Why I love the USPSTF

Readers of this column will already know that I am a great fan of the United States Preventive Services Task Force (USPSTF). But they may not know how far back that fan support goes.

The USPSTF was founded in 1984 to produce evidence-based policies for preventive care. In about 1986, while editor of JAMA, I was asked to consider becoming the primary destination for the USPSTF reports, after appropriate peer review, of course.

I discussed it with the Task Force volunteers, consulted our staff, and then agreed to do so. JAMA published the initial 12 background papers from 1987 to 1990, resulting in the first edition of “Guide to Clinical Preventive Services.”

I am proud of that. Why? Because the papers, the guide, and the process have stood the test of time.

The second task force was created in 1990, and the third in 1998, more since then. Some subsequent reports were published in the JAMA and more recently they have appeared in the Annals of Internal Medicine.

These USPSTF reports are one of the few, and at that early time, one of the only sources of important medical information that was influenced little or not at all by financial conflicts of interest of the authors or their institutions.

Task force members are usually experts in primary care, preventive medicine, and epidemiology-biostatistics, and deliberately note in the medical or surgical specialty or subspecialty most directly involved with the disease being studied and its prevention and treatment.

That fact became both the USPSTF’s greatest strength, namely economic neutrality, and its greatest vulnerability, namely being comprised of people who may know little directly about diagnosing and treating the disease in question.

But I support the structurally unbiased approach as being in the best interest of truth and the public. So much of the medical literature and the practice community are inherently biased.

Look at the membership of the USPSTF over the years. It reads like a veritable Who’s Who in American Medicine: Al Berg, Don Berwick, Hal Sox, Gene Washington, and Bob Lawrence for starters; then Sandy Schwartz, George Isham, and so many other dignitaries.

Consider the importance of these topics and task force reports over the years: mammography for breast cancer, PSA testing for prostate cancer, cervical cancer screening, osteoporosis screening, screening for obesity, use of Vitamin D, effectiveness of behavioral counseling interventions, prevention of neural tube defects, prevention of skin cancer, prevention of falls.

In other words, topics of daily applicability to the lives of most ordinary people and the practices of most physicians.

The USPSTF is destined to occupy a perpetual hot seat. With the emphasis on prevention from the Affordable Care Act and the requirement that we endeavor to spend healthcare dollars only on diagnostic and therapeutic products and processes that are effective and efficient, that seat will only get hotter.