RFK Jr. wants to add specialists to preventive care panel. Experts say it’s the wrong move

(CNN) — Less than a year after remaking a key vaccine advisory committee, US Health and Human Services Secretary Robert F. Kennedy Jr. has set his sights on overhauling an HHS panel of medical experts that determine what preventive care Americans can receive at no cost.

Kennedy is seeking to expand the US Preventive Services Task Force’s membership beyond primary care doctors to specialists, a move that raises concerns among some former panel members and other experts that specialists may not have the needed breadth of knowledge.

The task force recommends screenings for cancer, diabetes, heart diseases, sexually transmitted infections and other preventive care.

The task force’s work has a direct impact on millions of people’s wallets. Insurers must cover preventive services that get an A or B grade from the panel at no cost to patients, thanks to the Affordable Care Act.

In a notice published Thursday in the Federal Register, HHS is asking for nominations of new members, encouraging anesthesiologists, cardiologists, oncologists, radiologists, obstetricians and other specialists to apply. The agency anticipates that the new members will start serving in July.

It’s unclear whether Kennedy plans for these new members to fill the slots of the five members whose terms expired at the end of last year, or if he intends to replace the remaining 11 members or to expand the task force’s size.

The secretary has repeatedly blasted the panel, which was established in 1984, for poor performance.

“That task force has been lackadaisical. It’s not been doing its job,” he told a House committee this week.

Some of its advocates say Kennedy has already sidelined the task force. It has not met for more than a year and has been unable to advance recommendations that are under review or in development, including those related to autism spectrum disorder screening, breast cancer medication, chronic kidney disease screening and behavioral counseling for sexually transmitted infections.

Also, it did not submit last year its annual report to Congress outlining gaps in research and highlighting areas where more focus is needed. The report is used to help inform the National Institutes of Health’s grant decision-making.

Evaluating 92 topics

Some experts have raised concerns about Kennedy’s plan to broaden the panel’s membership to specialists.

The task force evaluates evidence across 92 topics, including cancer screening, behavioral counseling, chronic disease prevention and maternal health, said Dr. Aaron Carroll, a pediatrician and CEO of the nonprofit AcademyHealth, a national organization for health services and policy researchers.

“No single specialist has deep expertise across all of them, which is precisely why the task force has historically been composed of generalist primary care clinicians,” he said.

Prior solicitations for members noted that applicants should have expertise in patient care and preventive medicine, while the current one references “the ability to review scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services.” That is a substantially lower and broader bar, Carroll said.

“Reviewing evidence is not the same as having clinical expertise in prevention,” he said. “It opens the door to members who may be analytically capable but lack the grounding in what actually happens in a clinical setting when a recommendation reaches a patient and their doctor.”

In addition, specialists tend to be most knowledgeable at treating conditions, not at preventing them, said Dr. Alex Krist, a professor of family medicine at Virginia Commonwealth University and former chair of the task force.

“Interjecting the treatment perspective too much might miss some of the balance that’s needed in a good prevention recommendation,” he said, adding that primary care doctors better understand the feasibility of implementing recommendations.

Also, task force members base their recommendations on evidence-based research, not their opinions, he said. Members consult with specialty medical societies on their areas of expertise during the course of drafting the recommendations.

Specialists may have financial incentives to push for more screenings since the tests could yield more patients, even if the evidence doesn’t back up the recommendation, experts said. For instance, a radiologist could benefit from an increase in recommendations for imaging screenings.

Carroll also worries that Kennedy may seek to overhaul the task force in a way that weakens the Affordable Care Act, which the Trump administration has long sought to do through various administrative actions.

Republican Sen. John Barrasso, an orthopedic surgeon from Wyoming, has raised concerns about Kennedy’s treatment of the task force during his tenure at HHS. Barrasso praised the panel’s “40-year history of providing independent, evidence-based recommendations on preventive care” during a Senate Finance Committee hearing on Wednesday.

The secretary promised Barrasso that he would not “undermine any of those functions,” noting that the task force plays a “critical role in getting compensation for important, approved interventions.” Kennedy said he is adding specialists to “make sure that everybody is represented” and plans to increase the number of task force meetings and the transparency of those meetings.

An HHS spokesperson told CNN that specialists will strengthen the task force with prevention expertise in their fields.

“A mix of primary care experts and specialists helps ensure recommendations are broadly applicable and based on the latest, high-quality science,” Emily Hilliard, senior press secretary at HHS, said in a statement.

She did not address CNN’s query about how many members Kennedy plans to add to the task force.

The task force’s shakeup comes after Kennedy overhauled the agency’s highest-profile vaccine advisory group, the US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Kennedy, a longtime vaccine skeptic, replaced all of the committee’s members last year.

The new panel voted to abandon universal hepatitis B vaccination for newborns; placed restrictions on a combination shot that protects against chickenpox as well as measles, mumps and rubella; and took the unprecedented step of not universally recommending Covid-19 vaccinations, instead saying the choice should be based on conversations with a health care provider.

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