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Chair of U.S. Preventive Services Task Force Pledges to Recommend Re-evaluation of Recent Glaucoma Findings

Hon. Louis Sullivan, M.D., Former Secretary of HHS, Senator Norm Coleman, Deputy HHS Secretary Tevi Troy, Hon. Mark McClellan, M.D., Ph.D., and members of the patient and medical community participate in a conference to consider the scientific evidence countering the United States Preventive Services Task Force report dismissing the vital role of Glaucoma Screening

ARLINGTON, Va., Oct. 24 /PRNewswire-USNewswire/ -- The Potomac Institute for Policy Studies and the Glaucoma Foundation convened a daylong conference at the National Press Club to examine the recent United States Preventive Services Task Force (USPSTF) determination that there is insufficient scientific evidence to support the practice of screening for glaucoma. Participants called for transparency and accountability in the USPSTF's process for formulating its recommendations in the future.

The conference was addressed by Dr. Louis Sullivan, the Former Secretary of the Department of Health and Human Services (HHS); Dr. Tevi Troy, the current Deputy Secretary of HHS; Dr. Mark McClellan, former Commissioner of FDA and former Medicare Administrator; and Senator Norm Coleman (MN), in addition to glaucoma patients and advocates, two medical school deans, scientific experts, and representatives of Medicare, the Veterans Health Administration (VA), the National Commission for Quality Assurance (NCQA), and the former Surgeon General of the U.S. Navy.

The conference was convened because the USPSTF had previously declined to consider public comment presenting new information, and the speakers highlighted the urgent need for review of the evidence before patients might be further harmed. As Dr. Sullivan, the honorary conference chair, called for greater openness and transparency in the USPSTF policy process in his opening remarks, saying, " ... we're holding the hearing that should have been held, here in the public eye." Dr. Sullivan went on to say,

"How could it be that in the face of such scientific advances a federally

chartered advisory body would come along and say there is not sufficient

evidence to suggest that a family doctor such as myself should refer

patients at risk to be screened for glaucoma? [The USPSTF] finding

contradicts all recognized standards of care and seemingly contradicts

billions of dollars of scientific research invested by HHS under my

leadership and that of my successors."

Dr. Sullivan was introduced by Former Assistant U.S. Surgeon General and Potomac Senior Fellow, Adm. Roscoe Moore, D.V.M., Ph.D., M.P.H., USPHS (Ret.) who served as a conference co-chair. According to Dr. Moore, "The crux of the conference turned on the question of whether federally-funded clinical trials conducted between 1980 and 2005 had shown clear evidence of benefit to patients from detecting and treating glaucoma." The federal task force had been unable to find conclusive proof through a thorough review of the clinical trials literature and therefore rendered its finding of "insufficient evidence" to recommend for or against screening for glaucoma in Americans. This finding is of major importance because if incorporated into national policy it would affect the care of two million Americans at risk of blindness from glaucoma.

A succession of scientists, including Dr. Richard Parrish, Associate Dean of the University of Miami Miller School of Medicine; Dr. Rohit Varma, Professor of Ophthalmology at the University of Southern California; and Dr. Eve Higginbotham, Dean of the Morehouse School of Medicine, presented new data, which were not widely available at the time of the task force deliberation, that establish a link between early glaucomatous optic nerve loss and loss in visual function, particularly driving ability. Dr. Javitt presented evidence from the data files maintained by the Medicare program that even moderate vision loss confers significant additional direct cost on the federal budget.

"The dilemma," according to Dr. Jonathan Javitt, Senior Fellow of the Potomac Institute, Professor of Ophthalmology at Johns Hopkins University, and one of the working chairs of the conference, "is how do you prove something [i.e., that untreated glaucoma causes blindness] that everyone knows, that is obvious from animal experiments, and that can never be tested in a clinical trial because of the obvious ethical impossibility. Therefore, the conference focused on new evidence that even the earliest signs of glaucoma damage, which were observed in some clinical trials, are associated with meaningful effects on patient quality of life."

A series of policymakers including a senior medical officer of the Medicare program, a representative of the Veterans Health Administration, and Adm. Donald Arthur, M.D., former Surgeon General of the U.S. Navy, all characterized the USPSTF findings as inconsistent with independent reviews of the scientific record undertaken by their own organizations. Medicare, for instance, examined the science around glaucoma screening and supported the congressional action that instituted glaucoma screening as one of Medicare's first funded prevention programs. The Veterans Administration and the Military both include active screening for glaucoma in their health care systems. Senator Norm Coleman of Minnesota called forcefully for the USPSTF to reevaluate its findings. Senator Coleman remarked,

"Not only does needless blindness devastate people and their families, as

Dr. Javitt's work has shown, it has huge adverse cost implications for

federal healthcare programs. Unless we get smart about the use of

targeted prevention programs that keep people healthy, people will

continue to needlessly suffer, and healthcare costs in the United States

will continue to skyrocket."

"Glaucoma costs [the healthcare system] billions of dollars more if it is not treated effectively, not to mention the substantial impacts on quality of life resulting from poor vision...We need to make progress in prevention" said Dr. Mark McClellan. Further, he stated that "One of the most important things is having an open and transparent process on how to interpret [medical] evidence and how to develop it further. It is very important to have a broad range of perspectives accounted for in setting priorities for evidence based practice guidelines."

The National Commission for Quality Assurance was represented by Dr. Joachim Roski. NCQA is the organization that has inserted a glaucoma screening measure into the HEDIS (Healthcare Effectiveness Data and Information Set) scale, by which quality of health insurance plans is assessed. Dr. Roski informed the conference that NCQA has examined the USPSTF finding in the face of other expert opinion and published science, and had decided to retain its glaucoma screening measure regardless of the USPSTF's determination upon reconsideration of its glaucoma recommendation.

Dr. Ned Calonge, Chief Medical Officer of the Colorado Department of Public Health, State Epidemiologist, and Chair of the USPSTF, responded to the presentations by thanking the group for the thoroughness and respect with which the program had been assembled. He openly recognized the significance of the newly presented data in closing the gap that had led to a finding of "insufficient evidence." While he could not speak unilaterally for his task force members, he promised to bring the information to them with a recommendation that they take the extraordinary step of re-evaluating their findings related to glaucoma in advance of their normal five-year cycle.

The Glaucoma Foundation President and CEO, Scott Christensen, applauded the work of the conference participants in moving towards a consensus on glaucoma screening policy, which will have an enormous benefit for the millions of Americans at-risk for developing the disease. Dr. Dennis McBride, President of the Potomac Institute for Policy Studies, noted that such an extraordinary conference was needed to engage the scientific and medical communities in the USPSTF process, something that has not been part of its standard practice. He stated that the Potomac Institute will release a comprehensive report outlining its policy recommendations in late November.

SOURCE The Potomac Institute for Policy Studies
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