Health News Review

Under a blog post headline, “The meeting that wasn’t, and a surprise announcement,” federal health officer Dr. Kenny Lin announces he is leaving the support team of the US Preventive Services Task Force and resigning from the Agency for Healthcare Research and Quality.

That’s the surprise announcement.

The “meeting that wasn’t,” he explains, would have been today: “This was to be the first day of the third U.S. Preventive Services Task Force meeting of 2010… however, there is no USPSTF meeting today. And while the question of why the meeting was cancelled is perhaps easily answered by looking at the calendar, in my mind it is much less apparent how to repair the damage that this setback did to the Task Force, medicine, and the fragile public trust.”

He signs off:

“I will miss my colleagues at AHRQ and the Task Force very much. To borrow a line from a farewell message I sent to many of them last week, they deserve all our thanks for everything they do (and will continue to do) to make the U.S. health care “system” a little bit more rational, despite the many obstacles and challenges. Politics trumped science this time, as it has in the past, and may at times in the future. On the bright side, though, in a few more weeks the growing force of private sector allies of the USPSTF and evidence-based medicine will have one more member, and I’m ready and willing to speak my mind.”

The hyperlink to the story about the hijacking of USPSTF mammography recommendations one year ago was Dr. Lin’s – not mine.

I have tried to reach him by phone and email this morning but have not yet been able to do so.

According to his online bio, Dr. Lin is a Medical Officer for the U.S. Preventive Services Task Force (USPSTF). He provides technical assistance to the USPSTF in the form of drafting recommendations, conducting targeted evidence updates, and serving as a peer reviewer for USPSTF evidence reviews and products.

One other line in his bio is worth noting:

“Dr. Lin was the recipient of the AHRQ 2008 Article of the Year Award for his systematic review on the benefits and harms of prostate-specific antigen screening for prostate cancer.”

The USPSTF had originally been scheduled to vote on new prostate cancer screening recommendations today.

Last week I wrote that this meeting cancellation didn’t pass the smell test. Now it reeks even worse.

Comments

Thomas Reid MD PhD FACP posted on November 1, 2010 at 8:19 am

On the contrary, politics did not trump science in the mammography breast cancer screening issue. Rather, arbitrary cost cutting measures and “what if” scenarios dominated the USPSTF discussion and conclusions.
A practicing medical oncologist-hematologist

Gregory D. Pawelski posted on November 1, 2010 at 11:27 am

The efficacy of screening for breast cancer (or even prostate cancer) depends not only upon test accuracy, but upon the efficacy of proceeding with definitive diagnosis and therapy versus the efficacy of doing nothing at all. This is the problem with both mammography for breast cancer and PSA testing for prostate cancer.
There is no doubt that screening mammography and screening PSA can identify cancer at an earlier stage than in the absence of screening. But so what? Biologically, it appears that many cancers diagnosed at an earlier stage with screening are so aggressive that, even at the time of the time of earliest possible detection, there are already micrometastases, meaning that earlier extirpation of the primary tumor does not influence ultimate outcomes in a meaningful way.
More commonly, tumors are so indolent that metastases would not have occurred, even had diagnosis been delayed by one, two, or several years (i.e. until the lesion became palpable and was diagnosed in the former, pre-screening manner). So the only patients helped by screening are those who (1) are accurately detected by the screening exam and (2) which have a “Goldilocks” biology — not too aggressive/not too indolent.

Elaine Schattner, M.D. posted on November 1, 2010 at 11:53 am

I hope we don’t dumb-down the conversation to a Goldilocks fable.
But if pressed, an oncologist weighing in on these might consider that BC is, most often but not always, a medium-kind of growth that responds to early interventions such as chemo and hormones, and which occurs not infrequently in the mid-lives of women who have decades ahead in which they might benefit from those interventions. Prostate cancer is uncommon in young and middle-aged men; when it occurs in the elderly, most often but not always, its behavior is indolent (would that be small?) and rarely life-threatening.

Mark Ebell MD, MS posted on November 1, 2010 at 12:54 pm

The goldilocks analogy is actually used quite often in clinical epidemiology. Not dumb at all.