Faith-Based Medicine Doesn't Save Lives - Evidence Does.

Whenever a deeply held belief comes into conflict with evidence, the stage is set for the sort of pitched battle we’re now seeing over the U.S. Preventive Services Task Force (USPSTF) guidelines for prostate cancer screening. We’ve got headlines proclaiming “Men Can't Afford to Skip the PSA Test,” letters to Congress saying “the U.S. Government is putting the lives of thousands at risk,” and a doctor telling the New York Times, “ We will not allow patients to die, which is what will happen if this recommendation is accepted.”

The reality? The report (full versionhere) says that there is “moderate or high certainty that [routine PSA testing] has no net benefit or that the harms outweigh the benefits ,” and thus gives it a “D” rating. “D,” in this case, means “discourage this service.”

Note what the recommendation doesn’t say. It never tells doctors to “deny this service.” Nor does it say to insurers, “don’t pay for this service.” The USPSTF does not ration care, determine what private insurance has to cover, or even determine what Medicare will pay for.* Rather, the task force’s sole purpose is to distill research findings into concise advisory opinions for medical providers.

The effect of all the fearmongering -- in addition to misinforming men about the страшимыми of the PSA test – is to set the stage for some potentially dangerous political theater. Congress has a habit of threatening research agencies when their findings displease some important constituency. The last controversial recommendation from the USPSTF (which said there was no need for women ages 40-49 to have annual mammograms) generated such fallout that the current recommendation was held back for nearly two years – depriving men and their doctors of crucial information about the risks of getting a prostate screening test.

The task force had reason to be scared: health care research agencies have become political footballs before. In 1994 and then again in 1995, the Agency for Health Care Policy and Research was killed by the Republican-led House after another task force laid out the (poor) evidence for certain kinds of surgery for low back pain. A group of back surgeons went ballistic, ran to their Congressmen, and the House zeroed out the agency's funding. (The funding was only partially restored after Senators Bill Frist and David Durenburger, both Republicans, pleaded the agency's case. It was brought back to life with a much smaller budget and much diminished role in government medical research as the Agency for Health Care Research and Quality.) After its near-death experience, the renamed AHRQ got the message: don't do anything to rile up the doctors too much.

The chilling effect of such political pressure on medical research is worrisome—and never more so than now, with a deeply partisan Congress and a desperate need for honest research on ways to improve the practice of medicine. The AHRQ and the USPSTF perform indispensable work: AHRQ funds studies that are needed to know what works in medicine what doesn’t, and for which patients. The task force offers recommendations on immunizations, screenings for a huge variety of diseases, and other preventive care. Pointing out when we’ve been mistaken about a procedure or test is a critical function of that work.

Responsibly practiced medicine depends on our willingness to put our emotions aside, and look at what the data say—even when it’s counterintuitive, or when somebody’s ox is gored. It would be a huge disservice to patients and to the health care system to penalize the task force for doing a good job.

* Congress has already said that Medicare must pay for PSA testing for all men. Medicare also pays for all sorts of other procedures and tests that it probably shouldn’t, like Avastin for breast cancer and knee arthroscopy for arthritis, but that’s a topic for another blog.

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