Lupin 2023

What science-based guidelines mean for Rx

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Retail pharmacy operators and other health care providers recently were given a preview of the difficulties involved in implementing the findings of comparative effectiveness research, a science-based approach to evaluating the benefits and potential dangers of alternative forms of diagnosis and treatment.

Controversy erupted when the United States Preventive Services Task Force, an independent group of physicians and other experts reporting to the Department of Health and Human Services, issued new guidelines for breast cancer screening. Reversing long-standing thinking, the task force recommended that most women should not begin receiving regular mammograms until age 50, instead of 40, and that they do so once every two years, not on an annual basis.

Issuance of the findings immediately set off a firestorm, with patient groups, the American Cancer Society and a host of politicians speaking out vehemently against them.

The backlash caused government officials to hedge their bets. HHS Secretary Kathleen Sebelius issued a statement advising women to “keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.” Hardly a ringing endorsement of comparative effectiveness research.

In reality, the task force’s findings are not at loggerheads with what Sebelius had to say. In testimony before a House subcommittee early this month, Dr. Ned Calonge and Dr. Diana Petitti, who head the panel, sought to clarify it — after admitting shortcomings in the way the recommendation was originally presented.

“What we said is that screening starting at age 40 should not be automatic. Nor should it be denied,” they testified. “What we are saying is that the decision to have a mammogram for women in their 40s should be based on a discussion between a women and her doctor.”

The controversy surrounding the recommendations prompted quick legislative action. Amendments proposed by Sens. Barbara Mikulsi (D., Md.) and David Vitter (R., La.) and attached to the health care reform bill under consideration in the chamber instruct HHS to determine which type of screenings insurers should provide at no cost to women and to disregard the task force’s new approach on mammography.

Thorough debate about the results of comparative effectiveness research is a good thing. Experts differ on the guidelines for breast cancer screening, and the opinions of dissenting voices should be carefully considered before changes in practice are adopted.

But that dynamic needs to first play out in the medical and scientific community before being taken up in the legislative arena. Consensus about the evidence needs to be reached before policy makers intervene.

What all this means for community pharmacy is that the professionals on the front lines will be thrust into the role of helping patients understand and sort out contending views about the use of various health care treatments, especially prescription drugs and biologics. As the controversy over the task force’s mammogram recommendations demonstrates, confusion and passions are likely to run high.

Retailers will have to find efficient ways to equip pharmacists with a solid understanding of the latest science, as well as remind them that one size doesn’t fit all and treatments are most effective when they are geared to individual needs.

That approach, coupled with the unmatched accessibility of community pharmacy, should further enhance the profession’s standing as an indispensable part of the health care continuum.


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