On the 12th of this month, media reported that HHS was deleting twenty years of medical guidelines from its government website.
The Trump Administration is planning to eliminate a vast trove of medical guidelines that for nearly 20 years has been a critical resource for doctors, researchers and others in the medical community.
Maintained by the Agency for Healthcare Research and Quality [AHRQ], part of the Department of Health and Human Services, the database is known as the National Guideline Clearinghouse[NGC], and it’s scheduled to “go dark,” in the words of an official there, on July 16.
Medical guidelines like those compiled by AHRQ aren’t something laypeople spend much time thinking about, but experts like Valerie King, a professor in the Department of Family Medicine and Director of Research at the Center for Evidence-based Policy at Oregon Health & Science University, said the NGC is perhaps the most important repository of evidence-based research available.
Why would the administration delete this information? Experts say it was a unique repository that got 200,000 visits a month.
Medical guidelines are best thought of as cheatsheets for the medical field, compiling the latest research in an easy-to use format. When doctors want to know when they should start insulin treatments, or how best to manage an HIV patient in unstable housing — even something as mundane as when to start an older patient on a vitamin D supplement — they look for the relevant guidelines. The documents are published by a myriad of professional and other organizations, and NGC has long been considered among the most comprehensive and reliable repositories in the world.
So what was the pressing issue that forced elimination of a well-regarded, well-used, totally unpolitical resource?
AHRQ agrees that guidelines play an important role in clinical decision making, but hard decisions had to be made about how to use the resources at our disposal,” said AHRQ spokesperson Alison Hunt in an email. The operating budget for the NGC last year was $1.2 million, Hunt said, and reductions in funding forced the agency’s hand.
Not even an archived version will remain.
It’s hard to credit the notion that fiscal restraints required the deletion. After all, our “President” is spending billions on such things as repainting Air Force One and requiring a military parade a la Third-World Dictators. Toward the end of the linked report, there’s a hint:
The NGC has a screening process designed to keep weakly supported research out. It also offers summaries of research and an interactive, searchable interface.
That gatekeeping role has sometimes made AHRQ a target. The agency was nearly eliminated shortly after its establishment, in the mid-90s, when it endorsed non-surgical interventions for back pain, a position that angered the North American Spine Society, a trade group representing spine surgeons. A subsequent campaign led to significant funding losses for AHRQ, and since then, the agency as a whole has been a perennial target for Republicans who have argued that its work is duplicated at other federal agencies.
Organizations writing the guidelines for the big drug companies are paid handsomely in order to promote the companies’ products. NGC’s process provided a vetted, evidence-based resource comparatively free of that kind of influence. Gee-I wonder why it became a target for the GOP?
In 2016, when former head of HHS Tom Price was still a Congressman, one of his aides insistently protested publication of a study that was critical of a drug manufactured by one of Price’s campaign donors. According to ProPublica, Price wanted the agency to pull the critical research down.
While Americans are transfixed and distracted by the antics of our demented (and probably traitorous) accidental President, the largely unrecognized and unseen functions of competent governance are being systematically dismantled.
Even if America survives this maniac and his cabinet of disreputable and incompetent tools, it will take generations to repair the damage.