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© 2008 American Public Health Association
DOI: 10.2105/AJPH.2008.142026
LETTER |
Thomas R. Frieden, MD, MPH, is with the New York City Health Department, New York, NY.
Correspondence: Requests for reprints should be addressed to Thomas R. Frieden, MD, MPH, Commissioner, New York City Health Department, 125 Worth St, Room 331, New York, NY 10013 (e-mail: tfrieden{at}health.nyc.gov).
Goldman et al. present themselves as protectors of the doctor–patient relationship and suggest that New York City’s Health Department exceeds its mandate in addressing noncommunicable disease. Yet outreach for noncommunicable conditions, often using confidential information, has long been an essential part of public health practice (e.g., newborn baby visits, lead poisoning prevention programs), as has involvement with clinical management of patients (e.g., asthma, school health, and primary care provision).
Facilitating letters from doctors to their patients with diabetes extends this tradition. Letters include educational materials, and the service is supplemented by resources given to providers for patients (e.g., glucose strips, blood pressure cuffs, and recreation center memberships). The registry gives providers information about glycemic control that, in the absence of electronic records in practices, most would find difficult to obtain. If electronic records were universally adopted and their registry potential used in New York City, A1C registry would not be necessary. The Health Department, in a separate initiative, is promoting precisely this approach by extending electronic health records to providers caring for the sickest patients in New York City.1
Diabetes disproportionately affects people of color. To claim that services mainly benefiting Blacks and Latinos will "racialize" diabetes confuses a "racialized" disease with the actions to address it. Failing to prioritize vulnerable populations because of concern about "racializing" condemns people to inadequate care.
Goldman et al. also question the department’s proposal to remove the requirement for separate written consent for HIV testing. Ironically, the New York State law they defend actually deprives physicians of their autonomy to use judgment about how to counsel patients. In September 2006, the Centers for Disease Control and Prevention issued revised guidelines recommending routine HIV testing and removal of separate written consent. Currently, only 10 states require separate written consent for HIV testing. Written consent is a barrier that impedes early treatment and risk-reduction counseling for HIV-infected people.2 People who know they are HIV-positive decrease risky sexual behavior by approximately half.3 Separate consent procedures result in delayed diagnosis, premature death, and continued spread of HIV. Furthermore, 71% of Blacks, 63% of Latinos, and 65% of Whites think "HIV testing should be treated just like routine screening for any other disease."4
The system that Goldman et al. defend is failing miserably to deliver appropriate care for common and devastating diseases, despite the fact that the United States spends far more than any other industrialized country on health care.5 Diabetes and HIV/AIDS are major epidemics of our era, disabling and killing millions in this country, particularly people who are poor, Black, or Hispanic. Public health agencies have an obligation to intervene to try to reverse these epidemics and to reduce their impact.
Acknowledgments
The author thanks Shadi Chamany, Lynn Silver, Mary T. Bassett, Monica Sweeney and others in the health department for their dedication to monitoring, understanding, and working to reduce the burden of chronic disease and HIV/AIDS in New York City.
Accepted for publication April 28, 2008.
References
1. New York City press release. Mayor Bloomberg and Commissioner Frieden unveil state-of-the-art electronic health record technology [press release]. Available at: http://www.nyc.gov/html/doh/html/pr2008/mr064-08.shtml. Accessed June 3, 2008.
2. Branson BM, Handsfield HH, Lampe MA, et al. Centers for Disease Control and Prevention Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep.2006:55(RR-14):1–17.[Medline]
3. Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr.2005;39: 446–453.[CrossRef][Web of Science][Medline]
4. Kaiser Family Foundation. Survey of Americans on HIV/AIDS. Washington, DC: Kaiser Family Foundation, 2006. Available at: http://www.kff.org/kaiserpolls/upload/7513.pdf. Accessed June 3, 2008.
5. Frieden TR, Mostashari F. Health care as if health mattered. JAMA.2008;299:950–952.
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