of healthcare consumers into consideration. For me, this is the major lesson that has now been learned.
The pressure is now on regarding evidence-based medicine and expert task force recommendations, forcing Dr. Joseph W. Stubbs, MD, President, American College of Physicians, to rise to the occasion, defend EBM, and scold the authors of the "ill-founded attacks" (see: Statement on the politicization of evidence-based clinical research). Below is an excerpt from his statement:
The American College of Physicians (ACP)... believes that it is essential that research on the effectiveness and comparative effectiveness of different medical treatments not be influenced by political considerations. The U.S. Preventive Services Task Force (USPSTF) recommendations on mammography...have regrettably been used by some critics of the health reform bills being considered by Congress to make baseless charges that the bills would lead to rationing of care. Other critics have made unfair and unsubstantiated attacks on the expertise, motivations, and independence of the scientists and clinician experts on the USPSTF. ACP believes that it is essential that clinicians and patients be able to make their own decisions on diagnosis and treatment informed by the best available scientific evidence on the effectiveness of different treatments and diagnostic interventions....As is often the case with evidence-based reviews, the USPTF's recommendations will not always be consistent with the guidelines established by other experts in the field, by professional medical societies, and by patient advocacy groups. Such differences of opinion, expressed in a constructive and transparent manner so that patients and their clinicians can make their own best judgment, are important and welcome. It is not constructive to make ill-founded attacks on the integrity, credibility, motivations, and expertise of the clinicians and scientists on the USPSTF. Some critics have erroneously charged that the USPSTF's recommendations were motivated by a desire to control costs.....[I]n situations where there is likely to be some effectiveness of the service, the Task Force searches for evidence of the costs and cost-effectiveness of implementation, presenting this information separately from its recommendation and the recommendations are not modified to accommodate concerns about insurance coverage of preventive services, medicolegal liability, or legislation, but users of the recommendations may need to do so.
Here's what I think that Dr. Stubbs is saying in plain language. "Holy Toledo! There is some very serious stuff going down here. First of all, evidence-based-medicine is taking a beating in the press. Secondly, our esteemed journal and the USPSTF (how is this acronym actually pronounced?) is being accused of taking cost-effectiveness into consideration in its scientific deliberations. Thirdly, we are also accused of being in league with the insurance industry by paying attention to the cost of care. These canards are unworthy of comment but I am going to issue a statement anyway. If we made any mistake at all, it was ignoring the wishes of the female healthcare consumers of the country. But since when do prestigious medical task forces need to anticipate and factor the wishes of consumers into their recommendations?" I think that the answer is starting now.
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