Mayor Bloomberg, M.D. (from the New York Sun)
By Elizabeth M. Whelan, Sc.D., M.P.H.
Posted: Tuesday, April 4, 2006
Publication Date: April 4, 2006
This article appeared on April 4, 2006 in the New York Sun:
In an effort to curb the rapidly increasing health threat of diabetes in New York City, the Bloomberg administration earlier this year mandated that medical laboratories report the results of special diabetes-monitoring blood tests, along with the name and contact information of patients, to the City Department of Health. While efforts to reduce the devastating health consequences of diabetes are laudable, the violation of patient confidentiality and the precedent set by this new regulation should be the source of grave concern to all New Yorkers.
Diabetes is now among the leading causes of death in the city -- and its incidence is rapidly increasing. Genetics (family history) plays a major role -- African Americans, 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.
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 be "solved" by government intervention that goes beyond educational programs. But that is exactly what this new city mandate does: not only is personal medical data now being reported to city officials, but the Department of Health is now doing what they call "interventions": diabetics will receive letters and phone calls from city officials offering guidance on dealing with the disease. If you wish to keep your medical data confidential, you cannot. If you want to avoid "interventions," you must have sophistication and knowledge enough to fill out forms requesting that you not be contacted.
The mandated reporting of diabetes tests is the first such reporting program aimed at countering a non-communicable disease. But the Department of Health admits that this is only a first step in an emerging public health philosophy that assigns to government the responsibility for reducing the rates of chronic disease -- apparently in an effort to replicate the success of vaccination and chlorination programs, which reduced the toll of infectious disease in the last century.
The problem is that many of the leading chronic diseases are related to personal lifestyle factors like smoking, overeating, and sedentary living -- factors that, in a free society, do not easily lend themselves to government intervention.
Given the complete lack of protest in response to the new mandated diabetes reporting and tracking scheme (which, by the way, no New York City newspaper has thoroughly reported, although the regulation took effect in January), it is highly likely that we will see proposals to mandate reporting of serum cholesterol levels, high blood pressure, and body mass indices, followed by city interventions to prod us into changing our behavior to reduce the risks of heart attack, stroke, and the spectrum of maladies associated with obesity.
This new diabetes regulation is, in short, a harbinger of more intrusive legislation to come -- all in the name of "public health." It is high time to reflect on the question of what role (beyond education) the government should play in implementing "interventions" meant to protect us from ourselves. At the very least, the citizens of New York should have been given an opportunity to weigh in on this issue before it was implemented.