Health Secretary Robert F. Kennedy is considering firing all 16 members of the U.S. Preventative Services Task Force. In case you are wondering, the task force is an all-volunteer group of experts who make recommendations about which preventive services Americans should receive. Preventive services – think immunizations, mammograms, colonoscopies – all have a rating A, B, C, D and I. You can view the recommendations here. Services with recommendations of A and B are free under the Affordable Care Act.
Recommendations of the preventive services task force are sometimes controversial. For instance, breast cancer screening is recommended every two years for women beginning at age 40 until they reach age 74. The recommendations originally began at age 45 but advocates for breast cancer wanted the recommendations lowered to age 40. Any woman is free to ask her doctor to order a mammogram regardless of her age. A radiology clinic can probably secure a physician order for any customer who wants one. The point is without an official recommendation women under age 45 would have to pay out of pocket. Why lower the age? To boost access to free mammograms (paid by health plans). Why oppose lowering the recommended age? Because the cost per life year saved by screening women age 40 to 44 is astronomical. Another way to look at this is the cost per cancer detected:
In 2022, screening cost US$55 471 per 3D-detected and US$44 000 per 2D-detected invasive or ductal carcinoma in situ case.
That means it took a lot of mammograms to find cancer. This is especially true in the younger women. I do not have the figures available but the cost to find cancer among 40-44 years old women would be many times the figures for 60- to 64-year-old women. That is to say, the likelihood of a breast cancer diagnosis is not equal across all ages. The task force takes into account the marginal cost for finding or preventing diseases to make recommendations. There is usually a threshold for cost per life year saved (often referred to as quality adjusted life year) that determines the age cutoff, or which services are recommended. Screening for breast cancer in women age 40-44 likely did not meet the threshold but the breast cancer advocacy is powerful.
Why would the HHS Secretary want to replace all 16 members of the task force? Prevention is an area of public health, a notoriously left-leaning area of medicine. Kennedy has complained that the task force is too “woke,” pursuing a left-wing ideology. It could be that the Secretary believes the task force has recommended too many services compared to their cost (i.e. insurance mandates). For instance, pre-exposure prophylaxis (PrEP) Truvada is a medication sexually promiscuous gay men take daily to prevent HIV. Prices vary but can be expensive, in some cases (up to $24,000 a year for brand name drug). Health insurance often must cover them, although I could not find it on the task force A and B list. Reshaping the preventive service task force is a way to refocus priorities.
Kennedy is also a vaccine skeptic. The Preventive Services Task Force is composed of experts in the field. Experts in a given field, say, vaccinations, are often compensated by vaccine makers as consultants or have research grants in their field of expertise. The people who know the most about vaccines are proponents of vaccines to a degree greater than Kennedy thinks is appropriate. These conflicts of interest are difficult to overcome.
The composition of the U.S. Preventive Service Task Force is an interesting dilemma. Current members undoubtedly have priorities the administration does not support. Yet finding new members the public health community respects could also pose a challenge. In any case, a review of what preventive services qualifies as public health is a question worth asking.
Read more at: RFK Jr. to Oust Advisory Panel on Cancer Screenings, HIV Prevention Drugs