Wednesday, May 28, 2008

The philosophy supporting the "diabetes police" is more than frightening

I have written before about the movement of at least some of the public health community into areas not traditionally thought to be within their purview such as local public health departments monitoring the hemoglobin A 1 C levels. I was not aware of the degree to which the philosophy animating this movement was developed and being expounded in very explicit terms.

Thanks to Sandy Szwarc of Junkfood Science . Her entire piece should be read but below are some of the comments made by exponents of what you might call "the new public health ethics".

In a nutshell,the basic notion is that an individual's health and health related behaviors are too important to be left to the individual as they poise a threat to society and government must act for the good of society.

Ms. Szwarc quotes from a "thought leader" in this field of public health ethics, Dr. Angus Dawson who is at the Centre for Professional Ethics at the University of Toronto as he discusses his approach to the problem of obesity.

[the educational approach to battle obesity] "will fail as it wrongly assumes..that we ought to respect an individual's existing preferences " and "an ethical obesity policy ought to focus on collective interventions [ in which] the individual will not be able to opt out.

If people will not do what we know to be best for them and society we will make them do it.This seems to be the core of the public health ethics.

Lest you think that we are dealing with the relatively, unheard voice of a fringe philosopher in the wilderness (or at least in Canada),essentially the same theme is expressed by Dr. VJ Guillory who served on the AMA Expert Committee on Obesity when he wrote in the Journal of Public Health , "The mandate to ensure and protect the health of the public is an inherently moral one...and it implies the possession of an element of power to carry out that mandate."

In this age of supposedly evidence based medicine it is interesting to read one of the comments from a report about a meeting of the AMA Expert Committee on Obesity : "The magnitude of the obesity is too great to wait for evidence-based guidelines before increasing efforts focused on prevention and intervention." So it is ready, shoot, aim- all with very generous funding from the Robert Wood Johnson Foundation and it is individual freedom and autonomy the targets.


Anonymous said...

There will come a day when every citizen -- man, woman and child -- will be required by federal law to "weigh in" at designated local medical centers where a medical staff person following federal guidelines will determine the degree to which each person is overweight and how much weight in pounds and ounces shall be reduced within a year. Thereafter, yearly weigh-ins will be required to determine whether the set amount of weight loss has been accomplished. Weight loss goals accomplished will be rewarded with a small reduction in federal taxes due; for each previously required pound/ounce weight-loss reduction not accomplished one pays an additional tax. This would be a logistical, medical, financial and adequate/correct information sharing nightmare but hey! Gotta start somewhere, right?

Anonymous said...

doesn't it at least make intuitive sense that if the governement (the taxpayer) is going to increasingly pay for health care that it should have some say in the behaviors that will likely result in higher health care costs?

If individuals are responsible for their own health care, securing their own health insurance, footing the bill for what happens to their health, planning ahead, etc., then it would seem they could do whatever the hell they wanted (with their private insurer adjusting rates accordingly.)

But if we (taxpayers) are increasingly going to foot the bill, then we taxpayers, (with power through governement officials) are going to start either; 1)making the "unhealthy" pay more, or 2) start policing unhealthy individuals and try to make them healthier. It's in our (the taxpayer) interest to do this.

Is this not a logical/rational response? He who pays the bills gets to set the rules.

Anonymous said...

Are the tax payers not the the same group who will be made to follow the rules that is supposedly in the taxpayer interest?

Anonymous said...

Don't fall for the myth that overweight people HAVE higher medical expenses.
Those "costs of obesity" studies are so rife with bad science (like fail to account for AGE), it's amazing anyone takes them seriously.

Anonymous said...

By this logic, the government ought to force people to smoke. Smoking saves money on health care costs, because smokers die younger and don't require years and years of expensive medical attention as they age. Something like lung cancer kills fairly quickly and is relatively inexpensive.