Georgetown Professors Criticize Congress

Two Georgetown University professors published a commentary on Jan. 18 criticizing a section of Congress’ recent spending bill that outlines mammography screening recommendations for women.

Under the Affordable Care Act, private insurers are required to follow the recommendations of the United States Preventive Services Task Force, which is comprised of independent experts. However, the recent spending bill, the Consolidated Appropriations Act, overrides the ACA by directing insurers to follow outdated recommendations of the Task Force.

The act instructs private insurers to follow the United States Preventive Services Task Force’s 2002 recommendations with respect to breast cancer screening, prevention and mammography, ignoring a 2009 update to the Task Force’s protocol.

The 2002 recommendations instructed women to get mammography screenings every one to two years beginning at age 40. However, they changed their recommendations in 2009, instead stating that women should get screenings every other year beginning at age 50. The Task Force revisited their recommendations again last year and had findings consistent with their 2009 guidelines.

“While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger,” the Task Force wrote in its Final Recommendation Statement on Breast Cancer Screening published in January.

The Georgetown University Law Center O’Neill Institute for National and Global Health Law Director Lawrence Gostin and Georgetown University Medical Center Associate Professor Kenneth Lin published a viewpoint in the Journal of the American Medical Association criticizing the legislation.

“Essentially, Congress is requiring health insurers to ignore modern scientific assessments and instead use 14-year-old guidance,” Gostin and Lin wrote in their commentary. “By declining to acknowledge scientific progress, Congress may do more harm than good to women’s health. … When Congress required DHHS [Department of Health and Human Sciences] to link insurance coverage policy to outdated public health guidance, it was making a scientific judgment for which it is distinctly unqualified.”

Gostin and Lin criticized Congress for ignoring the recommendations of the Task Force and coming to its own conclusions on the issue.

“I would say that if you can discount the science in the case of mammograms it can be done with anything, and that would do a disservice to women and all patients,” Gostin wrote in an email to The Hoya.

Lin also emphasized that women may not be aware of the 2009 guidelines and would simply follow the instruction of their insurers, who would follow the 2002 recommendations.

“The problem is … that women are getting shortchanged,” Lin said.

Gostin argued that the actions of Congress are not only undermining women’s health, but the credibility of the Task Force as well.

“The U.S. should have a scientifically neutral body that is fully respected and adhered to. That was supposed to be the Preventive Task Force, but their judgment is too often overridden,” Gostin wrote. “The actions taken by Congress undermine the Task Force’s credibility and integrity.”

Gostin highlighted the importance of applying scientific evidence to public policy decision-making.

“I’m interested in how science is applied to critical public health policy decisions. We should uphold the role of science and evidence in health policy,” Gostin wrote.

The office of Congressman Charles Dent (R-PA), who sponsored the bill, did not respond to The Hoya’s request for comment.

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