Last week, Health Secretary Robert F. Kennedy Jr. fired the two leaders of the U.S. Preventive Services Task Force, a powerful expert panel whose recommendations shape preventive services, like cancer screenings, for millions of Americans. They were given little explanation for their firing, besides a vague pronouncement in a letter they received from Mr. Kennedy that it had been done “to protect the integrity of the task force’s work.”
One of us (Dr. Silverstein) served as the task force chair until March, when he left, as planned, when his term was up; the other (Dr. Wong) was one of the two individuals fired.
We had worried that something like this could happen ever since the Supreme Court affirmed almost a year ago that U.S. health secretaries can remove task force members at will. Mr. Kennedy had made it clear, repeatedly, that he had no love for the organization. He postponed all three of its scheduled meetings, blocked it from beginning work on new topics, suppressed new guidelines (including critical new recommendations on cervical cancer screening) and, most recently, accused it of being “lackadaisical and negligent.”
This is not the first time Mr. Kennedy has fired health experts without cause or injected politics into the mission of what is supposed to be an independent health advisory panel. The consequences here could be particularly wide-ranging. The U.S. Preventive Task Force is hugely influential in determining what types of counseling, screenings and preventive medications doctors recommend to Americans — and what insurance companies are required to cover, with no co-pays from patients. The screenings it recommends for cervical, colon, breast, prostate and lung cancer save tens of thousands of lives per year. Our recommendation for medication to prevent H.I.V. transmission could help eliminate as many as 90 percent of new H.I.V. cases among those at highest risk.
Our fear is that a task force beholden to political interests could roll back evidence-based recommendations and coverage. Or it could start recommending screening tests or other prevention strategies that are unproved, harmful or better for corporate profits than they are for patients. Mr. Kennedy has already promoted dubious treatments for autism spectrum disorder and measles. It is easy to imagine him calling for prevention strategies that propagate his views on dietary supplements or consumption of red meat. Or offering recommendations that bolster the financial interests of the myriad individuals in his circle who profit from fitness and nutrition products.
Traditionally, our organization is made up of 16 members — all unpaid, highly qualified experts with experience in primary care. But for the better part of the past six months, vacancies have been building up, as members finished their allotted terms and Mr. Kennedy and his director of the Agency for Healthcare Research and Quality did not appoint new members. With the recent firings, there are now eight open spots. Only within the past weeks has Mr. Kennedy moved to fill them.
We understand that the Supreme Court has conferred on the health secretary the power to appoint task force members, but typically, the task force chairs play a significant role in this process; now that Dr. Wong and his fellow co-chair have left, Mr. Kennedy will be able to reconstitute the organization without any guidance (or as he may see it, interference) from people who understand it most intimately.
If Mr. Kennedy tries to influence task force decision making, the next leaders of the task force cannot be truly independent — and trust in the institution from doctors and other health care providers will crumble.
We do not yet know who will replace the dismissed leaders or if the other eight members of the task force will remain. But we do know that for the foreseeable future, they will be working in service of an administration with little respect for scientific processes. The American people can trust disease prevention guidance only if it’s produced by people who are not influenced by political ideology, corporate dollars, advocacy organizations or preconceived notions of what we should do to promote our health.
Mr. Kennedy and Roger Klein, the director of the Agency for Healthcare Research and Quality, should be called to testify before Congress about their rationale for these firings. And the task force should be allowed to continue its work.
Patients across the country deserve to be guided by advice from primary care clinicians with the best and most up-to-date science at their fingertips. Without a trusted and independent task force, the health of our country will worsen.
Michael Silverstein is a general pediatrician and professor at Brown University. John Wong is a general internist at Tufts Medical Center.
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