How politics have weakened the USPSTF

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their work, however, the USPSTF won accolades and respect for “calling it as they saw it,” sticking strictly to the evidence and writing screening recommendations that frequently conflicted with more expansive guidelines promulgated by other professional organizations.

For example, the USPSTF differed from the Centers for Disease Control and Prevention in finding insufficient evidence to screen for hepatitis C, and only recommending HIV screening in high-risk patients (rather than universal screening between the ages of 13 and 64). Unlike the American Diabetes Association, which endorses testing for diabetes in all patients age 45 or older, the USPSTF found that the evidence supported screening only patients with high blood pressure. The Task Force clashed with the American Academy of Opthalmology in finding insufficient evidence to support routinely screening adults for glaucoma. And it checked the pharmaceutical company-supported enthusiasm for COPD screening by concluding that there was no benefit to routine spirometryin adults without respiratory symptoms.

A more politically-minded group (as federally-supported guideline committees tend to be) would probably have been unable to make such a series of controversial statements without stirring up a public backlash. But here, the USPSTF’s low profile served to protect it from the advocacy groups that dominate conversations about federal coverage for health care services. But in 2009, that all changed, as the Task Force was prominently featured in health reform legislation proposed in the U.S. House and the Senate. Ultimately, the Affordable Care Act mandated that USPSTF-endorsed (“A” and “B”) preventive services receive first-dollar coverage from Medicare and private health insurance plans.

Scrutiny of the USPSTF quickly intensified, especially after it issued a politically-radioactive new statement that stepped back from recommending routine mammography for women in their 40s. It was tagged as a “death panel” that, in the words of one spectacularly misinformed newspaper columnist, had “gone rogue” and ought to be immediately dissolved. (Not coincidentally, there is a Roger Maris-sized asterisk in the ACA’s list of USPSTF “A” and “B” services that basically directs insurers to disregard the USPSTF’s 2009 breast cancer recommendations and instead rely on the 2002 version.) With the Task Force literally fighting for its very survival, it was perhaps inevitable that politics would begin trumping science – which goes a long way toward explaining why members were willing to meekly go along with the absurd cover story that their November 2010 meeting was cancelled due to “scheduling conflicts.”

In the 17 months since the passage of health reform, the USPSTF has been only a shadow of its independent self. After publishing an average of one new statement per month for most of my tenure on their staff (2006-2010), a public comment process imposed by the Agency for Healthcare Research and Quality turned into a bottleneck for releasing timely, evidence-based recommendations. None of the 4 new statements that have successfully traversed the public comment process has been particularly noteworthy. Osteoporosis: a modest expansion of screening to more high-risk women under the age of 65. Testicular cancer: a reaffirmation of the near-universal consensus that screening is not necessary. Prevention of newborn gonorrhea eye infections: affirming the standard of care. And earlier this week, the USPSTF retreated from its previous recommendation against screening for bladder cancer was not warranted, instead finding insufficient evidence to make a statement one way or the other.

Of course, a Task Force that makes few waves is exactly what the current Administration wants. Never mind that clinicians and patients must continue to wait for long-overdue updates on screening for prostate cancer, screening for oral cancer, breast cancer chemoprevention, and vitamin D and calcium supplements. (All of these topics had already been voted by the Task Force and were within months of publication in March 2010 but have been subsequently delayed, postponed, or suppressed from entering the public comment queue.) How long can this state of affairs reasonably continue? As the 2012 elections draw nearer, how likely is it that the USPSTF will be permitted to advance any science with even remotely political implications? And – though it pains me to ask – is a Task Force that is forced to pull its punches due to politics really that much better than no Task Force at all?

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    I’m not sure I like the idea of committees, each with its own self interest, having the power to command where the hard-earned healthcare dollars of working Americans go. Is it just a teeny bit high-and-mighty to tell a taxpayer “Trust me. I know how to spend your money for you better than you do for yourself. Just give me your money and keep quiet”. Hmmm :)

    • Anonymous

      I have to disagree.  I don’t trust a doctor (or a medical society) to make recommendation that leads to profit.  Doctors in the US are more concerned with the bottom line than the health of their patients.

      • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

        Do you trust a patient better than you trust a politician or bureaucrat?

        • Anonymous

          Do you mean those endless support groups one finds on the internet?

          • Anonymous

            But that means the patient is just an algorithm. I thought we were fighting to be more than that? Although…it is true that the same disease will have one doctor recommending x therapy, one recommending y…another z. This is where a listening patient can earn from a doctor’s experience.

          • Anonymous

            You never really know if the doctor really feels that recommended treatment is the best or the one that provides the best profit for the doctor.

            Last year I went to a doctor who owned his MRI machine.  It was recommended I get an MRI even though the doctor failed to address the main issue.  Did I really need an MRI?

          • Anonymous

            Yeah…it sounds like your skepticism about the MRI is correct….as well..the doctor may need some. When there is profit attached it is hard to know the true motive. Even salaried doctors want their bonuses….patients can now be so much better informed….but even with that we live with the consequences of action and inaction (inaction by a doctor caused my daughter’s cancer to spread….another doctor ordered radiation…we took action….we live with the harm…but no benefit).

            What do you do? Ask the doctor if he gains anything from his/her ordering a test that may be risky? Did you see Newsweek this week? A great pic of a medical team coming after a terrified patient who is saying, “No!”. It is the one word that may save your life. It is a great article…it is online.

          • Anonymous

            Research, research, research…I already know the diagnosis and possible treatments when I walk in the door.  Seeing the doctor for this information is a formality.

            I have a great team of non-MD providers…I discussed the MRI with my PT. 

            I say no.

            Sorry to hear about you daughter’s cancer.  Cancer is tough.

          • Anonymous

            So you consult with non MD’s? That’s good….but I tend to think another set of experienced eyes going over the medical notes is good (our doctors miss stuff all the time…once a tech took me aside..risked her job…she probably saved my daughter’s life…another time my friend’s son was finishing his residency…we met for dinner he felt the doctors were not listening to me…he opened her EMR..had his mom call me…he said they missed something…indeed, they had..the cancer had spread to four more lymphs…I had to convince them to do a biopsy) I am sorry for the questions…I am living the CS Lewis words out…when he said he was so confused with grief he even liked distractions….we are in medical limbo…I come and go here…can’t keep up….but I wondered if your disease is life threatening? Non MD’s could mean friends, or a support group….there is wisdom in a multitude of counselors. In our case every doctor agreed….but I remember walking that lonely, sanitized hallway and stopping…I turned to my teenage and said, “We do not have to do this?”. She said we had no options….it was terrifying to move forward…even more terrifying to run away (which is exactly what my whole being wanted to do).

            So research is good…very good…but the financing leaves us skeptical…the government often supposedly, protects us from ourselves…keeps vital info from us…..and research often devours the opposers to their outcomes to the point it often seems like a duel of the mind to choose….a fearful mind is not the best platform for rational decisions….so it is good you have outside counsel….yet…….the answers at times seem as mysterious to me as my own body.

          • Anonymous

            I see a naturpath…she’s always good for a different perspective.  She sees those subtle things that most doctors don’t have time to evaluate.  My PT has been around a while and has been a better source of information than any doctor I see.  Friends, both online and off, are great for finding a direction for research.  I was able to diagnose a difficult issue from information I found on one of the WebMD message boards.  Always make sure the source of information is reliable.  While you don’t trust government, I don’t trust profit based entities to do what is best for me, especially the BigPharma…

            But I don’t have cancer.  I would guess the information is overwhelming and would think a good support group where different treatment options are discussed would be valuable.  Be careful, often times online support groups draw people who aren’t doing well and it will give you a sense of doom.

          • Anonymous

            Absolutely….when things are going well we do not feel the same compulsion we to vent. Watching the child I didn’t even immunize for fear of thimerosal, etc., drink the Atomic Cocktail broke me….my knees went weak.

