Responding to President Trump’s criticism of a federal judge who ruled against his asylum policy during his first term, Supreme Court Chief Justice John Roberts released this statement: “We do not have Obama judges or Trump judges, Bush judges or Clinton judges. What we have is an extraordinary group of dedicated judges doing their level best to do equal right to those appearing before them.” I am not qualified to comment on how closely federal and Supreme Court justices adhere to the partisan positions of the Presidents who appointed them. However, I was reminded of this statement when, over the weekend, the Wall Street Journal and multiple other news outlets reported that HHS Secretary Robert F. Kennedy, Jr. was planning to fire all the members of the U.S. Preventive Services Task Force (USPSTF) because he considers them “too woke.”
I worked for the USPSTF during the Bush and Obama administrations. The transition was seamless; the work went on as before. In the November 2009 uproar caused by the unfortunate timing of the USPSTF’s release of a new statement recommending that routine mammography begin at age 50 rather than 40, then-HHS Secretary Kathleen Sebelius clumsily tried to throw the Task Force under the bus by observing (correctly) that all of its members were appointed during the Bush administration – but this completely missed the point that members were selected for scientific expertise, not political ideology. In that respect, the USPSTF has been similar to the ACIP prior to RFK Jr.’s recently
replacing all of the latter’s members for nakedly political reasons.
“Woke” is such an overused pejorative in conservative political circles that it has lost all meaning, but it seems that the current HHS Secretary is responding to the Task Force’s recent efforts to ensure that their recommendations are
implemented equitably across people of all races and ethnicities, despite geographic and economic disparities in access to primary care and other resources critical for ensuring health. For example, it’s well-documented that eligible Black patients are less likely than others to be offered or undergo lung cancer screening, and that
interventions are needed to close this unacceptable gap. This is about as uncontroversial an idea in health care as there is, but apparently it is too much for RFK Jr. More likely, it’s merely an excuse to replace the current highly qualified members with his handpicked ideologues.
In the words of a former USPSTF member (and my friend and academic collaborator) Russ Harris, MD, MPH:
It may seem excessive [for the USPSTF] to spend so much time and energy on reviewing the evidence for health issues. After all, aren’t people supposed to “do your own research.” I wish it were that easy. What “doing your own research” usually leads to is finding a biased source on the internet or from an “influencer” on social media that is happy to give you their answer. That answer is certainly simple, but often wrong. Such answers are often based on self-interest, or on an ideological agenda, not on a careful review of the relevant evidence.
Recent letters to RFK Jr. from the
American Medical Association and
104 health organizations (including 6 of which I am a current or former member) have rightly pointed out that federal policymakers and health insurance plans rely on the USPSTF recommendations to provide coverage of effective preventive services (those rated “A” or “B” with at least moderate certainty of moderate net benefit) such as certain cancer screenings, depression screenings, and preventive services for cardiovascular disease. To tell the truth, I’m less worried about my patients losing access to these services than I am that replacing the current Task Force would result in a flood of signoffs on services where the evidence is insufficient to know if they work (e.g.,
multicancer screening tests) or tests that sound great intuitively but have been proven to not work, such as
screening for asymptomatic carotid artery stenosis, which causes more strokes than it prevents but is nonetheless performed by lots of for-profit companies. The USPSTF is a bulwark in protecting Americans against ineffective or potentially harmful preventive health care, and if RFK Jr. follows through on firing the members of the current panel, that protection will almost certainly cease to exist.
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