Posted on 07/14/2006 2:00:27 PM PDT by neverdem
Are mandatory aerobics classes in your future?
"When anyone dies at an early age from a preventable cause in New York City, it's my fault," New York City Health Commissioner Thomas Frieden declared recently (Financial Times registration required). In his campaign to make sure that no New Yorker dies before his or her time, Frieden has adopted an expansive notion of public health.
Historically, public health has focused on protecting people from the risks of communicable diseases. Thus public health officials have been empowered to mandate vaccinations, require the chlorination of water, order that milk be pasteurized, and quarantine sick people in order to control epidemics. Even the city's recent broad smoking ban was justified in part on the grounds that smokers were harming the health of others by exposing them to second-hand smoke.
But safeguarding people from the risks potentially imposed on them by third parties is no longer enough—Frieden now wants to protect people from themselves. So New York's Board of Public Health has turned its attention to the city's diabetics. In January 2006, the city's health bureaucrats began implementing a surveillance program that will eventually include nearly all of the city's 530,000 diabetics. In the current issue of Science, Columbia University professor of sociomedical studies Amy Fairchild, writes, "If New York comes to serve as a model, public health surveillance will take on a radical new form, entailing a reconfiguration of the relation between public health and medicine."
New York's radical new surveillance system requires mandatory electronic reporting of the glycosylated hemoglobin A1c values of all diabetics tested by all city laboratories to the Department of Health and Mental Hygiene (DOH). Keep in mind that diabetes is not a communicable disease. The recent increase in diabetes among Americans is associated with the increase in obesity. Unlike measles, a person cannot catch it merely by standing next to someone munching on a Krispy Kreme donut or pigging out on slices of Famous Ray's pizza.
Nevertheless, diabetes is a health problem for 20 million Americans. Diabetics have higher than normal levels of glucose in their blood. Years of higher blood glucose eventually damage small blood vessels leading to high blood pressure, and to kidney, heart, and nerve disease. One physician friend told me that he adds ten years to the age of his diabetic patients. Testing for A1c measures the average level of glucose in the blood for the past 2 to 3 months. Thus it's a convenient way for diabetics and their physicians to check how well they have been controlling their glucose levels. Generally A1c values for non-diabetics are below 7 percent and studies show that the closer a diabetic can keep this value to 7 percent or below, the less likely he or she is to suffer from the complications of the disease. Unhappily, one study estimated that only 37 percent of diabetics in the United States maintained A1c values below 7 percent.
Under the new city diabetic surveillance system, the results from all tests for A1c (estimated to be between 1 million and 2 million annually) will go the city's DOH. The registry will record the full name, date of birth, and address of each person tested and the date each test was performed. Diabetics whose A1c levels are too high will receive a letter and educational materials from the DOH and their physicians will be alerted to their test results. Frieden says that the surveillance information collected will remain confidential and any diabetics who don't want to hear from the DOH can opt out, but they cannot prevent their test results from being filed in the registry.
In her discussion of the diabetic surveillance program, Fairchild makes a distinction between "hard" and "soft" paternalism. "What distinguishes hard paternalism from its softer counterpart is the role of coercion," she writes. Fairchild concludes that the surveillance system is acceptable soft paternalism because "no one would be forced to undergo treatment or lifestyle change." What's wrong with a little education, courtesy of the DOH? As it stands, nothing much; but will the DOH's interventions stop at non-coercive letters, phone calls and pamphlets?
In the United States, the health care costs for diabetes top $45 billion annually and absorb 25 percent of Medicare's budget. In addition, 42 percent of diabetics receiving Medicaid in New York City have dangerously high A1c levels of above 9 percent. Should the chiding approach of letters and phone calls fail to get results, it's not difficult to imagine that Frieden and other city health officials would argue for applying a bit of "hard" paternalism because poor diabetics are busting city and state health care budgets. One step toward harder paternalism might be compulsory exercise and nutrition classes.
And why stop at monitoring diabetics? After all, far more Americans suffer from cardiovascular diseases than they do from diabetes. For example, 65 million Americans have hypertension (there is some overlap with diabetics); 100 million Americans have above-normal cholesterol and 35 million have high cholesterol. Heart disease costs nearly $200 billion in direct medical costs every year, much of it also picked up by Medicare and Medicaid. New York's diabetic surveillance program could be the harbinger for similar mandatory programs for monitoring everyone's serum cholesterol, hypertension, and even percentage of body fat.
In the past, Americans recognized a distinction between public and personal health. If I smoked, drank too much, supersized regularly or failed to get to the gym, it was my own fault, not Health Commissioner Frieden's. However, when (and if) government-funded universal health insurance becomes a reality, the distinction between public and personal health will fade away. Then get ready for your prescription for compulsory biweekly aerobics classes.
Ronald Bailey is Reason's science correspondent.
Who indeed?
Stay tuned for further Adventures of Citizen X!
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My tagline!
How about some SOMEC?
Okay, here's a data base that really is an invasion of my privacy. Where are the protests from the New York Times?
Never underestimate the ferocious acts of tyranny which can be exercised (pun) in the name of "Public Health."
