When advocacy overrides science, who benefits?

On March 4, then-federal minister of health Mark Holland paused the work of the Canadian Task Force on Preventive Health Care. It was an extraordinary move.

But perhaps not surprising since he had been angry with the Task Force for months, deeply disappointed by its draft breast screening guidelines published in May 2024. He disagreed with the recommendation to not routinely screen women in their 40s and immediately announced that he had asked the Public Health Agency of Canada to launch an external expert review of the Task Force’s processes.

The Task Force is an independent body, established in the 1970s to develop evidence-based guidelines for family physicians. Holland acknowledged that independence, but the tone of his ministerial missives was that the Task Force was so derelict in its duties that political interference was needed to restore public trust in Canada’s system of preventive health-care guidelines. It didn’t matter that the draft Task Force recommendation went on to suggest that for women in their 40s, screening should be guided by personal preference after being informed of the benefits and harms.

The minister explained that he’d had “important feedback” from “key leaders in the area” concerned about the Task Force’s procedures. He did not identify these leaders; however, in the 18 months preceding the minister’s actions, there had been an intense anti-Task Force lobby, led by the patient group Dense Breasts Canada in alliance with a small group of medical specialists, mostly radiologists. One of those radiologists pulled together several critics of other Task Force guidelines and founded the Coalition for Responsible Healthcare Guidelines.

The debate over breast screening as a public health tool dates back at least five decades and has been a fraught issue throughout the developed world. It is unlikely to be settled in Canada in 2025.

Our concern is that the Canadian public has been ill-served by two institutions meant to catalyze informed discussion: the media and the committees of Parliament that regularly hold televised inquiries into matters of public policy. Rather than provide insights into why screening is controversial, journalists and elected Members of Parliament have consistently given disproportionate attention to the Task Force’s detractors, many of whom have argued the Task Force be disbanded.

It now seems the Task Force will endure, but it will be changed. The expert review panel’s report was published June 13. “At a time when misinformation and disinformation challenge public trust in health care, the role of independent, evidence-based bodies such as the Task Force has never been more vital,” the panel said.

However, it stressed a pressing need to modernize the way it works. The current Minister of Health, Marjorie Michel, has requested that the Public Health Agency of Canada implement the panel’s recommendations to ensure that a modernized Task Force be fully operational by April 2026.

Again, the media have gravitated to the same “key leaders” for their views on the report. Members of the Coalition for Responsible Healthcare Guidelines include professionals who work in mammography screening, who treat patients with cancer or who research and hold investments in screening technology. Dense Breasts Canada includes women convinced that early screening would have made treatment of their cancer easier.

Task Force members are professionals trained in assessing the scientific validity of research, and in evaluating both benefits and harms of preventive health measures. A fundamental principle governing the Task Force operations that frustrates its critics is the requirement that voting members have no conflicts of interest. They must have no direct benefit from screening activities, for example, or any other activity related to their guidelines. This requirement largely excludes members of the Coalition from voting. One of their key demands is that “content experts” – specialists like themselves – should “lead the guidelines in their own fields.”

Coalition members and aggrieved patients inundated media outlets and politicians with the claim that the Task Force’s draft guidelines on routine breast screening for women in their 40s would cause hundreds of deaths.

Though parliamentary committees are intended to “gather input from many sources and discuss issues in depth,” the two committees that held hearings on breast screening – the Standing Committee on the Status of Women, known as FEWO, and the Standing Committee on Health, HESA – heard mostly from Task Force critics. Instead of exploring the facts regarding benefits and harms, and trying to understand the science, committee members gushed empathy; some told their own emotional stories of having had breast cancer.

Family physicians rely on the expert guidance from the Task Force. Nearly 2,000 citizens, mostly doctors, signed a petition opposing the pause in the Task Force’s work. Yet, in media coverage about the Task Force’s draft breast screening guidelines, their voices were virtually absent. Canadians should expect journalists and elected representatives to seek a range of perspectives on such an important matter.

The review panel was not tasked with reviewing the Task Force’s breast screening guidelines and was justified in focusing its report more broadly; however, we see value in naming and unpacking the way the breast screening “debate” became a one-note chorus. The attacks on the Task Force can be understood as an example of manufactured ignorance, a set of strategies used by those who benefit financially and in other ways to create confusion over a body of knowledge.

The tobacco industry’s campaign against the evidence that smoking is harmful to health is the template. The strategies are well documented and have been used to create doubt about human causes of climate change, among other issues. “Merchants of doubt” conceal or deny their conflicts of interest; they create alliances to act as echo chambers so that their messages come from many directions; and they seek out sympathetic individuals to tell emotional stories that support their claims.

To preserve democratic debate, Canada needs strategies to recognize and counter lobbies that drown out and discredit thoughtful disagreement over scientific evidence. A close reading of the expert review committee’s report makes clear that its members see a rigorous conflict of interest policy for voting members as essential to the Task Force’s credibility and independence. They see room for flexibility with “a limited number of nonvoting advisors” who would participate in specific phases of developing guidelines, and whose conflicts would be disclosed and managed.

While this strong endorsement of conflict of interest standards is encouraging, it’s a recommendation that vested interests will likely attack. Journalists, politicians and policymakers need to prepare for discrediting tactics by understanding that safeguarding against conflict of interest is fundamental in guideline development.

Parliamentary committee members should be aware of the lobby groups in their portfolios and of the (typically less well-funded) public interest actors who may hold contrary views. They should ensure that the latter constituency is respectfully heard and that conflicts of interest of all witnesses are investigated in advance and brought to light during hearings.

Journalism schools stress training on conflicts of interest, the strategies used to manufacture ignorance, and the policy areas, including health, where powerful financial interests can distort the evidence. Media outlets have a responsibility to ensure editors and journalists covering health are aware of these dynamics.

Advocacy and criticism by engaged parties is vital to the democratic process and should be encouraged. It’s also true that balanced and complete information is vital to making good health choices.