            Once I came online to see my daughter had posted as her status, “Do not research your disease online.”. The tales of woe and horror were astonishing. After reading Dr. Atul Gawande I sent an email to the surgeon asking that no residents perform surgery on my child. The Chief Resident did the cut…but he did the rest. It pays to charmingly appeal….but make sure they know that you know where they live! Ha!

          • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

            Good points. So sorry to hear about your daughter’s cancer. Having cared for my mother who died from lung cancer, I can’t even begin to imagine what it may be like to watch a child go through cancer.  

          • Anonymous

            You know…this means a lot when people care enough to say so! Thank you!

        • Anonymous

          If patients know what the best choice is for their medical care, why are we wasting money for doctors to talk to patients?  Just give me the numbers and I can make the decision.

          Do you think that everyone has the mathematical skills to evaluate the data?

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            Of course not EVERYONE has the skills to evaluate the data. However, what’s important is that everybody should have the RIGHT to try if the wish. It boils down to this. Medical-decision-making is never 100% perfect, just as is almost any type of decision, choosing what job to take, who to marry, what to eat for dinner, even. So when it comes to medicine, there are at least a few paradigms I can think of:

            A: The patient takes his earnings, does home research and has the options of getting advice from a doctor that he/she CHOOSES to see and then following that advice or not.
            B: The government takes the patient’s money involuntarily (via taxation). Then the politicians/bureaucrats will decide “on that patient’s behalf” what is done with that money and who that patient sees, based on the politicians’/bureaucrats’ interpretation of the data (AND based on their own complex motivations), which may or may not be influenced by lobbying from various corporations.

            So, e_patient, if I read your statement correctly, you are suggesting that YOU, as a patient have decision-making ability while other patients may not “have the …skills…to evaluate the data”. I find that a valid answer, because some patients are more sophisticated than others. Well, that still leaves my preference of choice A as the best answer, as long as the patient has a CHOICE of going over to choice B. Would you be in favor of a system where each person gets to choose for himself/herself?

            This means one could choose to say “I am an intelligent human being and would like to make my own decisions about my body. I opt out of having government people choose for me. Let me keep what I earn, and I’ll fend for myself and I won’t force others to bear my load for me” while another could say “I have no clue what I’m doing and can’t begin to think for myself. I’d like to opt in to giving a fat chunk of what I earn over to the government and have them take care of me”.

            Giving people freedom to choose seems the most ethical way. Now is it the most efficient way as well? The answer to that depends how efficient you think our current NO-CHOICE model is working.

          • Anonymous

            1.   It’s disigenuous to say I don’t have choices under the current system.
            2.  The government doesn’t provide me with healthcare.  You have alluded that I am some awful freeloader before…
            3.  Its also disengenuous for you to think that no one has ever helped you and you have no responsibility to your community.

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            1. We have to have our work product taken from us by the system whether we choose to or not. So that is the key area where we don’t have choice.
            2. I have no way of knowing your situation and I doubt that you are a freeloader.
            3. Many people have chosen to help me and I have chosen to help even more people.

          • Anonymous

            1.  You have a choice to practice medicine in a free market as all doctors do.  Since you engage in IVF, I would guess you already do.  My doctor has a choice not to accept Medicare.  From your comments, you seem concerned about the money you pay in taxes.
            2.  At this point, I get more healthcare dollars than I pay in.  Without insurance, I couldn’t afford my medication.3.  Some of those people who helped you were probably enabled by the government and your tax dollars.

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            If you get more than you pay in, that’s good for YOU, but that means that somebody else has to be paying in more than they get out, in order that you can profit at their loss. At least that’s the math that I understand. I hope it’s correct. But in the grand scheme of things, If you can get away with that (getting more than you paid in) and you are fine with it, there’s not much anybody can do to stop you. Put yourself in the shoes of those workers who are forced to pay in more than they get out just so you can get out more than you pay in and if you still think that’s fair to them, then there’s not much more we can get out of this.

          • Anonymous

            “If you get more than you pay in, that’s good for YOU, but that means that somebody else has to be paying in more than they get out, in order that you can profit at their loss.”
            This is the issue.  You pay more than you receive.  That bothers you.

