April 10, 2006

Disclose Diabetes Information in New York City? Caplan Says No.

New York Daily News asks the question as to whether the incredibly imaginative new idea the City has employed will work, is smart and is ethical. Caplan weighs in on the latter:
I love it when government agencies take action to prevent a real problem. Thus, I should love the fact that the city Department of Health as of last January requires medical labs to report your name to them if a test shows you are at risk of diabetes. But this is a public health program I don't like at all.

I recognize the plague that diabetes has become. Only 15 years ago, 1 in 10 New Yorkers was obese. Now it is 1 in 5 and climbing. The health-care costs of a diabetic are three times those of someone who is not. The toll the disease takes in premature death, blindness, immobility, pain, amputations and absence from work is beyond belief.

The numbers tell a story that demands a response. But the response should not be a letter from the health department.

The program is pretty mild. If you turn up positive for diabetes, the health department does not come and padlock your refrigerator. Someone simply calls or writes to let you know you're at risk. And you can send a form if you want them to leave you alone. You are still free to gobble up another pint of Haagen-Dazs.

But the precedent of having the health officials get your confidential medical information to contact you is simply too frightening to contemplate. Imagine the letters clogging your mail box as they write you to sleep more, stop drinking, lay off the marijuana or to get a condom on those private parts before heading out into the wilds of the city.

Even worse, they are generally writing to people whom no doctor will treat because they are covered by Medicare or Medicaid, who have lousy health insurance or who have no health insurance at all.

Writing warning notes to diabetics has the problem backwards. Our government needs to get us a health-care system that works and get our butts into it. Then they can start writing us hate mail if they think our backsides have grown too big. Anything less is just, well, sugarcoating.

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