Re: NY State Proposes Tracking Diabetics Via A1c Results
- From: Alan Mackenzie <acm@xxxxxx>
- Date: Tue, 26 Jul 2005 17:08:13 +0000
Jennifer <jenniferNOSPAM@xxxxxxxxxxxxx> wrote on Mon, 25 Jul 2005
> N.Y. Diabetes-Tracking Plan Draws Concern July 25, 2005 1:06 PM EDT
As somebody completely and utterly uninvolved, I find the tone of this
post so outrageously offensive, I feel I've got to reply. (Nothing
personal, J, I know you didn't write the stuff yourself.)
> NEW YORK - At least half a million New Yorkers have diabetes, many of
> them at risk for blindness, kidney failure, amputations and heart
> problems because they are doing a poor job of controlling their illness.
Ah yes, the medical systems are perfectly OK in themselves, of course,
just people are too stupid to look after themselves.
> The question is, how much privacy are they willing to give up for a
> chance at better health?
That won't matter a jot, because their privacy will be violated or not,
regardless of whether they're willing. This is always the tone of
politicians ramming invasive surveillance down people's throats.
> A century after New York became the first American city to track people
> with infectious diseases as a way to halt epidemics, officials here
> propose a similar system to monitor people with diabetes, a
> non-contagious foe.
We're talking about surveillance of people's private lives here.
> Conceived after a sharp rise in diabetes deaths over the past 20 years,
> the plan would require medical labs to report to the city the results
> of a certain type of test that indicates how well individual patients
> are controlling their diabetes.
Thus invalidating any resulting statistics right from the word go. Or
are we going to have anonymous drop-in centres where people can get HbA1c
tests, along the lines of AIDS tests.
> "There will be some people who will say, 'What business of the
> government is it to know that my diabetes is not in control?'" said Dr.
> Thomas R. Frieden, the city's health commissioner.
> 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.
That's an answer?
> By pinpointing problem patients, then intervening ever so slightly in
> their care, Frieden said the city can improve thousands of lives. "I
> don't think we can afford not to do anything," he said.
I'm intrigued by what he means by "ever so slightly". Abolishing the
confidentiality of their relationships with their doctors seems to be
part of it, though.
> The Board of Health vote on the proposal isn't likely until at least
> September, but it has already attracted attention from other public
> health experts and privacy advocates.
To say nothing of lawyers, since they're probably intending to break the
> The list of illnesses reported to public health authorities has grown
> over the years, but it still is almost entirely contagious diseases,
> like HIV, or conditions related to environmental toxins, like lead
In the first case, to protect other people from infection, and in the
second to protect other people from poisoning.
> Diabetes is different, threatening no one but the people who have it.
> "This isn't smallpox," said James Pyles, an attorney who represents
> health care groups concerned with medical privacy. "The state, or the
> city in this case, does not have a compelling interest in the health of
> an individual that overrides that individual's right to privacy."
> Pyles praised the intent of the program, but said unless diabetics are
> asked for their consent, it would be "an outright violation of the
> constitutional right to privacy" for the government to obtain their
> The city's program wouldn't initially get consent to collect data, but
> would allow patients to opt out later.
Wow, what a concession! Let people opt out later, after their names and
sensitive medical records have been broadcast round the entire city's
administration. Information which has once been stored in a large
computerised database can never be erased.
> The database would also be tightly controlled, off limits to anyone but
> department staff, the patients and their doctors, health officials say.
And of course, health insurers will never be given access to these
records under any circumstances. Anybody here believe in the tooth
> Over time, doctors could receive letters, telling them whether their
> patients have been getting adequate care.
Eh? I think, somehow, the doctors will already be aware of the care
they're giving their patients. Or is the intention here to penalize
doctors who fail to impose "proper care" on their patients?
> People who skip checkups might get a note from their doctors, reminding
> them of the dangers of untreated diabetes.
Yes, they might. And in five years time, they might be getting notes
from the city administration reminding them that they'll be due to pay
hundreds of dollars in penalties if their HbA1C readings don't come down
to what the administrators regard as acceptable.
> The plan is akin to the surveillance system put in place in 1897 to
> fight tuberculosis. At first, doctors were outraged they had to report
> TB cases to the government, but it became a model after deaths plummeted.
> The American Diabetes Association supports New York's plan. It could be
> a great tool for doctors who find it difficult to track patients over
> long periods, said the ADA's Dr. Nathaniel Clark.
Since when has it been a legitimate part of a doctor's remit to track
As a matter of interest, has the ADA been suborned by the pharmaceutical
industry and health care providers the way that the German equivalent
> Currently, he said, people who aren't aggressive about their care can
> easily fall through the cracks.
What a bloody cheek! Bring in a violent metaphor, and insinuate that
people who aren't violent are a problem.
> Some switch health care providers, and many people living in poor
> neighborhoods where diabetes is common don't have a regular doctor.
You mean, people who can't afford a regular doctor?
> Dr. Paul Simon of Los Angeles County's public health department, said
> other big cities could follow New York's lead.
> "Some people are uncomfortable with public health departments expanding
> their scope beyond infectious disease, but I would say we have to do
> it," he said. "Chronic disease really accounts for the major portion of
> years of life lost to illness, these days."
> New York's program would involve collecting the results of A1c tests,
> which indicate blood glucose control over a few months, unlike the daily
> glucose tests diabetics give themselves. The A1c test is given for both
> Type 1 and Type 2 diabetes, the latter linked to obesity and accounting
> for about 90 percent of American diabetics. The program would cost
> between $1 million and $2 million a year, the health department said.
How about instead providing properly funded public health services,
accessible to all? I suspect this would actually solve the pertinent
> Dr. Amy Fairchild, an expert on public health ethics at Columbia
> University, said disease monitoring programs have historically been
> able to overcome privacy worries if the health threat is sufficiently
Yeah, because disease monitoring programs typically don't experience
worry. Whether those whose privacy is violated can overcome their
worries, to say nothing of anger and resentment, and whether they should,
are radically different questions.
> "We respond with surveillance when we believe something has reached
> epidemic proportions," Fairchild said. "And this may fit the profile.
> Have we become a nation of obese people who are all going to get diabetes?"
It would be far better to respond with treatment than surveillance.
> The program's success, she said, may depend partly on how patients
> respond. "It's not necessarily that someone has that information. It's
> that they're pestering you. 'The next thing I know, you'll be telling
> me what I can and can't eat,'" she said.
.... to say nothing of being told to re-chanelling scarce money from
buying food, paying rent and paying off debts to buying medical services.
Patronising little madam!
> Nationally, diabetes is the sixth leading cause of death, according to
> the Centers for Disease Control and Prevention. It afflicts about 18.2
> million Americans.
> Sandye Poitier-Johnson, 57, a public school principal in Harlem who was
> diagnosed with diabetes a few years ago, said most people could use
> help monitoring their condition.
Then found facilities where people can go and get help.
> "People say, diabetes is serious, but they don't take it seriously,"
> she said. "I wouldn't think that this was Big Brother or Big Sister
> watching me. I would welcome the help."
> She urged the city, though, to get patient consent first. "There is
> enough privacy invasion already in our society," she said.
Alan Mackenzie (Munich, Germany)
Email: aacm@xxxxxxxx; to decode, wherever there is a repeated letter
(like "aa"), remove half of them (leaving, say, "a").
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