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华尔街日报

当民主党人憎恨卫生专家时When Democrats Hate Health Experts

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克里斯·奥米拉/美联社Chris O'Meara / Associated Press

民主党人热衷于将广泛的监管权力交给所谓的“专家”,但当共和党人掌权并任命他们不喜欢的人选时,他们却提出反对。美国预防服务工作组(U.S. Preventive Services Task Force)就是一个发人深省的新案例。

Democrats love to hand supposed experts sweeping regulatory power, but then they object when Republicans are in charge and appoint experts they don’t like. A revealing new case in point is the U.S. Preventive Services Task Force.

奥巴马医改法案赋予这个准独立机构强制推行筛查项目的权力,保险公司必须免费为患者提供这些服务。民主党人声称,这将确保民众能够获得救命治疗。然而,他们对近期该机构任命医学专家一事表现出的不满,暴露出他们实际上希望利用该机构限制那些他们认为成本过高的医疗服务。

ObamaCare empowered the quasi-independent panel to mandate screenings that insurers must cover at no cost to patients. Democrats said this would guarantee access to life-saving care. But their dyspepsia over the recent appointment of medical specialists to the panel betrays how they want to use the panel to restrict care they deem too costly.

[audio] 参议员比尔·卡西迪谈社会保障改革与唐纳德·特朗普的“单一多数派”:“我们非常担忧这些成员可能在推动其专业领域内的医疗服务方面产生过度影响。”上周,17位民主党参议员致信卫生与公众服务部部长小罗伯特·F·肯尼迪。

[audio] Sen. Bill Cassidy on Social Security Reform and Donald Trump’s ‘Majority of One’ “We are greatly concerned about the potentially outsized impact these members could have in pushing for services within their specialty,” 17 Democratic Senators wrote last week to Health and Human Services Secretary Robert F. Kennedy Jr.

民主党人无法理直气壮地质疑新任命的专家资质。新任工作组主席是克利夫兰诊所的一名儿科血液肿瘤学家。另一位任命者则在德克萨斯州运营着一个胃肠病学研究中心。其他新成员还包括一名UCLA医学院的心脏病专家,以及密歇根大学预防心脏病学教授——他领导着一个训练人工智能识别心血管疾病的实验室。

Democrats can’t credibly take issue with the qualifications of the new appointees. The new task force chair is a pediatric hematologist-oncologist at the Cleveland Clinic. Another appointee runs a gastroenterology research center in Texas. Other new members include a cardiologist at UCLA medical school and a University of Michigan professor of preventive cardiology who leads a lab that trains AI to detect cardiovascular disease.

民主党人真正担忧的是,这些专家可能会建议增加更多疾病的预防性筛查。按照传统,卫生与公众服务部部长任命该机构成员时,通常会参考公共卫生组织的建议,并优先选择初级保健医生。

What Democrats worry about is that the specialists might recommend more preventive disease screenings. The HHS secretary has traditionally appointed primary-care practitioners to the panel based in part on recommendations from public-health groups.

拜登政府任命的主要是缺乏特定疾病领域专长的通科医生。他们的在线简历显示,其主要专长在于多样性、公平性和包容性。与专科医生相比,初级保健医生对最新疾病和筛查研究了解较少,这也是该机构常常落后于医学发展步伐的原因之一。

The Biden appointees were mainly generalists without disease-area expertise. Their online résumés suggest they mainly specialized in diversity, equity and inclusion. Primary care doctors are less familiar with new research on diseases and screenings than specialists, which is one reason the panel is often behind the medical curve.

该工作组在2012年建议不要进行前列腺特异性抗原检测——其理论是这可能会出现假阳性,而生长缓慢的肿瘤不太可能致死患者。随后,晚期前列腺癌的发病率激增。该小组随后在2018年修改了建议,建议医生与55至69岁的患者讨论筛查的风险和收益。

The task force recommended against prostate-specific antigen tests in 2012—on the theory that it could turn up false positives and that slow-growing tumors are unlikely to kill patients. The incidence of advanced prostate cancer surged. The panel then modified its recommendation in 2018 to suggest physicians discuss risks and benefits of screenings with patients ages 55 to 69.

但该小组仍保留了对70岁及以上男性进行PSA检测的反对意见。原因是什么?谁知道呢,但左翼的一些人认为,对老年男性进行筛查可能导致不必要的治疗,因为他们可能在癌症致死前因其他原因去世。

But the panel retained its recommendation against PSA tests for men 70 and older. Why? Who knows, but some on the left argue that screening older men could result in unnecessary treatment since they may die of something else before cancer kills them.

该小组总体上建议很少进行预防性筛查。它既不支持皮肤癌筛查,也不建议医生指导患者如何检查身体上可疑的痣和生长物。专家们是否担心患者一旦发现可疑痣就会涌向皮肤科医生?

The panel overall recommends few preventive screenings. It doesn’t endorse screenings for skin cancer or recommend that physicians counsel patients on how to look for suspicious moles and growths on their bodies. Do the experts worry patients will rush to the dermatologist if they detect one?

不久前,自由派宣称美国需要更加注重疾病预防。如今他们却想限制他们认为成本过高的检测。这正值人工智能使得检测能够更好地早期发现疾病并预测风险因素。一项最近的研究发现,一种正在研发中的血液检测能够大约87%的时间准确检测出1期和2期胰腺癌,且假阳性率较低。

Not long ago, liberals claimed that the U.S. needed to focus more on preventing disease. Now they want to restrict tests they claim are too costly. This comes as artificial intelligence is enabling tests that can better detect diseases in early stages and predict risk factors. A recent study found that a blood test in development could accurately detect stage 1 and 2 pancreatic cancers roughly 87% of the time, with a low rate of false positives.

保险公司可以覆盖该工作组未推荐的筛查,但医疗补助和医疗保险通常不会。民主党人想要“全民医保”单一付款人制度的真正原因,是为了让他们及其专家能够决定我们其余人能获得什么样的医疗服务。

Insurers can cover screenings not recommended by the task force, but Medicaid and Medicare generally don’t. The real reason Democrats want a “Medicare for All” single-payer system is so they and their experts can decide for the rest of us what care we can get.