Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. is planning to fire all the members of the U.S. Preventive Services Task Force (USPSTF) and replace them with members of his own choosing, according to media reports.
The Wall Street Journal reported Friday that Kennedy plans to remove the 16 task force members because he considers them “too woke.” The task force is an independent entity convened by the federal government that makes recommendations for preventive services.
In an email to MedPage Today on Saturday, HHS spokesperson Andrew Nixon said: “No final decision has been made on how the USPSTF can better support HHS’ mandate to Make America Healthy Again.”
Under the Affordable Care Act (ACA), public and private insurers are required to cover at no charge any preventive services that are given a Grade B or higher recommendation by the USPSTF. These include screenings for breast, colon, prostate, and lung cancers; depression; diabetes; obesity; and sexually transmitted infections.
That Kennedy may fire all of the USPSTF members is raising alarm among public health experts, especially because he fired all the members of another advisory group last month, the CDC Advisory Committee on Immunization Practices (ACIP), and replaced them with eight new members, several of whom were known to be vaccine skeptics. The new members were appointed without undergoing the rigorous vetting for conflicts of interest that previous committee members underwent, which sometimes took more than a year.
“This is a tragedy again,” Georges Benjamin, MD, executive director of the American Public Health Association, said in a phone interview about the media reports. “This man is out of his mind.”
“We vet people for these task forces very carefully,” Benjamin continued. “Conflicts do occur, but the issue is transparency — it’s understanding where you’re coming from, and then doing the best you can to mitigate any conflict you have, by either not participating in certain parts [of a meeting], or if you do participate, participate with some degree of honesty.”
If Kennedy were to fire the current USPSTF members, “he [would be] removing people who are highly qualified and committed, and know the [subject] area,” he said. “The question is, is he going to put in people who were not really qualified on these task forces?”
The American Medical Association (AMA) also weighed in, with AMA executive vice president and CEO John Whyte, MD, MPH, telling Kennedy in a letter Sunday that AMA members had a “deep concern” about the possible removal of the task force members. “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,” he wrote.
The Infectious Diseases Society of America (IDSA) expressed concern as well. “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,” IDSA President Tina Tan, MD, said in a statement. “Recent increases in the rates of certain STIs [sexually transmitted infections] — especially including congenital syphilis in infants — as well as new cases of HIV and viral hepatitis fueled in part by the opioid epidemic and more difficult to access healthcare, underscore that our nation must significantly deepen its commitment to preventive healthcare, not undermine it.”
Colleen Kelley, MD, MPH, chair of the HIV Medicine Association (HIVMA), said in a statement that “Weakening the USPSTF jeopardizes access to preventive services for Americans that save lives and reduce healthcare costs. Grounding public health decisions in scientific evidence is vital to people with and vulnerable to HIV and to the health of all Americans.”
The task force was the subject of a Supreme Court ruling last month in a case known as Kennedy v. Braidwood. In that case, Christian-owned businesses and six individuals in Texas challenged the ACA coverage requirement, according to an issue brief from KFF, a health policy research and news organization. In particular, the court considered whether the structure of the USPSTF violates the Appointments Clause.
The plaintiffs alleged that the preventive services requirements for private health insurance are unconstitutional and also that the requirement to cover pre-exposure prophylaxis (PrEP) treatment for HIV prevention violates the Religious Freedom Restoration Act. They said they should not have to cover services that their employees don’t need or those that the employers object to. The federal government, representing the other side, argued that the USPSTF’s oversight by the HHS secretary is constitutionally appropriate because HHS may remove members at will and can determine when health insurance issuers must start providing coverage for new recommendations.
The High Court ruled in favor of the government’s argument that the task force structure is constitutional. “Task force members are inferior officers whose appointment by the secretary of HHS is consistent with the Appointments Clause” of the Constitution, the court wrote in its summary, which was authored by Justice Brett Kavanaugh.
The task force also made news earlier this month when Kennedy abruptly canceled a USPSTF meeting scheduled for July 10. The task force was set to discuss diet, physical activity, and weight loss to prevent cardiovascular disease in adults, according to a source.
At that time, an HHS spokesperson confirmed to MedPage Today in an email that USPSTF “will not be meeting on July 10,” but did not give a reason. “Moving forward, HHS looks forward to engaging with the task force to promote the health and well-being of the American people,” the email stated.
Benjamin noted that Kennedy recently signed off on a recommendation from the newly constituted ACIP to remove the mercury-based preservative thimerosal from flu vaccines, despite the fact that the CDC website says thimerosal is safe for such uses. “We got a recommendation that wasn’t evidence based, and then he signed off on it,” Benjamin said. “So I’m concerned that now he’s going to repeat this effort again and again. It’s going to undermine good scientific recommendations.”
Update: This story was updated on July 27 to include comments from the AMA, and again on July 28 to include comments from IDSA and HIVMA.
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