The American College of Physicians has weighed-in the media flap over evidence-based medical recommendations . ACP's for them. So are we. We have no expertise in the area of mammography, but we are close students of the larger question over whether "evidence" or "experts" should be the source of our public health policies. We weigh-in on the side of evidence-based recommendations.

ACP president Joseph W. Stubbs decries "the politicization of evidence-based clinical research." He calls for reliance on evidence and a transparent process. Noble words, we'd agree.

But inconsistent. ACP still carries on its website, a 2004 advisory to ignore the 2003 findings of this same US Preventive Services Task Force ; USPSTF found insufficient evidence to support a population salt-reduction strategy . We agree with that evidence-based conclusion as well and invite Dr. Stubbs to join us in advocating a "constructive and transparent" process on the salt/health controversy.

With that single caveat, we commend the ACP statement that

... critics have made unfair and unsubstantiated attacks on the expertise, motivations, and independence of the scientists and clinician experts on the USPSTF.

ACP believes that it is essential that clinicians and patients be able to make their own decisions on diagnosis and treatment informed by the best available scientific evidence on the effectiveness of different treatments and diagnostic interventions. The USPSTF is a highly regarded, credible and independent group of experts that performs this role, on a purely advisory basis, to the Department of Health and Human Services, as it relates to interventions to prevent or detect diseases. As is often the case with evidence-based reviews, the USPTF’s recommendations will not always be consistent with the guidelines established by other experts in the field, by professional medical societies, and by patient advocacy groups. Such differences of opinion, expressed in a constructive and transparent manner so that patients and their clinicians can make their own best judgment, are important and welcome. It is not constructive to make ill-founded attacks on the integrity, credibility, motivations, and expertise of the clinicians and scientists on the USPSTF.

Some critics have erroneously charged that the USPSTF’s recommendations were motivated by a desire to control costs. According to the Agency for Health Care Research and Quality, “the USPSTF does not consider economic costs in making recommendations.” The Agency continues, “it realizes that these costs are important in the decision to implement preventive services. Thus, in situations where there is likely to be some effectiveness of the service, the Task Force searches for evidence of the costs and cost-effectiveness of implementation, presenting this information separately from its recommendation” and the “recommendations are not modified to accommodate concerns about insurance coverage of preventive services, medicolegal liability, or legislation, but users of the recommendations may need to do so.” [emphasis added in bold]

Under the bills being considered by Congress, the USPSTF will have an important role in making evidence-based recommendations on preventive services that insurers will be required to cover, but the bills do not give the Task Force — or the federal government itself — any authority to put limitations on coverage, ration care, or require that insurers deny coverage. Specifically, the House and Senate bills would require health plans to cover preventive services based in large part on the evidence-based reviews by the USPSTF, but no limits are placed on health plans’ ability to offer additional preventive benefits, or in considering advice from sources other than the USPSTF in making such coverage determinations. Accordingly, patients will benefit by having a floor – not a limit – on essential preventive services that would be covered by all health insurers, usually with no out-of-pocket cost to them. Patients will also benefit from having independent research on the comparative effectiveness of different treatments, as proposed in the bills before Congress. The bills specifically prohibit use of comparative effectiveness research to limit coverage or deny care based on cost.

The controversy over the mammography guidelines illustrates the importance of communicating information on evidence-based reviews to the public in a way that facilitates an understanding of how such reviews are conducted and how they are intended to support, not supplant, individual decision-making by patients and their clinicians.

ACP urges Congress, the administration, and patient and physician advocacy groups to respect and support the importance of protecting evidence-based research by respected scientists and clinicians from being used to score political points that do not serve the public’s interest.

Let's all agree on the process: follow the science. And then let's agree that digging in to defend the current politically-correct policies -- whatever they may be, but in our area of concern, policies that try to guide salt intake levels -- should be seriously questioned when such independent policy auditors as the USPSTF point out discrepancies between policy and evidence. To paraphrase the strategy that unraveled the Watergate scandal: follow the evidence. Let's not cherry-pick the science and support only the outcomes we like.