Wednesday, July 27, 2005

New York City Public Health Proposes Gathering Data on All Diabetic Patients Without Their Consent

From the Associated Press, how the New York City Department of Health proposes to collect data on individual diabetic patients' control (assessed by hemoglobin A1C). "The plan would require medical labs to report to the city the results of a certain type of test that indicates how well individual patients are controlling their diabetes." "By pinpointing problem patients, then intervening in their care, [City Health Commissioner Thomas] Frieden said the city can improve thousands of lives." "The city's program wouldn't initially get patients' consent to collect data, but allow them to opt out later." "Doctors could receive letters, telling them whether their patients have been getting adequate care."
Frieden justified the program thus, "There will be some people who will say, 'what business of the government is to know that my diabetes is not in control?'" "The answer, he said, is that diabetes costs an estimated $5 billion a year to treat in New York and was the fourth leading cause of death in the city in 2003, killing 1,891 people." Frieden concluded, "I don't think we can afford not to do anything."
Dr. Paul Simon of Los Angeles' public health agreed, "Some people are uncomfortable with public-health departments expanding their scope beyond infectious disease, but I would say we have to do it. Chronic disease accounts for the major portion of life lost to illness, these days."
Hold the phone, here. Because diabetes is a severe and costly chronic disease, a local government feels it has the justification to collect individual patient data, without the patients' consent, and then intervene directly in their care? We are on a real slippery slope here, since this justification could be used to intervene on nearly any aspect of medical care, or of private behavior for that matter.
In the past, public health has involved some uncomfortable trade-offs between protecting the population from disease and individual rights. However, most of those diseases were infectious or toxic, and the measures involved protecting people from exposure. But using chronic disease as a justification for the government assuming this degree of control of medicine and of individual's behavior would involve breath-taking trade-offs.
Health Care Renewal quiz time: what nation in the 1930s was known for the unprecedented vigor of its anti-smoking campaign? Hint, an article in the British Medical Journal in 1996 featured a poster with this testimonial, x "drinks no alcohol and does not smoke.... His performance at work is incredible." [For the answer, go here.]
For the tip, thanks to MedPundit.

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