Health guidelines should be transparent. The Task Force’s aren’t
The Canadian Task Force on Preventive Health Care (Task Force) has been paused by Health Minister Mark Holland. This follows early findings of an External Expert Review on the Task Force and its work.
In response, Task Force proponents have written both an opinion piece and a petition letter. The pause was necessary, and the Task Force’s response proves it.
The Task Force claims to be internationally well-regarded, but this is only in the context of evaluations by other methodology groups, not by content experts and not on the basis of patient outcomes or the modernity of its guidelines.
Recently, the group posted a chart showing glowing scorecards from a guideline-rating group. The Task Force received full marks on “updating” its guidelines, when in fact some haven’t been updated in over a decade.
On closer inspection, source documents for the group’s glowing evaluation were hidden behind a USD $5700 paywall. After being asked to remove the chart, it was taken off the front page of the website and placed it on its own dedicated page.
The Task Force cynically oversimplifies — and strawmans — the criticisms of its detractors.
The breast cancer screening guideline has been a particular pain-point, not because of “lobbyists,” or “vested commercial interests,” but because it is an outlier among modern guidelines across the world.
Other jurisdictions have responded to multiple factors, including updated evidence, criticisms of a particularly troublesome clinical trial, increasingly younger women getting breast cancer and a growing understanding of the impacts of genetic and racial risk factors.
The criticisms and fallout of the Task Force’s guidelines go far beyond just breast cancer screening. There are evidence-based critiques from experts and lagging Canadian healthcare practices resulting from Task Force guidelines on prostate cancer, cervical cancer, colorectal cancer, lung cancer, hepatitis C, pediatric developmental delay, pregnancy/postpartum mental health, and vision impairment.
In the recent petition, sent out to thousands of healthcare providers from the email address of a Task Force administrator, the Task Force asked physicians and others on its email distribution list to sign a document which disingenuously suggested the decision to pause it was politically motivated, using phrases such as “[the decision to pause the Task Force] deeply shakes our trust in our political leaders.”
Even the title of the opinion piece from the Task Force invokes “government meddling,” but it is the profoundly unaccountable and opaque structure of the Task Force that paradoxically led to the need for this step.
Most concerningly, the petition does not mention that Minister Mark Holland called for the pause based on the initial findings of the External Expert Review. In fact, the petition does not mention the Review at all. This a glaring omission and one I can only assume is deliberate.
In addition to this key omission, there are several strawman arguments or misrepresentations in the document. I’ve not heard of anyone calling for “guidelines based on expert opinion rather than rigorous and impartial analysis of scientific data” and I challenge the Task Force to provide any supporting examples of that claim.
One of the groups advocating for the Task Force’s modernization is the Coalition for Responsible Healthcare Guidelines, which I chair. This group includes several population health specialists, such as those holding degrees in epidemiology and Masters in Public Health who are experts in the rigorous analysis and interpretation of data.
The petition is little more than incendiary misinformation. To collect signatures without full disclosure of the circumstances is manipulative at best and deceptive at worst. Some signatories might not have added their names had they known the Task Force may have fared poorly on its External Review or even that a Review was pending.
Task Force members have a right to express dismay at the pause, but to rope colleagues into supporting them without disclosing the entirety of the context is a disservice to the Canadian medical community.
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Dr. Shiela Appavoo is a clinical professor in the Department of Radiology & Diagnostic Imaging in the Faculty of Medicine & Dentistry at the University of Alberta and chairs the Coalition for Responsible Healthcare Guidelines.