“I was just swapping emails today with Andy von Eschenbach, who was the head of the National Cancer Institute, the head of the Food and Drug Administration. ...He wrote me to point out that the most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people. So if you ask me, do I want some Washington bureaucrat to create a class action decision which affects every American's last two years of life, not ever. I think it is a disaster. I think, candidly, Governor Palin got attacked unfairly for describing what would, in fact, be death panels. And what von Eschenbach will tell you if you call him is: The decision to suggest that we not test men for -- with PSA will mean that a number of people who are susceptible to a very rapid prostate cancer will die unnecessarily. And there was not a single urologist -- not a single specialist — on the board that looked at it.”
--Former House Speaker Newt Gingrich (R-Ga.), during at the Post-Bloomberg debate, October 11, 2011
Gingrich made this comment in response to a question about research indicating that much of money spent on treatments and interventions in the last two years of life does little to prolong life. He didn’t really answer the question but instead launched into an attack on the recent draft recommendation by the U.S. Preventive Services Task Force that men over the age 50 no longer have a screening test (the prostate-specific antigen, or PSA) for prostate cancer. The panel said “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”
The draft recommendation has certainly been controversial. Michael Milken, the disgraced financier who founded the Prostate Cancer Foundation, wrote in The Washington Post last week the test likely saved his life. As it happens, Andrew von Eschenbach, who Gingrich cited as an authority, is a senior fellow at the Milken Institute—and a senior advisor with the Center for Health Transformation, a think tank set up by Gingrich.
We’re not going to get in the middle of the debate over the PSA test. Von Eschenbach, in an email, said that Gingrich quoted him correctly. “To abandon PSA is to revert to the digital rectal examination being the only means to detect early prostate cancer and thereby allow potentially lethal prostate cancer to go undetected,” he said. “There is no current cure for advanced prostate cancer.”
The argument on the other side — that for each life saved many more are ruined — was detailed in a New York Times magazine article on Sunday.
We also are not going to deal again the “death panel” claim, a Four-Pinocchio claim that was thoroughly debunked by PolitiFact before The Fact Checker column was launched. But we are interested in Gingrich’s assertion that Washington bureaucrats were responsible for this decision and that urologists or “a single specialist” were not involved. How accurate is that?
The U.S. Preventive Services Task Force, first convened in 1984, is supposed to make recommendations about which preventive services should be incorporated in primary medical care, rating different services with a letter grade. (The draft recommendation for the PSA test gives it a “D.”)
The funding for the task force comes from the Department of Health and Human Services, but the 15-member panel is made up mainly of primary care physicians, medical professors and other experts. Going down the list, we spotted Timothy J. Wilt of the University of Minnesota School of Medicine, who among his other qualifications is the coordinating editor of the Cochrane Collaborative Review Group for Prostatic Diseases & Urologic Malignancies. Wilt’s research specializes in “common urologic diseases in older adults.”
That certainly doesn’t sound like a Washington bureaucrat. In fact, the task force members come from all areas of the nation, with only one inside-the-Beltway representative — a doctor at Virginia Hospital Center in Arlington.
Wilt said he is not an urologist in terms of having “the technical surgical or radiation delivery expertise of a urologist or a radiation oncologist.” But he said that was not particularly relevant because “the evidence report that our recommendations were based on was peer reviewed by urologists.”
Wilt further said:
I am a general internist with a clinical practice that involves primarily older men, many who have questions and concerns about prostate cancer screening and treatment. I provide these discussions and patient care relevant to that on a very frequent basis. My clinical research expertise is as a health services researcher in health promotion, disease prevention, detection and treatment of chronic medical conditions especially in older adults. In particular my focus is in urological diseases especially prostate cancer. Evaluating the benefits and harms of screening for prostate cancer and making decisions about implementation to our patients requires these expertise.
The US Preventive Services Task Force is comprised of 16 nonfederal, independent experts in primary and public health disease prevention, detection and health promotion. Many individuals have specific research and clinical expertise in cancer screening and care. As primary and public health care providers members of the US Preventive Services Task Force are at the front lines of having to discuss with patients and assist them in making many medical decisions about their overall health including screening and treatment for prostate cancer. As such we are uniquely and importantly positioned to both evaluate the evidence and to know the implications of our recommendations on the patients that we provide health care.
Gingrich spokesman R.C. Hammond explained that Gingrich said the recommendations stemmed from Washington bureaucrats because “federal bureaucrats at the Agency for Healthcare Research and Quality do everything from staff support to disseminating information to managing the nomination process for members to serve on the Task Force.”
Hammond said that “while the actual members of the Task Force may not be employed by the federal government, the entire operation is supported and managed by the federal government, and the decisions made by HHS are closely aligned with its recommendations,” making it what he called “a de facto arm of HHS.”
Hammond added: “Dr. Wilt's background is impressive, but the fact is he is not a urologist.” As he put it, “the commission quacks like a bureaucrat, is depended on by bureaucrats, then it’s a bureaucrat.”
Some of the task force’s recommendations have been controversial, such as saying women under age 50 did not need a mammogram every year. But in that case, HHS Secretary Kathleen Sebelius distanced herself from the recommendation, saying it would not impact policy — suggesting much less coordination between HHS and the panel than Gingrich claims.
The Pinocchio Test
Gingrich goes too far in his complaints about the task force. He leaves the impression that a group of bureaucrats set the policy, when in fact the task force is made up of medical experts. (Hammond, in fact, also faulted Wilt for his role in the mammogram recommendation, saying he was “one of the leading voices” for it, which suggests board members are independent operators.)
The complaint about not having a urologist on the panel also seems misplaced, given that the urologists were involved in gathering the evidence—and that Wilt’s expertise is the urological issues of older men.