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Cth
01-11-2006, 09:20 AM
http://smh.com.au/news/world/new-yorks-plan-to-monitor-diabetes-raises-privacy-issues/2006/01/11/1136956242171.html

NEW YORK CITY will monitor the blood sugar levels of its diabetic residents, marking the first time any government in the US has taken the controversial step of tracking people with a chronic disease.

Under the program, the city will require laboratories to report the results of blood sugar tests directly to the health department, which will use the data to study the disease and to prod doctors and patients when levels run too high.

The unprecedented step has been hailed by health experts as a bold attempt to improve care for diabetes, one of the nation's biggest medical problems due to the ageing population and the obesity epidemic.

But some public health experts, ethicists and privacy advocates say it raises serious concerns about confidentiality and represents an alarming government intrusion into people's medical care.

The move is a harbinger of applying tactics traditionally reserved for infectious diseases to chronic conditions such as heart disease and cancer.

"Because of the enormous number of people affected and the costs, chronic diseases have become the most prominent issue in public health," said Lawrence Gostin, the director of the Centre for Law and the Public's Health at Georgetown and Johns Hopkins universities.

US governments have a long history of tracking infectious diseases such as gonorrhoea, cholera, malaria and, more recently, AIDS, to protect the public.

But the New York effort marks the first time any government has required routine reporting of lab tests for a major chronic, non-infectious disease.

Health officials plan to use the data to monitor quality of care and which parts of the city are being hit hardest by diabetes.

They will also use it to intervene in individual cases.

High blood sugar can lead to a host of serious health problems, including heart attacks, kidney failure, amputations from nerve damage and blindness, but the effects can be limited by careful use of diet, exercise, drugs and insulin.

"It really ravages and wreaks havoc on the body," said Diana Berger, who heads the Diabetes Prevention and Control Program in the city's Department of Health and Mental Hygiene.

But the plan has alarmed privacy advocates, particularly because the information is being collected without consent. Doctors may not even know the data is being collected.

Other privacy advocates are concerned about whether the data could be passed on.

"This is really a recipe for invasion of privacy," said Sue Blevins, president of the Institute for Health Freedom. "Under the law, personal health information can be shared without consent for many purposes."

That fear is shared by some diabetics. "I don't want the city telling me what to do nor do I want the city telling my physician what to do," said Steven Lazarus, 44, a diabetic.