“The American Liver Foundation (ALF) believes that, by failing to support the importance of testing those at risk for hepatitis C, the USPSTF trivializes a serious public health problem, for which substantial scientific evidence and FDA-approved tools and therapies demonstrate that diagnosis and treatment are beneficial....
"The primary concern of the ALF is the USPSTF recommendation that there is insufficient evidence to recommend for or against routine screening of high-risk adults effectively provides a rationale for health care providers to stop HCV testing for highest risk individuals and for third party payers not to reimburse for the testing. This flies in the face of the accumulated expertise and findings of the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) Consensus Conference Panel on the Management of Hepatitis C. CDC and Consensus Conference recommendations are based on the intermediate outcomes regularly curing people of HCV infection....
"In addition, the ALF believes that:
- Hepatitis C awareness must be increased among the general public and within the medical community.
- Screening and diagnosis should be available to everyone who needs or wants it.
- Information regarding treatment options should be available to anyone who needs it.
- Effective hepatitis C treatment must be available to anyone who needs it."
In line with my post yesterday, the ALF further states that considerations about the value of hepatitis C testing cannot wait until data on long-term effectiveness of testing, care and treatment interventions become available.
The concept of "evidence-based medicine" has gained increasing prominence over the last decade. At the same time, doctors and researchers on the frontlines of clinical care recognize that the accumulation of data typically lags behind advances in clinical practice. Evidence-based guidelines, even those relying on expert opinion, inevitably look conservative compared to state-of-the-art care and cutting-edge innovations.
A future post will discuss these issues with respect to the new AASLD guidelines for clinical practice referenced in yesterday's post.