Big Brother Will See You Now

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Wed, 26 Apr 2006 09:30:22 -0700 (PDT)

Big Brother Will See You Now

 

 

 

(Do you trust your government for it to mandate healthcare to you?)

 

 

 

http://www.cbsnews.com/stories/2006/04/25/opinion/printable1544627.shtml

 

Courtesy: National Review Online

 

 

CBSNews.com

 

Big Brother Will See You Now

April 25, 2006 (National Review Online) This column was written by

Elizabeth M. Whelan.

 

 

Earlier this year in New York City, a public health regulation went

into effect that set a new and very troublesome precedent, one that

insinuates government agencies into personal medical matters.

 

In mid-January, the city began legally requiring laboratories that do

medical testing to report to the Health Department the results of

blood sugar tests for city residents with diabetes — along with the

names, ages, and contact information on those patients.

 

City officials are not only analyzing these data to assess patterns

and changes in diabetes prevalence in the city, but are planning

" interventions. "

 

Simply put, diabetics will soon receive letters and phone calls from

city officials offering advice and counsel on how to effectively deal

with their medical condition. If you wish to keep your medical data

confidential, you cannot.

 

If you want to avoid the " interventions, " you can go online and fill

out forms requesting that you not be contacted — that is, if you even

know the program exists, and you have the sophistication and

technology to access the government's " do not contact " forms. (None of

the New York City newspapers have done any in depth coverage of this

new regulation and its implications.)

 

Diabetes is now among the leading causes of death in the city (and

nation) — and its incidence is rapidly increasing. Genetics (family

history) plays a major role — blacks, Asians, and Hispanics are much

more susceptible to diabetes than whites, for instance. Obesity is a

major risk factor for the disease. If not managed prudently, diabetes

causes kidney failure, heart attacks, strokes, and other

life-threatening or debilitating illnesses. There is good reason for

the city's public health establishment to be concerned.

 

But given that diabetes prevention (through weight control) and

management (through diet planning, exercise, monitoring, and

medications) are matters of personal commitment and responsibility,

the disease cannot effectively be " solved " by government intervention

that goes beyond educational programs.

 

The city's new reporting policy represents a dramatic change in

public-health and preventive-medicine strategy. Government officials

have for years required reporting of various infectious diseases. For

example, sexually transmitted diseases are reportable so that partners

can be traced and alerted to the possibility that they too may be

infected. Similarly, if a plague, such as ebola or smallpox, were to

break out, we would expect government to track the disease and even to

wield quarantine powers. But what those cases have in common is that

the diseases in question are communicable.

 

The mandated reporting of blood-sugar tests is the first reporting

program aimed at countering a non-communicable disease. And this may

be only a first step in what is an emerging public-health policy that

assigns to government the responsibility for reducing the rate of

certain diseases — and obesity, after all, contributes greatly to the

toll of disease in America. Thus, we can expect that there will be

similar proposals mandating reporting of serum-cholesterol levels,

blood-pressure readings, and body-mass-index (BMI) scores, with

subsequent " interventions " to get people to change their behavior and

reduce the risk of heart attack, stroke, and the spectrum of maladies

associated with obesity. And we can expect even more government rules

and regulations — designed to protect us from what some in public

health deem to be the modern-day " vectors " of disease, just as

mosquitoes are the vector for malaria.

 

Along these lines, some states have recently contemplated legislative

moves to ban certain food advertising, impose higher taxation on

so-called " junk foods " and alcohol, and restrict the sales of soda and

other foods and beverages. NYC Health Commissioner Thomas Frieden

believes that government should go even further in coercing Americans

toward better health: He predicts we will have " regulations to

facilitate physical activity, including point-of-service reminders at

elevators and safe accessible stairwells [and] modifications of the

physical environment to promote physical activity. "

 

Some are resigned to this new regulation, arguing that if government

is assigned the role of paying for health care, it is entitled to

intervene to reduce the risks of disease and thus reduce the costs.

But as we set forth into this brave new world of public health, some

facts cannot be ignored:

 

The implicit assumption behind these monitoring and follow-up programs

is that government can be as successful in reducing chronic disease

through legislation as it was in wiping out many infectious diseases

through classic public-health measures like vaccination and

chlorination of water. However, there is no evidence that these new

government efforts will pay off in terms of better health.

 

Matters of patient confidentiality and personal responsibility have

been totally overlooked. It is safe to say that most Americans do not

want their medical profiles to be a matter of public record. And they

do not want clerks from the local health department calling them and

telling them how to live their lives. Since so many of the risk

factors for chronic disease involve lifestyle factors — overeating,

lack of exercise, smoking, and more — the emerging health policies are

blurring the distinction between public health and personal health,

the former lending itself to community-wide mandates, the latter more

appropriately the sphere of individual action and commitment.

 

In contacting diabetes patients to urge them to follow various

protocols to preserve their health, the city is not only shattering

the confidentiality of the physician-patient relationship but assuming

that personal physicians are incapable of performing this role.

 

When the government's phone calls and letters nagging people to eat

better, quit smoking, and be more physically active don't work, the

next phase of the war on chronic disease may be a harshly punitive

one, with fines and other restrictions on those who fail to heed the

health warnings. The message will be: Live a healthy life or the

government will punish you.

 

New York City's law mandating the reporting of diabetic blood tests is

a harbinger of more intrusive legislation to come — all in the name of

public health. It is high time we reflect upon the difference between

public and private health, critically evaluate what role the

government should play in the prevention of chronic disease, and

carefully assess what cost we might pay in privacy and individual

freedoms as the government performs " interventions " to protect us from

ourselves.

 

 

Dr. Elizabeth M. Whelan is president of the American Council on

Science and Health.

 

 

By Elizabeth M. Whelan