Science and transparency are crucial for the panel that recommends what primary care physicians examine in patients.
The U.S. Preventive Services Task Force (USPSTF) has a new chairman who is a familiar face to the board.
Michael J. Barry, MD, was announced as new chair of the Task Force on March 15. Barry has been a Task Force member since 2017 and he served as vice chair from March 2021 to February 2023.
USPSTF, by its own description, “is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of people nationwide by making evidence-based recommendations about clinical preventive services.”
Apart from the Task Force, Barry is the director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital. He is also a professor of medicine at Harvard Medical School and a primary care clinician at Massachusetts General Hospital.
Barry sat down with Medical Economics to discuss his background, the job of the Task Force, and the state of primary care.
Editor’s note: This transcript has been edited for length and clarity. This interview took place before the March 30, 2023, federal court ruling in the legal challenge to part of the Affordable Care Act that affected free coverage of preventive services recommended by the USPSTF. Barry later shared a statement on that court case.
Medical Economics: What made you want to become a physician? And what first drew you to primary care?
Michael J. Barry, MD: Well, as I thought about what I wanted to do back in college, I thought about three dimensions. I thought about wanting to learn something every day, I wanted to feel I had helped someone every day, and I wanted no boring days. And medicine looked to be that from the outside. And 40 years later, it has been.
Medical Economics: Can you discuss the interaction with the Task Force analysis process and primary care physicians? Do the doctors share their reactions and responses during those public comment periods? Would you like to get more involvement, or are you swamped as it is?
Barry: Well, let me first make the point that our recommendations are really aimed at all clinicians and there are many clinicians beyond doctors who provide primary care in the country, and they're really all important contributors to the health of our population. We believe in transparency, so as we develop a recommendation from the very start with a research plan to indicate how we'll look at the published medical literature for evidence about the benefits and harms of a preventive intervention, actually developing a draft recommendation statement, we have pauses for public comment. I should say not only clinicians, but anyone can comment, just as anyone can recommend a topic for consideration by the Task Force. And we do get lots of comments, many from clinicians, some from the public or patients, and we take those comments seriously and review every one. How many we get depends a lot on the topic. And sometimes you feel a little bit swamped with some recommendations, but in general, the more input, the better. And again, we do take that input seriously. And when we publish a final recommendation, we summarize how that's changed from, say, the draft recommendation, based on the public comments we received.
Medical Economics: As a primary care physician, how would you describe the status of primary care in the U.S. health care system today? Can you talk about some of the strengths, and what would you like to see changed?
Barry: Well, the I suppose the state of primary care in the country is a little beyond my remit as chair of the Task Force, despite it being an important and broad role. But as a practicing primary care clinician for adults for 40 years or so now, I can tell you that primary care clinicians are busy, busy, busy. There doesn't seem to be enough time for everything because, you know, nothing falls really outside the scope of what we do. Our job on the Preventive Services Task Force is to help those clinicians with the tough task of prioritizing what they do for their individual patients. And you know, there is an important role of going from the recommendations we make, which are really for populations or groups of the population, to the task in primary care of adapting those to the individual patient and particularly their own preferences and values in terms of making decisions about what they'll do to improve their own health.
ME: What advice would you give to other primary care physicians, and especially young doctors, about making sure that their patients have the information that they need to make the best decisions?
Barry: For me, one of the most rewarding parts of being a clinician is helping people make the decisions that will influence their health over time. And there's no really one-size-fits-all to that process. And you know, it's an honor, I think, when patients and their families let you into their lives, let you know what's important to them, and work together as a partner to, again, make good decisions that influence health. And that has kept me excited about my role in primary care for, oh heavens, four decades now.
Medical Economics: Especially after the COVID-19 pandemic, there has been a lot of discussion about inequities in health care and social drivers of health, social determinants of health, factors that take place outside the doctor's office that do have an effect on patients’ health. Is it the place for the Task Force to consider those? Could there be recommendations that come out in the future about how physicians may address and help their patients with those drivers of health?
Barry: The Task Force has been thinking about the fact that those social determinants explain a lot more of the morbidity and mortality in the population, and even our health care. And thinking about how we include those in our individual recommendations, and how we might make recommendations specifically on screening for social determinants of health going forward, is something we've talked about. So, stay tuned, I think there’s some more coming up.
Medical Economics: Another topic that's been in the news quite a bit lately, and one that we may be just at the beginning phases of, deals with artificial intelligence. Maybe not tomorrow, but in five years, 10 years, 20 years, do you think that there will be a computer doing the job of the Task Force?
Barry: Well, there's that old Yogi Berra quote – it's hard to make predictions, especially about the future. But, you know, I can't say. I think there'll be more assistance from artificial intelligence for the kind of work we do because we need to combine both the effects of medical research and we need to think about patient preferences and how they fit in. As I mentioned before, there's often not a one-size-fits-all recommendation for anyone. So I think there'll be room for the human touch both on the Task Force and in primary care practice. But I think it'll evolve in a new and exciting way over time.