The Death of Independent Expertise

USPSTF is about to go the way of ACIP, because preventive medicine is too woke

Photo credit: Reuters

Last Friday, the Wall Street Journal reported that Health and Human Services Secretary Robert F. Kennedy, Jr. had added the US Preventive Services Task Force (USPSTF) to his list of enemies marked for termination. USPSTF is an independent panel of experts that advises the HHS secretary on all things prevention.

Preventative medicine is really important for long-term health at population scale, because it is how we have access to things like cancer screening. I don’t particularly enjoy getting pap smears and gynecological exams, but I definitely like knowing whether I have cancer or not. I suspect that I’ll probably have the same attitude toward colonoscopies. USPSTF are all publicly nominated based on their expertise and serve voluntarily, in an open and transparent capacity. Meetings are open to the public. The public can comment on them and on USPSTF’s recommendations. Independent expertise and transparency are foundational to effective, science-based public health policy. It’s essential to building and maintaining public trust.

I also like the fact that people can access preventative services for things that I am not at high risk for. Like preventing intimate partner violence and caregiver abuse of older adults, cavities in children under 5 years of age, type 2 diabetes, Rh(D) incompatibility during pregnancy, suicide among adolescents, and HIV and viral hepatitis transmission. As far as I’m concerned, providing services to people that prevent them from suffering from life-threatening illnesses is a good thing for governments to do and a valuable investment in public health.

USPSTF also brings great value to the American economy. It saves costs by preventing serious diseases that can be very expensive to treat. Catching cancer earlier leads to less invasive treatments and better survival outcomes. Preventing obesity leads to preventing type 2 diabetes, which not only kills people but costs a lot of money to treat and manage. And a healthier workforce is a more productive workforce. Having fewer sick and dead people benefits Americans whether they personally benefit from preventive services or not.

Cancer screening isn’t “woke”

Kennedy’s stated complaint about the USPSTF is that it is too “woke.” It’s hard to say what exactly is “woke” about USPSTF other than it focuses on diseases afflicting populations who aren’t ranked among the favored classes of human by crackpot fascist enablers. What “woke” means in the context of HIV prevention is that Kennedy and his patrons don’t like queer people. In the context of intimate partner violence prevention , maternal mortality, and reproductive and breast cancer screening, “woke” means that they don’t like women. When health equity is called “woke,” it means that they don’t like Black and Latino people. BRCA1 and BRCA2 genetic cancer screening is “woke” it’s because they don’t like Black and Ashkenazi Jewish women. And the “woke”-ness of preventing cognitive decline lies in their animosity toward disabled people.

That’s because disease prevention isn’t woke. Determining which populations are most at risk and thus need focused preventative services are scientific issues. Targeted, evidence-based recommendations ensure that resources are spent most effectively, providing the most benefit to the people who are the most at risk. “Woke” as Kennedy uses it is a justification for being openly bigoted and illegally withholding services from people on the basis of their identities.

To my knowledge, Kennedy has never defined what he means by “woke.” I’d hazard a guess that it’s something along the lines of excessively diverse, equitable, and inclusive. If woke means “too DEI”, then what is the opposite of that? Kennedy is literally saying aloud that he intends for preventive services to be available only to an exclusive group, limited to those of his choosing, and that he will be as discriminatory as he wants to be. He prioritizes this over the many good reasons to retain USPSTF, because this is about securing authoritarian power rather than health care. And that means that the Department of Health and Human Services is carrying out its mandate in deference to racism, misogyny, anti-LGBTQ+ hatred, antisemitism, religious intolerance, and ableism instead of, you know, health and human services.

Getting ACIP-ed

Kennedy now has a precedent for disbanding an independent expert advisory panel. He fired all 17 members of the CDC’s Advisory Committee for Immunization Practices (ACIP) in June, replacing them with a roster of malevolently clownish anti-vaxxers who promptly started making anti-vax recommendations. My colleague Gregg Gonsalves pointed out in The Nation that Kennedy was following the same playbook and USPSTF is about to get “ACIP”-ed.

From Gonsalves’ excellent article in The Nation, forecasting USPSTF’s grim fate

USPSTF has another thing in common with ACIP. The recommendations made by ACIP and USPSTF are used by insurance companies to decide whether they want to pay for something or not. If USPSTF is replaced with a bunch of wellness profiteers who believe that we can prevent cancer or Alzheimer’s or heart disease with supplements they sell rather than medically proven screening and clinical prevention programs, insurance companies may decide that annual mammograms are an expense they’d rather not continue to pay. Or that they don’t want to provide PrEP to people to stop them from getting infected with HIV. Or that they don’t want to pay for kids to get mental health care that might prevent them from attempting suicide.

The American Medical Association (AMA) wrote a letter to Kennedy expressing “deep concern” about the USPSTF’s future on the basis of the burden of disease that will be caused if “cost sharing” (ie: not covered by insurance) on preventive services becomes more widespread. Unfortunately, Kennedy doesn’t give a fuck about the AMA’s concerns. He is not a person who can be convinced to change course, especially when you consider that as a very accomplished anti-vaxxer, he’d racked up a sizable body count already. He contributed to the deaths of 83 kids during a measles outbreak in Samoa, he has contributed to 3 more measles deaths this year by encouraging unproven alternative treatments to vaccination, and he drove his ex-wife to suicide. He is a pseudoscience-addled bigot and an ideologue who cannot be reasoned with.

Here’s what will happen if USPSTF joins ACIP on the other side of the public health rainbow bridge and insurance companies stop covering these preventative services: cancer mortality will start to climb, because people will take longer to catch their cancer. Heart disease and type 2 diabetes will increase, since people will lose access to drugs and support services that reduce these risks. HIV outbreaks will occur, as insurance companies no longer cover PrEP. More women will die in pregnancy or childbirth. More babies will be born sick because of a lack of prenatal care. More pre-teens and teenagers will die by suicide. More families will be buried in medical debt. More people will be sick. More people will be dead.

This is precisely what Kennedy wants, because he profits from it. The people he will appoint to USPSTF will profit from it, just as the new members of ACIP are profiting from it. However, Kennedy also knows that it’s bad for his bottom line if experts point out that he is intentionally enabling preventable illness and death and counter his wildly inaccurate claims. Because he is hopelessly corrupted, he will never listen to experts or consider their actual arguments. So his solution is to eliminate expertise altogether.

Lots of authoritarian regimes have eliminated experts—particularly scientists and physicians—throughout history. The Nazis did it. So did Stalin. So did Mao. Dissident intellectuals and scholars with the ability to directly respond to lies with facts threaten authoritarians who wield fear, confusion, and ignorance to maintain their power. If Kennedy can kill expert advisory panels in government policymaking, he will be able to kill more people without experts opposing him with facts.