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.
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