Battle lines drawn as Kennedy mulls firing the USPSTF

News broke last Friday that HHS Secretary Robert F. Kennedy Jr. wants to dismiss all 16 volunteer members of the U.S. Preventive Services Task Force.  

By now the pleas for him to reconsider, initially sporadic, have gathered into a steady drumbeat.  

“I am writing to express our deep concern with the recent reports of your intention to remove all of the members of the USPSTF,” wrote American Medical Association CEO John Whyte, MD, MPH, in a July 27 letter addressed directly to Kennedy. “Given the essential role USPSTF members play in weighing the benefits and harms of preventive services such as screenings, behavioral counseling, and preventive medications, and making evidence-based recommendations for implementation in primary care settings, we urge you to keep the previously appointed USPSTF members and continue the task force’s regular meeting schedule to ensure recommendations are put forth, updated and disseminated without delay.”

Hospitalist Thomas Lew, MD, of Stanford Health Care, said July 28 the firings would “greatly damage all the work we’ve done in preventative care, making people sicker and driving up costs and premiums. To put it mildly, this is extremely concerning—and doing the opposite of making America healthy.”

Lew may have been responding to a terse comment from HHS spokesperson Andrew Nixon. “No final decision has been made,” Nixon said Friday, “on how the USPSTF can better support HHS’s mandate to Make America Healthy Again.” 

Concern is widespread and passionate 

In any case, numerous other HHS watchers have sounded alarms similar to those rung by Whyte and Lew. Examples:

• “Reports that Secretary Kennedy intends to dismiss all members of the U.S. Preventive Services Task Force are concerning. It is critical that the USPSTF continue to operate free of political interference and that its members have relevant expertise and rely on the best available scientific data to make recommendations.”—Tina Tan, MD, president of the Infectious Diseases Society of America
   
• Many primary care clinicians consider USPSTF guidelines to be the “most trusted source for their recommendations. That trust is based on being consistent over 40 years, using the same rules over time, being careful that, as new members join, they’re vetted for conflicts of interest and that they consistently apply the Task Force methods to making decisions.”—Michael Barry, MD, internal medicine professor at Harvard Medical School and a former member and chair of USPSTF 
   
• “This is a tragedy again [in the wake of Kennedy’s recent firing of all members of the CDC Advisory Committee on Immunization practices]. This man [Kennedy] is out of his mind. … [I]s he going to put in people who are not really qualified on these task forces?”—Georges Benjamin, MD, executive director of the American Public Health Association

The latest round of defenses of the USPSTF follows a letter sent July 9 by more than 100 healthcare organizations to House and Senate committee leaders. “The USPSTF’s transparent, rigorous and scientifically independent process is a national asset,” the groups wrote. “We urge Congress to protect and preserve the USPSTF’s current structure and operations to ensure that everyone continues to benefit from trusted, evidence-based preventive care.”

Reuters points out the 40-year-old USPSTF offers guidance to clinicians on everything from routine breast cancer screening to drugs for preventing HIV infection. The news service also notes that, in June, the U.S. Supreme Court upheld the constitution of the task force and ruled in favor of its recommendation to cover preventive care.

The other side feels no less strongly 

For Kennedy’s part, he hasn’t tipped his hand on what it is that he doesn’t like about the USPSTF in its current configuration. Over the weekend, ABC News reported he views the group as “too woke.”

To flesh out his likely rationale for taking that position, one has to look outside the mainstream press.

For example, earlier in July—well ahead of Friday’s news—Joseph Addington of The American Conservative made the case from that political persuasion’s point of view, suggesting the task force seeks not preventive-medicine equality for all but special treatment for some. 

Since the beginning of the Biden administration, the USPSTF has been “quietly engaged in a project of reconfiguring itself into an instrument of social justice and advocacy of left-wing ideological priors in both the private practice of medicine and in public health,” Addington wrote.

One party’s ‘health equity’ is another’s ‘new discrimination’ 

Addison cites content published in two USPSTF reports in 2021, as follows:  

The first, titled “Actions to Transform US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services,” laid out a proposal for “iterative changes to USPSTF processes, methods and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism.” These recommendations include a commitment to “describe race as a social construct with origins in slavery, oppression, exploitation and discrimination and describes various frameworks related to racism,” to “develop an inclusive language guide as one of its steps to address systemic racism,” and to prioritize research and recommendation topics “that have high potential for advancing health equity or addressing systemic racism.”

The second report, “USPSTF Approach to Addressing Sex and Gender When Making Recommendations for Clinical Preventive Services,” is equally sinister. The report notes that making recommendations based on biological sex is vital for the practice of good medicine, but it asserts that self-identification takes precedence over biological fact. … The report details that the task force will, as a result, end references to men and women and replace them with gender-neutral language or other “appropriate” terms such as “individuals with breasts.” The USPSTF also pledged to prioritize transgender and other populations of sexual minorities in selecting topics for research, as well as promising to hand over any relevant research and draft recommendations to gender activists for review and comment.

Addison’s considerably detailed argument is posted in full for free.

As of end-of-day Tuesday, Kennedy had not yet announced whether or not he plans to go ahead with the USPSTF firings.