The Department of Health and Human Services, and many other federal agencies, love having experts to advise them. But are the experts always unbiased? Some are, while others are probably not. The U.S. Preventive Services Task Force is made up of 16 primary care experts, all volunteers who make recommendations about cost-effective preventive medical services and screenings. Health insurance is required to cover recommended preventative care services with no cost sharing. The care that is free is spelled out with potential screenings given a grade of A or B. For many years the Task Force recommended breast screening begin at age 50, with a mammograms every two years. The debate about how young to screen and how often to screen is controversial, although it should not be. Advocates for aggressive screenings want screening recommendations changed to every year beginning at age 40. The newest draft guidance lowers the age to 40 as advocates want, but stopped short of recommending screenings every year rather than every two years.
Cancer is a disease of old age. Increasing cancer screening for younger people raises costs with very little gain in the number of life years saved. For that reason insurers and many public health experts oppose lowering the age for screenings due to the risk of false positives outweighing the benefits. I haven’t seen the figures but the marginal cost of lowering the age for recommended screening to every year is probably tens of millions per life year saved. In other words, it’s a big waste of money, all paid for by our insurance premiums.
At another time the Task Force recommended against thyroid cancer screening saying it had little benefit. Those who profit from unnecessary screenings cried foul. They lobbied for enhanced thyroid screenings guidelines. One expert had this to say about screening recommendations:
…benefits and harms are the only variables that go into a grade; costs never factor into the task force’s decisions. Moreover, “it is critical that members have expertise in prevention and primary care alone,” Grossman said. “We believe this is a specialty in and of itself.” He added that the task force welcomes input from disease specialists and has procedures for involving them “at every stage of the recommendation development process.”
But specialists can’t vote on the task force’s final recommendation. Being excluded from the final vote wasn’t so worrisome to specialty groups until the ACA required that commercial health plans cover preventive services with an A or B rating without copayments and deductibles. Since President Obama signed the ACA into law in 2010, the task force has become a “full-fledged policy authority” with a powerful influence on health care economics…
So basically, few doctors and medical societies cared about the composition of preventive care screening recommendations until there was a chance to profit from more screenings. Oh, and costs should be a consideration in all recommendations.
There is a concept in economics called regulatory capture. That is when the industry being regulated captures and influences the regulators. That is what has happened in health care. With the goal of influencing health policy, drug and device manufacturers are showering a lot of money around to those able to influence health policy. But are experts’ opinions truly opinions? Or does money impact experts’ opinions? The Lancet described conflicts of interest as an invisible force shaping health systems and policies.
…there has been little attention to a fundamental force in decision making: conflicts of interest. Conflicts of interest arise when the potential for individual or group gain compromises the professional judgment of policy makers or health-care providers.
Conflicts of interest underpin rent-seeking and informal practice across the world…
The bible of behavioral psychiatric health is the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The 5th edition is the most controversial in the history of the DSM due to the so-called false positive problem. That refers to disagreements about the boundary between what is considered a disorder and what is considered normal variation. Making the criteria vague allows psychiatrists to reel in more patients, some who don’t really have a problem. One study found 60% of those on the editorial panel of the DSM-5 receive industry payments.
The National Academies of Science was developing new guidelines on diet and drinking. In the process it had to drop two of its experts because they had financial ties to the alcohol industry. Come to find out, the two were replaced with a new panelist, also with ties to the alcohol industry.
Another example of how industry money may affect health policy is food and dietary guidelines.
A report published Wednesday by the nonprofit U.S. Right to Know makes those concerns plain. Nine of the 20 experts on the 2025 Dietary Guidelines Advisory Committee have had conflicts of interest in the food, beverage, pharmaceutical or weight loss industries in the last five years, the report found.
Medical studies are often tainted with industry money and influence.
When doctors want to help untangle confusing and sometimes contradictory findings in the scientific literature, they often turn to specially crafted summary studies. These are considered the gold standard for evidence. But one of the leading advocates for this practice is now raising alarm about them, because they are increasingly being tainted by commercial interests.
The British Medical Journal (now called BMJ) published a study of the leaders of influential professional medical associations across the United States. The study found nearly three-fourths had industry ties to drug and medical device firms. The following is an excerpt from the study:
Population 328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians.
Results 235 of 328 leaders (72%) had financial ties to industry.
Whenever you read about medical experts making recommendations, changing a recommendation or adding new recommendations just keep in mind their views may be clouded by money. Often after a controversial change it comes out in the news that the experts have industry ties.