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Wednesday, August 08, 2012

USPSTF-Thanks goodness they have"no emotional,ideological or financial conflicts of interests"

Dr. Otis W. Brawley,of the American Cancer Society, characterized the USPSTF as ideally suited to provide an objective,unbiased assessment of the state of the science (medical science in this context as it applies to screening for disease) because:

"The Task Force Members have no emotional,ideological or financial confidants of interests."

This quote can be found in the Annals of Internal Medicine,Prostate Cancer Screening: what we know,don't know and believe" (Annals Int Med. 22May 2012.)

Somehow the appointment process utilized by the AHRQ (Agency for Healthcare Research and Quality) which,as best I can tell, appoints the members to the Task Force, is able to cull out potential appointees who have ideological and emotional conflicts of interest as well as the more easily determined financial conflicts.

The techniques employed by AHRQ should be made public as appointing individuals without any biases would be incredibly important in regard to the judiciary (particularly the Supreme Court) .Such a determination would be invaluable for voters in selecting a candidate.AHRQ has an ethical obligation to make this marvelous selection process public.Their vetting process seems to have discovered a new group (sub-species?) of humans who are except from the cognitive flaws that psychologists such as Daniel Kahneman and Amos Tversky, have described. Other authors such Drs Jerome Koopman and Pamela Hartzband have commented on the subjective elements in what passes for objective analysis of medical data;the public is fortunate to have decisions made for them by a panel who can be objective all the way down.

Quoting Koopman and Hartzband:

For patients and experts alike, there is a subjective core to every medical decision. The truth is,despite many advances, much of medicine still exists in a gray zone where there is not one right answer"

Panels designated as expert have at their disposal sophisticated statistical methods and standard epidemiological concepts, but at the end of the process some one or some group has to make a value judgment. Some one has to say the risks are or are not worth the benefit.

The financial conflicts , or course, are the easiest to discern. Ideological biases is a little more difficult to exclude. As far as "emotional biases" I have no clue as to what a litmus test of that would be,but apparently Dr. Brawley does as does the AHRQ.

The majority of Task Force members come from medical academia. If it were the case that medical academicians as a group are of a certain mind set or world view it would be specially important to weed out those whose priors might include a certain default view about screening for what ever reason.

It is commonly held the academics in general are more likely for example to vote democratic than republican and are more likely to be characterized as progressive rather than conservative or libertarian and tend to vote than way. Fortunately there is nothing in the progressive world view ( which posits that elites should make the really important decisions rather than the individual) that would lessen their ability to make an unbiased assessment.

Many of the task force members have MPH degrees or more advanced degrees in Public Health. Could it be the case than special training in public health might lead one to adopt (or seek such a degree because one has already adopted ) a world view in which the inevitable tension between the good of individual versus the good of the collective is more than a little slanted towards the later. Perhaps, but presumably AHRQ vetting procedure has been able to select candidates who have no prediction for either position.

Rather than declare than the task force is composed of creatures marvelously bereft of any and all biases and thus describing creatures not previously known to exist on earth I suggest the following description is more realistic:

Highly trained,well educated conscientious, fallible people trying hard to make the best decision they can dealing with difficult information supplied with less than complete information and using mathematical tools that offer approximate answers rather than categorical eternal truths.

Does a person's priors (past experiences,education,world view) inform the way they read the data in regard to a certain issue.? Common sense , general experience and a great deal of generally accepted psychological research all suggest the answer is yes.

Paragraphs of over done, self serving sarcasm may give some personal satisfaction but my first reaction to Dr. Brawley's statement was the phrase made famous by John McEnroe referring to a shot by his opponent that everyone in the stadium but the umpire saw that the ball was out is really all the claim deserves. "You've got to be kidding me."

1 comment:

Hal Dall, MD said...

Who are these impartial beings? See DrRich for his astute(as usual)explanation: http://covertrationingblog.com/fun-with-guidelines/who-writes-those-clinical-guidelines-anyway