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    Thursday, February 09, 2006

    Expansive Public Health: This may be the real reason behind the New York Times series on diabetes - to promote support for this city health department program:

    New York City will create a registry of glycosylated hemoglobin test results - an estimated 1 million to 2 million results per year - that is linked to identifying information about the patients and about the physicians who ordered the test. The data will include the full name, date of birth, and address of the person tested and the date the test was performed. The registry, which will be funded by the health department, will be used to map the epidemiology of hyperglycemia and to monitor the epidemic. Says Frieden: 'We should know how many New Yorkers have diabetes that is badly out of control, where they are, and who cares for them. This knowledge should be very powerful for assessing how we are doing on a population basis and in reaching out to doctors and, through doctors wherever possible, to their patients to provide more support.' Starting in July 2007, the department also hopes to implement and evaluate a pilot intervention program in the South Bronx, which would be funded through grants. Eventually, there may be additional uses for the registry data.

    In other words, not only will diabetes be a reportable disease in New York City, it'll be a state-monitored one. Having done a good job of curbing the spread of infectious disease, public health officials are expanding out to other diseases. Their goal, apparently, to eventually eliminate death:

    The endeavor has aroused concern about patients' privacy and raised questions about the role of health departments. However, Thomas Frieden, the city's health commissioner, said the aim is to respond to an epidemic of a chronic disease with the type of surveillance and other tools that health departments routinely use to prevent and control communicable diseases. As he explained in an interview, "We have to get a better handle on what is really the only major health problem in the United States that is getting worse, and getting worse rapidly."

    There are an estimated 530,000 adults in New York City with diagnosed diabetes. About 9 percent of adults report having received a diagnosis of diabetes; in the South Bronx, the prevalence of diagnosed diabetes is 18 percent. When it comes to chronic diseases, says Frieden, public health officials have been "asleep at the switch." His view, as expressed in a 2004 editorial in the American Journal of Public Health, is that "local health departments generally do a good job of monitoring and controlling conditions that killed people in the United States 100 years ago. Yet noncommunicable diseases, which accounted for less than 20 percent of U.S. deaths in 1900, now account for about 80 percent of deaths. Our local public health infrastructure has not kept pace with this transition.

    Color me unconvinced. There's a vast difference between an communicable disease that spreads from person to person and thus causes a public health threat and a disease that remains in one person's body, largely under that one person's control. And the state has no business intefering in the latter. Where's the "keep your laws off my body" outrage?

    posted by Sydney on 2/09/2006 09:41:00 AM 9 comments


    Although my libertarian parts of self are aghast that I'm saying this, it is a valid arguement that if the state is paying the costs of treating an illness or its sequella, then the state can claim the need to monitor and reduce the costs of such treatment. "He who pays the piper calls the tune." The tricky part is the balance between public health and individual liberties. I don't pretend to have an answer for that one. Another slippery slope to tread.

    By Anonymous Anonymous, at 12:52 PM  

    But does the state pay all of the bills. This law will require all diabetics to be registered and subject to State control for their treatment.

    Another issue is spending tax dollars. Is this simply creating another bureaucacy to be funded by an ever increasing tax load.

    NYC has any number of problems that need addressed instead of creating a mandated tax payer funded study. I am also sure their will be many high paying patronage jobs to go along with this project.

    By Anonymous Anonymous, at 2:02 PM  

    'Eventually, there may be additional uses for the registry.'


    By Anonymous Ice Scribe, at 2:45 PM  

    Anonymous- Perhaps this is perpetuating another bureaucracy that should be allowed to die. Two weeks ago, I had a university MPA tell me that the cardinal rule of public health is never, ever stop or cut back a program.

    Ice scribe- if you want to hear creepy public health "We know what's best for you" Big Brother talk, go visit Effect Measure. Excellent avian flu reporting but anyone with "libertarian parts" might be taken aback.

    By Anonymous dani, at 4:31 PM  

    'Eventually, there may be additional uses for the registry.'

    This is scary. Really scary. What is next? "War against chronic deasese" similar to the oh-so-successful war on drugs? Obligatory preventive measures? Maybe my growing up in a totalitarian country makes me paranoid.

    Infectious deasese is one thing since nobody wants people with active TB sitting next to them in NYC subway. But it is really not my business if the guy sitting next to me in the bus has diabetes; he cannot "give" it to me. So how is it an issue of public health? Maybe it is my English, but I really don't understand it.

    I agree with anon at 2:02 about cost. a) the government programs only pay for retired on medicare or very poor on medicaid, but they want to track everyone b) the cost of this program may be higher than the money this program might save (if any).

    By Anonymous diora, at 1:41 PM  

    I love the line about stopping death! I am absolutely amazed that people just do not get that people DIE!! They do- young old and in between. Some have no risk factors and die well before they should on paper. SOme have tonnes of them, and never stop living well into their nineties. And then the rest muddle in the middle somewhere. The words from an old song come to mind- Did you ever think as the hearse goes by, that you might b the next to die, they'll put you in a long white box, and there you will whither and decay and rot

    And the worms go in
    And the worms go out
    And the ants play pinochle on your snout.

    We all end up as worm food people.
    No matter what we eat, where we lived or what diseases we had or did not have. All the do-gooders in the world cannot ever end this FACT.

    Now, registering people with diabetes smacks of job making, scariness and the question WHAT NEXT comes to mind. Heart disease? Cancer? Kidney failure? For why, for what and for who is this information really being collected. If it was optional- fine. If not- move the hell out of Dodge people, and tell them NO!!

    By Anonymous Anonymous, at 2:05 AM  

    This comment has been removed by a blog administrator.

    By Blogger Scott, at 8:22 AM  

    The fact is that neither the State nor the City of New York are incurring any major costs to care for diabetes.

    In an interview with CNN, Dr. Frieden stated, "There will be some people who will say, 'What business of the government is it 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. But Dr. Frieden's statement was very carefully worded to suggest that diabetes costs New York City far more than the city actually spends on the disease. Of the estimated $5 billion spent to treat diabetes in New York, private health insurance pays the overwhelming majority of this figure, not New York City. In fact, according to The New England Journal of Medicine, as of February 2006, the NYC Health Department had an annual budget of just $950,000 allocated to diabetes and a staff of just 3 people.

    One must really question whether Dr. Frieden is an actual medical doctor, or a spin doctor.

    By Blogger Scott, at 8:24 AM  

    Bt the way, those concerned that this registry is being implemented without any challenge should rest assured. A website is already available at: www.stopnyca1crtracking.org.

    By Anonymous Anonymous, at 8:32 AM  

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