You probably have heard that the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation against prostate-specific antigen (PSA) screening for prostate cancer this week. What you might not be aware of is the amount of time, effort and resources the AAFP invests in evaluating recommendations from federal agencies and other professional medical organizations.
Thomas Houston, M.D.
Busy physicians don't always have time to immediately -- and thoroughly -- evaluate every new recommendation or guideline that is published, let alone the lengthy evidence reports on which they are based. (The evidence report(www.uspreventiveservicestaskforce.org) for prostate cancer is more than 5,000 words.) But we can identify and rely on trusted sources to do some of the important and time-consuming work for us of reviewing guidelines and discussing new developments in science and health from the family medicine perspective.
The AAFP Commission on Health of the Public and Science, which is responsible for developing and evaluating evidence-based clinical guidance recommendations for the Academy's Board of Directors, is one such source. The commission is made up of 17 active family physicians, as well as medical student and resident representatives. It also includes liaisons from the AAFP Board of Directors and a state chapter executive, and it receives support from Academy staff.
The commission's Subcommittee on Clinical Preventive Services reviews every recommendation issued by the USPSTF and the CDC's Advisory Committee on Immunization Practices. The USPSTF(www.uspreventiveservicestaskforce.org) -- an independent panel of experts in preventive medicine and primary care, including family physicians -- is considered the gold standard for evidence-based primary care recommendations, and the AAFP rarely disagrees with this task force because of its exacting methodology and high standards for evidence.
That was the case with the prostate cancer screening recommendation, which was reviewed by the subcommittee during an open-comment period last fall. Although the recommendation has generated some controversy among media, subspecialists and patient groups, the subcommittee was strongly in favor of the task force's draft report and recommended to me, the commission chair, that the AAFP endorse it. After approval by the Board of Directors, the Academy submitted comments to the USPSTF in favor of the draft.
The USPSTF's final recommendation(www.annals.org) was published May 22 in the Annals of Internal Medicine. Simply put, the expected harms of PSA screening outweigh the potential benefits. Although screening may help one out of 1,000 men avoid death from prostate cancer, the same number of men will develop blood clots in their legs or lungs due to treatment. Twice as many will suffer heart attacks due to treatment, and many more will be left impotent or incontinent.
You can find all of the AAFP's recommendations for clinical preventive services online.
In addition to the Subcommittee on Clinical Preventive Services, the AAFP Commission on Health of the Public and Science also has subcommittees devoted to
- disparities and underserved populations;
- public health issues; and
- clinical practice guidelines.
The Subcommittee on Clinical Practice Guidelines is responsible for developing the Academy's own guidelines, as well as evaluating and recommending whether the Board should endorse guidelines from other organizations. In evaluating the recommendations of others, the subcommittee considers how well developed a recommendation is (including its methodological structure), the level of evidence on which it is based, whether to support it and what level of support to give it.
The subcommittee also collaborates with other organizations to create joint guidelines. For example, the AAFP is working with American College of Obstetricians and Gynecologists and others on a guideline on trial of labor after cesarean, or TOLAC. A draft is expected this summer.
Another example of the commission's current work includes development of a position paper on opioids that will cover a broad spectrum, including safe prescribing and how the Academy should respond to legislation or regulation that affects the ability of family physicians to manage a patient's pain.
The commission also
- reviews AAFP policies every five years and makes recommendations about whether to retire, retain or revise the Academy's positions that relate to scientific issues;
- considers resolutions brought forth by the Congress of Delegates, the National Conference of Special Constituencies, and the National Conference of Family Medicine Residents and Medical Students;
- responds to requests from the Board of Directors that fit into its scope of work;
- represents the family physician clinical and public health perspective to other medical specialty, governmental and voluntary health organizations; and
- provides input for Academy initiatives and programs, such as Tar Wars.
The Commission on Health of the Public and Science is just one of five AAFP commissions. The others are Continuing Professional Development; Education; Finance and Insurance; Governmental Advocacy; and Membership and Member Services. These commissions keep the Academy humming, doing work vital to its mission -- to improve the health of patients, families, and communities by serving the needs of members.
Thomas Houston, M.D., of Dublin, Ohio, is chair of the AAFP Commission on Health of the Public and Science.