Is it time to shoot the b*stards yet?
Same thing for the words "Public Safety".
Otherwise known as "physical jerks (1984)."
Then why not throw this frickin' self-important bureaucrat into gen pop on multiple counts of murder. He can get HIS exercise doing unspeakable things with other inmates.
Say, does this crap have anything to do with the UN Health 2010 initiative, or is this just a local variety of jungle rot?
No. However, it's time for all conservative New York City inhabitants to move to red states.
Damn...and you don't want to have bad paper work when that happens!
Edmund Burke said something like remove internal restraint, and one shall find oneself constrained from the outside. This is a grotesquely exaggerated constraint imposed to make up for a relatively minor lack of internal restraint.
If cooking classes were required in school people might know how to eat better at a lower price. But I think proposed curriculum changes won't make this health commissioner feel good enough about himself, hence the grandstanding.
Okay, you want an example of an abuse of surveillance technology and big govt forcing/requiring people to do something, THIS is the example that I turn to the 'state' and say "FORK YOU!" (U know what I mean).
What about the tired old mantra the left trots out for abortion: "This is something to be kept private and confidential between a person and their doctor"?
This may be 'soft' compulsion or whatever the hell the new spin term is, but you just KNOW the long-term plan is to force changes in peoples' lives. In the not-to-distant future, just think of all the pissed off diabetic liberals going into Starbucks when they swipe their card to pay for their double mocha latte's the clerk gets a message saying the NY DOH says I can't sell you that, it's bad for you blood sugar.
This kind of stuff is the true concern of people who are against a big brother society. This example hits everyone in a society group, it's not voluntary (records are sent whether you 'opt-out' of receiving info or not), and you can't do anything to stop your records from being sent.
Who the fork does the NY DOH think it is? It's time to put some biblical fear into these 'public servants' - HEY MORONS - YOU WORK FOR US, WE DON'T ANSWER TO FRIGGIN' YOU!!!
That's the other thing about these libs - they think they're so much better than the common man. Common guy needs to be told what to do - what to eat, what to drink, when to sleep, etc. These friggin libs have little God complexes and want to play the role. "I made a difference today! I prevented 76,432 diabetics from having a donut!
Friggin' hypocritical nany-state big brother faceless bureaucrat paper-pushing condescending know-it-all liberals!!!!!
>>>>Okay, here's a data base that really is an invasion of my privacy.
It is right here:
http://wonder.cdc.gov/data2010/focus.htm
Click on the drop box of the focus areas and see what we will be catalogued on.
I've really got to rent that movie, 1984.
>>>does this crap have anything to do with the UN Health 2010 initiative
Absolutely. Remember my thread here?
http://www.freerepublic.com/focus/f-news/1563271/posts
Healthy People 2010
Check out the database I have linked in with the 28 initiatives.
http://wonder.cdc.gov/data2010/focus.htm
DATA2010
This is the database that is suppose to interact with the number assigned to the microchips.
The finding suggests that diabetes patients should increase their efforts to curb such fluctuations if they want to reduce the risk of complications such as heart disease and damage to the eyes, nerves, and kidneys. It also bolsters the view that continuous glucose monitors and, eventually, an artificial pancreas, could have a tremendous impact on reducing diabetic complications by preventing repeated highs and lows.
The research, led by Louis Monnier, M.D., was conducted at the University of Montpelier and published in the Journal of the American Medical Association (Vol. 295, No. 14, p. 1681, 2006).
The study found that glucose fluctuations trigger "oxidative stress," changes in metabolism that lead to cell damage and cell death and contribute to complications. It was known that hyperglycemia had this effect, but now it appears that repeated highs and lows can be equally damaging.
Previously, chronic hyperglycemia was viewed as the main cause of blood vessel damage. As a result, diabetes care has focused on reducing hemoglobin A1C (HbA1c) levels, which indicate average blood glucose for a two-to-three-month period.
But the Montpelier study underscores that average levels can be misleading. Two people with similar HbA1c levels might have a dramatic difference in the number of glucose "excursions"-when glucose levels depart from normal range and fall too low or rise too high. In recent years, more researchers have concluded that HbA1c readings are not the only measure of good glucose control.
The development of accurate continuous glucose monitors now allows researchers to design experiments that measure glucose fluctuation. The devices can record glucose levels continuously over several days and keep a record of the entire period, making it possible to see how many glucose excursions occur and how drastic they are.
The Montpelier researchers studied 21 patients with diabetes over a three-day period, measuring how often glucose levels went significantly high and low. They found that patients with more glucose fluctuation also had higher levels of a biochemical marker for oxidative stress. Although the study was conducted with type 2 diabetes patients, the findings should apply to type 1 patients as well.
In fact, the correlation between glucose fluctuation and oxidative stress was more direct than the relationship between sustained hyperglycemia and oxidative stress. In other words, glucose fluctuation seems to have a more direct, predictable effect on oxidative stress, and presumably, complications.~snip~
If our country keeps going in the direction its going, I'm gonna *NEED* drugs!!
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