            Do I think its fair?  Is spreading risk fair?  Isn’t that the purpose of insurance?

            I have no problem contributing, financially or otherwise, to the health of my community.  I pay for a fire department that has never been to my house.  I gladly pay these taxes, knowing my neighbors will be safe, not just me.

            Would you rather I died instead of taking up such valuable resources?  My guess is you don’t have the guts to say that someone should die if they don’t have enough cash, even though all your comments imply just that.

          • Anonymous

            If you get to complain about funding my medication, do I get to complain about funding your education?  You took more than your fair share of taxpayers dollars?

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            I apologize that this thread is getting way off topic, but I’ll take the bait one last time. I don’t ask you to fund my education, my business, my dinner or my gas money unless you choose to. If you are somehow being forced to fund anything for me against your will, it’s certainly not my doing nor even my intention. Most importantly, how can we remedy that immediately? :)

          • Anonymous

            I’m sorry, you don’t live in a world where you are not forced to do pay for things.  Why stop at healthcare?  UCLA is a public school and taxpayers were FORCED to subsidize your tuition.  Your staff was trained with public money-perhaps you should fire them and find staff that paid for their education so.  I am FORCED to pay for the roads on which you drive.  I am FORCED to subsidize your food, your safety.  So when YOU stop forcing me to pay for all of this, then I will worry about that nominal 1.45% you pay for Medicare.

            Once again, you didn’t answer the question.  Would you prefer I died than being forced to pay for my medication.

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            Again, you are entitled to your opinion, but the fact is I am not the one forcing you to pay for all those things you list. And if I truly am the one forcing you, then I hereby relinquish you of all such obligations to me. Go in peace. :)

          • Anonymous

            LOL. Banishing now are we? Ha! I like it…but must say the point is taxation is forced…anyone who goes to a state run and paid for institution is getting a gift from the taxpayers…so are free lunches…food stamps, etc. Unless it’s paid back it is a gift….oops…an entitlement that some label as immoral to take what isn’t your own…and that is on topic…the ideologies of political parties who say foolish things like every dollar spent on food stamps produces almost $2 back….I’m not buying it….wait a minute….my representatives gave me no choice.:)

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            Spreading risk through insurance is fair. Your gladly paying your taxes is fine. It is morally wrong for somebody to die because they don’t have the cash. I guess there are many things that we are in agreement about after all.

          • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

            OK, as someone who earns a reasonably high salary and no illnesses that I know of, I am certainly paying more into the health care then I get from it. I’d imagine my mother with her lung cancer took more than she paid during her life, but I am not certain given as she’s been paying into Medicare for years, and was healthy up until the last 2 years of her life. It’s difficult to say. But this is how any insurance works: you pay the premiums in case you’ll need the money. If you don’t need it, you end up subsidizing those who do. Sure, Medicare may not be a well-run insurance, but if you think that you’ll be able to afford treatment for serious illness(es) in your late life if you happen to need it without it, you may be mistaken. The fact is that nobody wants to insure people over 65. Yes, something needs to be done so that you and I can have it when we are older, but the subject here is USPSTF not Medicare. 

            Do you imply that USPSTF recommendations somehow increase costs?  If not, what does how much you or I pay have to do with the price of tea in China? USPSTF recommends against certain tests and treatments that may otherwise result in waste. If you worry about spending, why do you have problems with USPSTF. If anything, USPSTF recommendations are quite handy when you want refuse a test.

          • Anonymous

            Of course, we are not talking about Medicare… Dr. Lee is commenting on my employer provided healthcare he feels is so unfair.  The company that provides this care is self insured…and since it is a shipping company that pays for my healthcare, there is a high probability that Dr. Lee helps pay for my medication, not just the workers he so valiantly defends.

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            Your employer-provided healthcare seems fair.

        • Anonymous

          Medicine Residents’ Understanding of the Biostatistics and Results in the Medical LiteratureDonna M. Windish, MD, MPH; Stephen J. Huot, MD, PhD; Michael L. Green, MD, MSc

          Author Affiliations: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

          Corresponding Author: Donna M. Windish, MD, MPH, Yale Primary Care Residency Program, 64 Robbins St, Waterbury, CT 06708 (donna.windish@yale.edu).

