Could politics kill science?

The answer is, quite possibly, yes, based upon our observations of the House Subcommittee on Health’s hearing on the updated U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations.

The recommendations — written by a panel of authorities from biostatistics, epidemiology, primary care, cancer medicine and population based screening and recently published in the respected Annals of Internal Medicine — have elicited an undeserved reaction, based on unfortunate timing, poor communication, and bad media coverage. But the worst factor has been the political opportunism displayed by some congressional leaders who are using its findings as a case study in rationing and government intervention that they allege could happen if health care reform legislation is passed.

A brief synopsis: The USPSTF is a federally commissioned body whose sole job is to analyze the extant data, which does or does not support whether a given test or procedure is effective in prevention of a given disorder. The last time the USPSTF reviewed the data on mammography was in 2002. So, to update its recommendations, the task force revisited the data in 2007, and by 2008 (prior to the presidential election), had concluded that the evidence in favor of routine — i.e. automatic mammography for women between the age of 40 and 50 — was not enough to make a strong recommendation. Therefore, in the recently published report, they explicitly left it to physician and patient to decide if screening should be done based upon individualized concerns.

This last provision was overlooked by some major players in the media, and was reported as being a recommendation against all mammography screening between the ages of 40 and 50. An outcry ensued, and politicians jumped on the bandwagon to decry the report as the first step toward government intervention and rationing. This was clearly not the spirit or intent of the new recommendations, nor was it true that the USPSTF had a political or cost-containing agenda whatsoever, which they were accused of.

It is not within the scope of this editorial to flesh out the methodology that was used, but we are sufficiently convinced that the recommendations were based on scientific evidence derived from review of well-controlled clinical trials already published in peer reviewed publications and we do not doubt the integrity of those who were involved in making them.

The problem is, of course, that the recommendations, which have the veneer of being counter intuitive, have been misinterpreted as a recommendation against screening and therefore have been viewed as heresy, violating a fundamentally held belief that cancer screening inherently saves lives and does more good than harm.

The USPSTF explicitly studied the net benefit of screening, which balances the good that screening does against the bad. Without a doubt, some bad things can come from a screening test, including false negative readings which miss cancer, and false positive results which can cause psychological stress and complicated, unnecessary follow up testing and procedures, radiation exposure, and potential disturbance of non-invasive lesions.

With respect to the group of women between age 40 and 50, the evidence in their considered review is not strong enough to make it automatic. So, their conclusion was, let it be a matter to be decided between a woman and her physician. It was not a recommendation to prohibit such screening.

A reasonable person would conclude that if there were any questions in the medical world about these recommendations (and most assuredly there were, including such august organizations as the American Cancer Society) that reasonable scientific debate would ensue. However, this is not an ordinary time — we are in the midst of a supercharged debate on health care reform— and so, as if on cue, political hacks seized upon the issue to try to turn it into a warning sign of impending government intrusion into medical decision making.

What has developed is a bonfire of banalities conducted by ignorant politicians who either don’t know or knowingly ignore the scientific method (it didn’t matter that several members of the subcommittee were physicians, some of whom displayed an embarrassing lack of appreciation for analytical thinking).

The worst example came when Congresswoman Marsha Blackburn (a non-physician) of Tennessee unctuously asked the testifying USPSTF physician scientists to submit the methods they used in their research. Perhaps she had not even read the report, which clearly gives a methodology, as does every scientific paper. Did the congresswoman believe that the task force was hiding something? Or did she believe that she herself, with no scientific background, might uncover a flaw in their methodology?

We don’t know the answer to that one. But we do believe that Congresswoman Anna Eshoo of Palo Alto had it right when she said the following: “If we wander away from science, from evidence-based science in our country, then it will be a march to folly. Sometimes we debate and we question the scientists and how they arrived at the conclusions they have come to. But science is something that has been honored by the American people for a long time. This is not about anybody’s political science as much as members are tempted to drag that into it.”

This is not the first example of politics trying to subvert science. Whether it is evolution, stem cell research, climate change, corn derived ethanol or cancer screening, it is alarming when politicians attempt to bend or alter the empirically based science for political gain. Those who toil in the scientific method and report what they see, blind to any given set of interests, deserve our unconditional respect and admiration. After all, isn’t the pursuit of knowledge — even if the facts are inconvenient or counter-intuitive — what ultimately advances our country?