RFK Jr. May Eliminate the USPSTF, Original Task Force Members Warn

HHS could completely eliminate the U.S. Preventive Services Task Force (USPSTF) or delegitimize the independent body like it did with CDC’s Advisory Committee on Immunization Practices (ACIP), two original USPSTF members warned.

“The USPSTF, the entity established by the Reagan administration to bring scientific rigor to prevention policy, is now under threat by the Trump administration, particularly Secretary of Health and Human Services Robert F. Kennedy Jr.,” argued Robert Lawrence, MD, the first chair of the task force when it started over four decades ago, and Steven Woolf, MD, MPH, its first scientific advisor, in an Annals of Internal Medicine commentary.

The task force has been around since 1984 and is made up of volunteer experts who review evidence and provide evidence-based recommendations on screening and other preventive care. By law, recommendations that garner an A or B grade — such as colorectal or breast cancer screenings — must be covered by insurers without any cost sharing for patients.

“All this is in jeopardy,” according to Lawrence and Woolf, who warned that current law requires coverage of care even if the USPSTF starts making sketchy recommendations based on weak evidence.

“Purchasers and insured populations could find themselves paying for dubious screening tests or for counseling patients about vaccine risks or unconventional dietary practices,” they wrote. “As occurred with the ACIP, the medical and public health community may lose trust in the USPSTF and look to professional organizations for guidance on preventive services.”

Lawrence, who is emeritus professor of environmental health and engineering at Johns Hopkins University in Baltimore, said in a phone interview that he had been concerned when he “learned last summer that on 2 days’ notice, HHS canceled a regular meeting of the task force. That came on the heels of ACIP being disbanded and replaced by a bunch of ideologically motivated [vaccine skeptics]. Dr. Woolf and I feared we were going to face the same situation with the task force.”

As of yet, no new task force meeting dates have been announced. In addition, the terms of five members of the 16-member task force expired on Dec. 31, with no plans announced for their replacements, even as four draft guidelines are set to be finalized. Those guidelines, according to the New York Times, address screening adults for unhealthy alcohol use, self-swabs for cervical cancer screening, counseling for women at increased risk for perinatal depression, and vitamin D supplements to prevent fractures and falls in older people.

However, the task force’s future is unclear, cautioned Lawrence and Woolf, who is director emeritus of the Center on Society and Health at Virginia Commonwealth University in Richmond.

“It cannot be abolished without congressional approval, but Secretary Kennedy can scuttle the USPSTF by choking off its budget and staff,” they wrote in their commentary. “He may replace its members and jettison its rules of evidence to revise or rescind USPSTF recommendations that touch on topics that are ideologically sensitive with the administration, such as drug use, sexually transmitted diseases, HIV infection, or mental health. Recommendations that prioritize services for high-risk groups, such as minoritized or LGBTQ+ populations, may disappear.”

“The situation is alarming,” Lawrence said. “Hopefully this piece will attract enough attention in the health community to get people advocating for rules-based order in the world of public health, because it certainly has been battered by the actions to date.”

The authors pointed out that in years past, patient advocacy groups like the American Cancer Society were supportive of screening, but evidence that it improved health outcomes was limited, and insurers were reluctant to cover screening tests, “making preventive services a luxury available only to those who could afford the out-of-pocket costs. In what was then known as ‘reverse targeting,’ preventive services were least available to the high-risk patients most likely to benefit.”

Before the rise of evidence-based medicine, “experts tended to recommend what they had been taught in training or had observed in clinical practice and often cited selected studies that confirmed their biases,” wrote Lawrence and Woolf. “The guideline development process was opaque, generally unpublished, and vulnerable not only to biases but also to conflicts of interest. There was no expectation to collect and describe all relevant evidence.”

The arrival of the evidence-based medicine movement in the 1980s caused researchers “to shed the old ways and adopt a more rigorous approach to the critical appraisal of studies and to produce evidence-based recommendations supported by data,” they continued. “The USPSTF was a forerunner in this movement. Inspired by a similar task force in Canada, the USPSTF introduced rules of evidence, systematic search methods to ensure a comprehensive review of all relevant studies, a scoring system for rating studies, and letter grades to link recommendations to the quality of the science.”

Uptake of preventive services remained an obstacle due to co-payments, however, especially for high-risk patients. That all changed in 2009 following the passage of the Affordable Care Act, which stipulated that any USPSTF recommendation with an A or B grade must be insured at no cost to patients.

Today, 17 years later, “a generation of insured Americans have grown accustomed to free mammograms, colonoscopies, oral contraceptives, and other USPSTF-recommended preventive services,” they wrote.

Lawrence said in the interview that he has heard that some task force members — who are usually generalists such as family physicians, internists, and pediatricians — will be replaced with specialists. “If you have a cardiologist or nephrologist, rather than a general internist, you’re likely to end up with somebody who has a different take on things, where their expert opinion is going to be driven by their own more narrow view of what the health needs of the population are,” he said.

One member of the task force early on was a medical sociologist, “because a lot of the recommendations — especially around things like behavior change for risk reduction — are in the domain of social science … and if they all get replaced by a group of people who are each bringing a certain specialty orientation, it’s going to interfere,” Lawrence said.

The trust physicians place in the USPSTF’s recommendations didn’t happen overnight, noted Lawrence and Woolf.

“It took decades of hard work to build the reputation of advisory bodies, enhance analytic methods for the critical appraisal of evidence, and refine processes for producing evidence-based recommendations,” they wrote in their conclusion. “Current efforts to toss this progress aside in pursuit of political or ideological aims are destroying the infrastructure that took decades to build. It is an existential threat to clinical practice and population health that we ignore at our peril.”