The federal Preventive Services Task Force, the group that created a political firestorm this week with its recommendation that women get less-frequent mammograms, was created to be insulated from politics.
Yet, some observers say, its apolitical nature may have made it naïve about just how strongly Congress; some professionals, like radiologists; advocacy groups, like the American Cancer Society; and members of the public would react.
As soon as the task force's guidelines were released on Monday, recommending against routine mammograms for most women in their 40s and saying women should consider having the screening test every other year instead of annually, the maelstrom erupted.
Republicans and some groups, like the American College of Radiology, said the guidelines were made in response to the Obama administration's wish to save health care dollars.
The health and human services secretary, Kathleen Sebelius, distancing herself from the group's recommendations, told CNN on Wednesday, "This panel was appointed by the prior administration, by former President George Bush."
Dr. Diana Petitti, the vice chairwoman of the task force, said Thursday that she had been taken aback by the reaction. She did not realize, she said, the extent of the context. There has been an intense controversy over the screening of younger women, dating back more than a decade and involving Congressional hearings.
"I was relatively unaware of it," she said. "I have been made aware of it now."
Dr. Michael LeFevre, another task force member, said he, too, had been caught off guard by the way the guidelines were received. The task force's message was distorted, he said, into a purely negative one, when the group meant to encourage women to make their own decisions.
"It's partly our fault," Dr. LeFevre said, adding that the group would now be trying to figure out how they could have gotten their point across without stirring such a controversy.
But Dr. Philip Lee, who was an assistant secretary for health in the Clinton administration, said he was surprised by how politically naïve the task force members seemed.
"Here we are on the lip of health care reform," he said, a time when people are suspicious of any talk of taking away benefits. And the task force says, "They just have to look at the evidence and present the evidence and that's that?"
The task force was created in 1984, at a time when screening methods for cancer, cholesterol levels and diabetes were just emerging and rarely paid for by insurers. So Dr. J. Michael McGinnis, deputy assistant secretary for health, decided to set up the group to evaluate how well such methods worked.
He decided right away that the group had to be insulated from politics. The idea, he said, was to identify medical experts who could objectively evaluate evidence and to protect the group from any political pressures so they could write honest assessments.
And so the United States Preventive Services Task Force was born. It is financed by the Department of Health and Human Services but works at arms length from it, making its decisions without consulting the agency.
Panel members said politics and questions of cost were never part of their discussions of the risks and benefits of mammograms — in fact they are prohibited from considering costs when they make guidelines. It was the scientific evidence, they said, that led them to conclude that women in their 40s should carefully consider whether they want to be screened rather than assuming they should start screening then. And it was the evidence, they said, that led them to conclude that screening every other year provides all the benefits of screening annually.
They also said they never thought of themselves as being political appointees, much less being Bush appointees.
Medical experts become members of the task force by nominating themselves or, as usually happens, by being nominated by colleagues and professional organizations.
They are vetted by Health and Human Services to be sure they have no conflicts of interest, their names are published in the Federal Register, and they are appointed by the head of the Agency for Health Care Quality and Research, which is part of Health and Human Services.
"I grew up in the '60s," said one panel member, Dr. J. Sanford Schwartz, a professor of medicine, health care and economics at the University of Pennsylvania. "My kids grew up under a banner saying 'Question authority.' That's where I am coming from."
Dr. Russell Harris, a professor of medicine at the University of North Carolina, whose term on the task force recently ended, said, "I'm sure George Bush would never have appointed me to anything."
Some members, in fact, find the accusations that they were politically motivated a bit hard to fathom. In 2002, the group, with different members, said for the first time that screening could start at 40 but that doctors should inform women about the potential benefits, harms and limitations of the test. They also said mammography's benefits increased as women grow older, until age 70. Committee members said they considered those guidelines a weak recommendation for screening women in their 40s, although they were widely interpreted as a strong endorsement.
That time, their report was announced at a news conference by the Health and Human Services secretary, Tommy G. Thompson, and critics of that report said that it had been influenced by Mr. Thompson, whose wife had had breast cancer.
Yet, Dr. Lee said, the task force should have known what it was getting into with its new guidelines.
"For so many years, you've got certain highly regarded people in the medical profession saying that women ought to be screened at age 40," he said. "This is an idea that has taken hold."
So, Dr. Lee said, for the task force to simply put out its guidelines and expect people to change their minds was not realistic.
