Sorry, but thanks to RFK Jr., you now have to know what the USPSTF is.

Plus, updates from the FDA and other must-know stories in public health.

In today’s Inside Medicine, we have one larger story, followed by some updates from inside the FDA. Then we’ll round it out with three miscellaneous (but important) stories I’m following. Thanks as always to Dr. Atul Gawande for some great insights on one of those stories.

There’s lots to keep tabs on, but I’m glad you’re interested enough to be here with me to bear witness on what’s happening. The energy of this community is truly inspiring. Keep your comments coming!

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RFK Jr. threatens to overhaul evidence-based preventive services in the United States.

In a perfect world, most people wouldn’t have to know what the United States Preventive Services Task Force (USPSTF) is. But now that the Wall Street Journal has reported that HHS Secretary Robert F. Kennedy may fire all of its voting members, it’s time for you to know.

The USPSTF is, in its own words, “a scientifically independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services.”

At least, that’s what it has been for decades—which is why its publications have long been considered among the most rigorous out there. For the first three decades of its existence, USPSTF recommendations were highly respected and influential. But it was the Affordable Care Act that gave the body a special place in our healthcare system, legally requiring private health insurers to cover preventive measures that received A or B level recommendations from USPSTF research teams. That’s why today, the USPSTF carries its deliberation with transparency, requiring input from experts and public stakeholders.

Since the topics are often highly technical, teams of subject matter experts are assembled to tackle every question under consideration. These teams are called Evidence-based Practice Centers. These teams do quiet but crucial work. Their assessments of the medical literature directly determine what preventive care a large number of Americans get covered for free. (Medicare and Medicaid are not bound by USPSTF recommendations, but they often follow them.)

If the Wall Street Journal reporting is correct, the USPSTF is about to be under attack. We should be under no illusions about how serious this might be. We’ve seen this movie before. In June, Secretary Kennedy fired every member of the CDC’s Advisory Committee on Immunization Practices—another body whose recommendations must by law be followed by insurers. As we all know, Kennedy replaced a body of seasoned experts with a new panel of handpicked (read: frequently problematic) replacements. In its first meeting, the newly-installed body voted to remove thimerosal from US flu vaccines (a safe preservative falsely linked to autism), based on one low-quality presentation by a known anti-vaccine activist. We don’t know what ACIP will do next, but it’s highly likely that it will continue to undermine vaccine science.

If the USPSTF follows the same path, Americans could soon lose legal access to cost-free preventive services. It’s hard to imagine Secretary Kennedy would vacate the USPSTF without the intention to take away important services. If that were not the plan, why bother doing this? He’s already signaled that he believes the group is too “woke.” (I pause here to mention that the USPSTF’s most recent publication was entitled “Intimate Partner Violence and Caregiver Abuse of Older or Vulnerable Adults: Screening.” Ah yes, what a woke topic.

It bears mentioning that the USPSTF has long been seen as a somewhat conservative expert body when it comes to recommendations. Notably, it prominently highlights when its own recommendations are based on evidence that the body itself considers insufficient. This kind of humility adds credence to their work, in my view. It’s also worth remembering that USPSTF recommendations have not always been popular—but that they’ve stood by their work. For example, the task force does not recommend routinely screening most middle age or older men for prostate cancer with PSA blood tests, despite tremendous pushback from advocacy groups, many of whom were not pleased that the data showed that screening had more harms than benefits for many populations. But that’s the point of the USPSTF: to follow the science, not popular opinion.

As my colleague Dr. Bill Hanage recently said to me, we want evidence-based policymaking, not policy-based evidence making. Based on what we saw at the June ACIP meeting, I’m concerned that a newly-configured USPSTF would be likely to cherry-pick its evidence to reach a pre-ordained conclusion on hobby horse topics for Secretary Kennedy. If that happens, we will have lost another venerable American scientific institution.

Open tab: “As Past USPSTF Chairs, We Fear for the Future of the Task Force—In the wake of a cancelled July meeting, we'd like to clarify its role and structure.” Opinion published in MedPage Today.

Updates from the FDA. In: “expert panels.” Out: FDA scientists.

I’ve been spending a lot of time speaking with FDA insiders lately. The mood is not good over there, I must say. Here’s a quick rundown on some of the stories developing there:

1. As an important MedPage Today story by Rachael Robertson reports, the agency has convened a handful of “expert panels” on high-profile topics as of late, including antidepressants in pregnancy. These panels function differently from advisory committees, groups whose activities are governed by official policies designed to ensure quality, transparency, and public participation. The problem is that, unlike advisory committees whose work must follow certain rules (such as providing adequate advance notice), these panels seem to be hastily thrown together PR events. That said, their influence on any genuine regulatory activity, if any, remains opaque.

2. A Citeline story by Sarah Karlin-Smith describes an ongoing exodus of FDA scientists. The well-sourced report matches what I’m hearing from my sources too, which is that RIFs, early retirements, and increasingly demoralized scientists looking for work elsewhere have drastically reduced the agency’s capacity to do its usual high-quality work. Newly-installed FDA officials have signaled that they believe the work by teams containing some of our nation’s best scientific reviewers might be replaced by the judgment of one person (sidebar: the Wall Street Journal editorial board/opinion page is apparently not a fan of the FDA’s new top scientific officer Dr. Vinay Prasad, nor are a bunch of Conservative voices), or maybe just AI. Which leads us right to…

3. According to CNN, the FDA’s new, but apparently undertested, AI tool is busy making stuff up. Sweet!

Three other public health/science stories I’m also following.

So much going on, but we have to stay on top of things. Here are three stories I’m following that I think you should know about.

• Every article published in the CDC’s top journal, Morbidity and Mortality Weekly Report, now requires approval from HHS Secretary Robert F. Kennedy Jr., according to this report of a recent slowdown in publications from MedPage Today’s Kristina Fiore. Does that make RFK Jr. the de facto editor-in-chief of MMWR? Now there’s a scary thought.

• PEPFAR, the US program that has saved millions of lives through the prevention and treatment of HIV/AIDS, may once again be on the chopping block, according to The New York Times’s Stephanie Nolan. The story of PEPFAR this year has been “will they or won’t they kill it?” Pressure has, at times, spared the program from elimination faced by most other global health programs, thanks to DOGE. So far, PEPFAR has been the one program that seemed poised to possibly survive. Here’s what my colleague Dr. Atul Gawande (who ran global health for USAID under President Biden), told Inside Medicine about this last week (lightly edited for clarity):

  • “PEPFAR has been the best off of foreign assistance programs. But it has been cut to between 50%-60% of its former budget….The plan to cut an additional half billion in the rescission budget was turned back. The major issue is that USAID was a critical implementer for almost half the program (including all the purchasing of medications and diagnostics; and most for orphans and vulnerable children) and its staff have been laid off. Also HIV prevention—PrEP [pre-exposure prophylaxis] especially—has been largely stopped. There will be a small gesture of rolling out long acting prevention like lenacapavir [a life-saving injection that prevents infections with just twice yearly dosing] but no other major pushes, and that will be a big source of losing ground. A small number of USAID staff have been hired at State Department headquarters, but it is fractional.” —Dr. Atul Gawande.

• The American College of Obstetricians and Gynecologists announced that it will stop accepting federal funding for its programs, given the current landscape. A statement to its members was shared on LinkedIn, and is pasted below.

  

That’s all for now. Thanks for reading and supporting science, facts, and the actual American way!

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If you have information about any of the unfolding stories we are following, please email me or find me on Signal at InsideMedicine.88.