          ABSTRACTContext  Physicians depend on the medical literature to keep current with clinical information. Little is known about residents’ ability to understand statistical methods or how to appropriately interpret research outcomes.

          Objective  To evaluate residents’ understanding of biostatistics and interpretation of research results.

          Design, Setting, and Participants  Multiprogram cross-sectional survey of internal medicine residents.

          Main Outcome Measure  Percentage of questions correct on a biostatistics/study design multiple-choice knowledge test.

          Results  The survey was completed by 277 of 367 residents (75.5%) in 11 residency programs. The overall mean percentage correct on statistical knowledge and interpretation of results was 41.4% (95% confidence interval [CI], 39.7%-43.3%) vs 71.5% (95% CI, 57.5%-85.5%) for fellows and general medicine faculty with research training (P < .001). Higher scores in residents were associated with additional advanced degrees (50.0% [95% CI, 44.5%-55.5%] vs 40.1% [95% CI, 38.3%-42.0%]; P < .001); prior biostatistics training (45.2% [95% CI, 42.7%-47.8%] vs 37.9% [95% CI, 35.4%-40.3%]; P = .001); enrollment in a university-based training program (43.0% [95% CI, 41.0%-45.1%] vs 36.3% [95% CI, 32.6%-40.0%];P = .002); and male sex (44.0% [95% CI, 41.4%-46.7%] vs 38.8% [95% CI, 36.4%-41.1%]; P = .004). On individual knowledge questions, 81.6% correctly interpreted a relative risk. Residents were less likely to know how to interpret an adjusted odds ratio from a multivariate regression analysis (37.4%) or the results of a Kaplan-Meier analysis (10.5%). Seventy-five percent indicated they did not understand all of the statistics they encountered in journal articles, but 95% felt it was important to understand these concepts to be an intelligent reader of the literature.

          Conclusions  Most residents in this study lacked the knowledge in biostatistics needed to interpret many of the results in published clinical research. Residency programs should include more effective biostatistics training in their curricula to successfully prepare residents for this important lifelong learning skill.

    • Anonymous

      I agree…the government does little well….and if it’s federally paid for there oughta be a big red flag on it. I thought the caution they declared was legitimate….not concrete. In medicine little is concrete…but those IPAB’s developed by the healthwonks need to go….go now….says Dr. Seuss! Ha!

  • Homeless

    From ahqr.gov

    The USPSTF is an independent panel of non-Federal experts in prevention and evidence-based medicine and is composed of primary care providers (such as internists, pediatricians, family physicians, gynecologists/obstetricians, nurses, and health behavior specialists).
    So government bureaucrats are doctors….Why are these doctors worse than the one I see?

  • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

    Again, I won’t judge on your behalf whether the USPSTF is better or worse than the doctors that you can see. What I advocate is for YOU to have that choice. You want to trust that panel to make your choices for you? Go for it. I wish you the best. You want to research for yourself and find a different doctor that you choose. Go for it. I wish you the best.

    Or do you think it’s better just to force everybody to captively (is that a word?) abide by a panel of people known as “experts” and not have the choice to choose their own doctor and health strategy? Even if that’s what YOU want, do you have the right to force other people to do the same?

    Again, I respect your assertion that there’s no magic wand that will tell you which doctors / lawyers / teachers / hairstylists / plumbers / mechanics that a person can or can’t trust. But that doesn’t mean you shouldn’t have the right to decide. And if you don’t want to choose, then you still have to choose a politician / bureaucrat that you trust to make your decisions for you. And if you don’t trust anybody but yourself, then you can fend for yourself. And if you don’t even trust yourself, well, hmm…then perhaps you can just go to the Lord in prayer (assuming you trust God). E_patient, I’m out here arguing in favor of your freedom to choose and perhaps I’m misinterpreting, but I hear you wavering back and forth between saying doctors don’t have your best interests at heart if they were to make their decisions for you and then saying that patients don’t have the ability to analyze for themselves and then saying that a panel is the best entity to trust. I’m fine with all that, then you go ahead and trust that panel, but I hope you’re not advocating forcing your neighbor to trust that panel if he/she does not wish to. Are we good? :)

    • Anonymous

      I do have a choice.  I had a choice whether or not to get a mammogram when it was recommended that I get one at age 40.  I still have a choice now that they are not recommended.

