The Problem Isn't That the Task Force Says "No." It's That Science Sometimes Does.

AcademyHealth President and CEO Aaron Carroll explores the role of the U.S. Preventive Services Task Force and why prevention only works when the evidence shows it helps.

In May, I wrote that the real story behind the upheaval at the U.S. Preventive Services Task Force (USPSTF) wasn’t simply the firing of its chairs. The deeper story was the slow dismantling of the evidence pipeline that supports the Task Force: canceled meetings, shrinking staff, and changes in how members are selected and how scientific evidence moves through the federal system.

Since then, I’ve noticed another theme emerging in coverage of the Task Force. The debate is increasingly framed as a choice between a panel that has been too slow and too cautious, and a new approach that promises more preventive care for more Americans. It’s an appealing argument because prevention is one of the few things almost everyone agrees on. Who wouldn’t want to detect disease earlier? Who wouldn’t want to prevent illness before it starts?

Those are the right goals. But they are not the question the Task Force was created to answer.

Prevention Is Only Helpful If It Helps

Preventive care has transformed medicine. Vaccinations, blood pressure screening, colorectal cancer screening, tobacco cessation counseling, and many other preventive services have saved lives and improved health for millions of Americans. We should absolutely want more preventive care when the evidence shows it works.

The challenge is that prevention is not automatically beneficial simply because it happens earlier. Screening healthy people is fundamentally different from treating someone who is already sick. Screening tests can save lives, but they also carry risks: false positives, unnecessary procedures, overdiagnosis, anxiety, and treatments for conditions that may never have caused harm. Detecting a disease earlier does not necessarily mean a person lives longer or healthier. Sometimes it does. Sometimes it doesn’t.

That is why preventive medicine demands such a high standard of evidence. Before recommending that millions of healthy people undergo a screening test, we have to answer a deceptively simple question: does this improve health enough to outweigh the harms?

That answer cannot come from instinct, optimism, or even good intentions. It has to come from evidence.

What the Task Force Actually Does

One of the biggest misconceptions about the USPSTF is that it decides which preventive services Americans should receive. In reality, it sits at the end of a much longer scientific process.

Researchers conduct clinical studies over many years. The Agency for Healthcare Research and Quality supports Evidence-based Practice Centers that systematically review the entire body of published research on a topic. Those reviews are then presented to the Task Force, whose members evaluate the quality of the evidence, weigh the benefits and harms of screening, solicit public comment, and ultimately issue recommendations.

By the time a recommendation reaches the Task Force, years (sometimes decades) of scientific work have already taken place.

This is why one phrase appears so often in Task Force recommendations: “the current evidence is insufficient.”

To many people, that sounds like indecision or unnecessary caution. In science, it means something very different. It means researchers have not yet generated enough high-quality evidence to answer the question with confidence.

That isn’t a failure of the Task Force. It’s the conclusion the evidence supports.

Evidence Changes Recommendations

If that sounds frustrating, it should. Patients living with devastating diseases understandably want answers as quickly as possible. Physicians want better tools. Advocacy organizations want more options for the communities they serve.

Science, however, doesn’t move because we want an answer. It moves because new evidence changes what we know.

We’ve seen that happen repeatedly throughout the Task Force’s history. In 2021, after new research showed rising rates of colorectal cancer among younger adults and demonstrated that earlier screening could improve outcomes, the Task Force lowered the recommended age for routine colorectal cancer screening from 50 to 45. That recommendation expanded access to preventive care for millions of Americans. It happened because the evidence changed, not because the Task Force adopted a different philosophy or lowered its standards.

The evidence can move recommendations in the other direction, too. In 2012, after large trials showed that routine PSA screening for prostate cancer prevented few deaths while producing substantial overdiagnosis and treatment harms, the Task Force recommended against it. In 2018, with longer follow-up data and better approaches to managing low-risk cancers, it revised that position and recommended that men aged 55 to 69 make an individual decision with their clinicians. Neither change reflected a new philosophy. Both reflected a change in what we knew.

That is how evidence-based medicine is supposed to work. Researchers ask important questions. Studies are conducted. Evidence accumulates. Recommendations evolve.

Why the Current Debate Matters

Many of the diseases now receiving attention deserve more research. Alzheimer’s disease affects millions of families. Chronic kidney disease remains a major public health challenge. New technologies for detecting cancer are advancing rapidly and hold tremendous promise.

None of that is in dispute.

What concerns me is the growing suggestion that if the Task Force isn’t recommending enough preventive services, the solution is to replace the people evaluating the evidence with people who are more willing to reach different conclusions.

If decades of research have not yet answered an important clinical question, replacing the reviewers does not create new science. That may produce more recommendations, but it does not necessarily produce better ones.

Why Independence Matters

I’ve also seen calls for the Task Force to include more specialists representing particular diseases and conditions. Specialists are indispensable to the process. They conduct much of the research the Task Force reviews. They identify emerging questions. They provide public comment and clinical expertise throughout the development of recommendations.

But the Task Force was never intended to function as a collection of disease advocates.

Every specialty quite naturally wants to improve outcomes for the patients it serves. Every patient advocacy organization wants more attention devoted to the condition it fights every day. Companies developing new diagnostic technologies believe their innovations deserve consideration. Those perspectives are valuable, and they belong in the conversation.

The Task Force has a different responsibility. Its job is to step back from those individual perspectives and ask a broader question: given everything we could recommend to healthy Americans, which preventive services have sufficient evidence to improve health across the population?

That distinction matters. Every disease is important. Every patient population deserves better care. Every promising technology comes with compelling stories about the lives it could change. The Task Force exists because someone has to evaluate all of those claims according to the same evidentiary standard.

Without that common standard, recommendations inevitably become influenced by which diseases have the strongest advocates, the most persuasive stories, or the greatest commercial interest behind them.

If We Want More Prevention, There’s a Better Path

If our national goal is to expand effective preventive care, there is a straightforward way to do it: Invest in the evidence.

Fund the clinical trials that answer unresolved questions. Strengthen AHRQ and the Evidence-based Practice Centers that synthesize the research. Allow the Task Force to meet regularly, deliberate publicly, and evaluate new evidence as it emerges. Support the researchers whose work ultimately determines whether a promising idea becomes a recommended preventive service.

None of those steps guarantees that a particular screening test will receive a favorable recommendation. That is exactly as it should be.

Science begins with a question, not an answer. Research exists to determine what works, not to validate what we hope is true. When the evidence changes, recommendations should follow. If the evidence hasn’t changed, we should be honest enough to say so.

The value of the Task Force has never been that it recommends more preventive care. Its value is that clinicians and patients can trust that its recommendations are driven by evidence rather than enthusiasm, commercial interest, or political preference.

Those recommendations will always disappoint someone. Some advocates will believe they move too slowly. Others will think they go too far. That’s inevitable when the standard is evidence rather than preference.

We want recommendations that people can trust because they followed the evidence wherever it led, even when the answer was, “we don’t know yet.”