      I have a choice to get any test or procedure that I can find a doctor to perform if I have the money to pay for it.  Consider Nadya Suleman…So we are really talking about whether insurance companies and Medicare/Medicaid should pay for such tests.  Since you prefer the free market, why take away such market forces to decide whether a screening test is necessary and valued?  Or are you championing all those poor people who can’t afford to pay for their own healthcare by insisting that government pay for all their healthcare choices?

      I have considered that USPSTF’s guidelines when making choices for my healthcare.  Knowledge is power…not captivity.  To advocate for knowledge to be held only be those making the profit seems like captivity to me.

      • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

        I’m not 100% clear on what your view is. Are you in agreement with what I’ve stated previously? If not, what area can we discuss? To address your comment, I do not agree with taking away market forces, if that’s what you’re asking. People should have free choice to engage in mutually voluntary interactions — whether patients, doctors or whoever. The freeing up of market forces will greatly reduce the cost of healthcare to more affordable levels, especially if you consider the indirect boosts to prosperity and productivity on a national scale.

        • Anonymous

          So you agree that the USPSTF doesn’t take away choice?

          We aren’t discussing my views, we are discussing the flaws in your views.

          1.  The USPSTF aren’t bureaucrats…they are doctors providing information.
          2.  If Medicare chooses not to pay for a screening test, your still have the choice to be screened.
          3.  If someone can’t afford to pay for the screening test, Medicare actually gives them a choice.
          4.  Such recommendations as given by the USPSTF actually empower patients to make the choice that is best for them, not the doctor’s pocketbook.
          5.  Without insurance, I have fewer medical choices.

          • http://www.facebook.com/people/Terence-Ivfmd-Lee/1523282856 Terence Ivfmd Lee

            1. Is it information for information’s sake, meaning “Here’s some information with our opinions. You are free to do what you wish with that information”? Or does it have the power to dictate to people what to do? Educate me. I’m not very familiar with what they are.
            2. Makes sense.
            3. But do OTHER people have the free choice not to participate in paying into Medicare if they don’t feel it’s right for them?
            4. Sure. OK.
            5. Makes sense.

            I guess we’re more in agreement. If I accept what you say that the USPTSTF’s guidelines are just for informational purpose only and there is nobody using that information to either force people pay for screening, force people not to pay for screening, force peoplpe to get screening or force people not to get  screening, then that sounds all peaceful and happy to me and we’re all good.

    • http://profiles.yahoo.com/u/66NCFAXDWYB7JVNVNLNIUTCUVU Violetta V

       
      USPSTF do provide information, and I agree that it’s your and my choice to follow their recommendations or not. But
      1. USPSTF recommendations provide good information in one place about the view of a panel of doctors on whether benefits of a specific test/treatment outweight the risk, they also summarize the available data very well and provide referenceds. Sure, I personally like to not just blindly follow recommendations but read the data for myself. But reading USPSTF rationale is very informative, and is certainly a better place to get information than movie stars, tv doctors or flyers from radiology labs advertising certain tests and claiming you need to have them (never mind that they are more likely to harm you than help you).

      2. Not everyone has time or ability to read the studies and evaluate the results of multiple someimes conflicting studies, and that includes doctors. It’s important to have an unbiased panel of experts who could look at the data and provide recommendations based on this data. Other sources of recommendations – cancer societies, disease support groups, organization of specialists in a specific disease (evaluation of studies data is a job of epidemiologists, disease specialists don’t see the overall picture), are usually biased towards treatment/testing as they see only the disease and not the overall picture.

      But you and I still have a right to decide for ourselves, after all it’s our bodies.

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