http://content.nejm.org/cgi/content/full/354/6/545

where we find that mandatory reporting ‘was promulgated under the department’s statutory authority to report and control chronic diseases and to regulate clinical laboratories’, and is designed to monitor a huge problem. In one area, South Bronx, ‘the plan is to provide physicians in the South Bronx with a quarterly roster of their patients, stratified according to the level of glycemic control, along with best-practice recommendations for diabetes care. Participating physicians may also receive notification about patients who are due for follow-up tests but have not received them.’

There are no ‘government health police’ - in any case ‘At present, the health department has only three staff members and a $950,000 annual budget dedicated to diabetes control’ - and ‘concern about privacy will be addressed by “having a very easy opt-out policy. If people don’t want to hear from us, they will never hear from us.’

And this is all based on work in Vermont:

‘the Vermont Diabetes Information System, a registry-based decision-support and reminder system funded by the federal government, which is targeted to primary care physicians and their patients with diabetes. Clinical laboratories throughout Vermont electronically submit data — not just glycosylated hemoglobin values but also other laboratory data that are used in managing diabetes. The program involves 10 hospitals, 121 primary care providers, and about 7350 patients in 55 primary care practices in Vermont and New York. It is being evaluated in a randomized, controlled trial to determine the effect of the information system on diabetes control as measured by glycosylated hemoglobin values. ‘

Are you really suggesting that undertanding the extent of diabetes and best practice for its management should not be done?

As for HIV, this came from an article that talked about how NYC tackled tuberculosis in the 1990s. Personally, I don’t agree with compulsory detention, but we do that for people who are severely mentally ill. Those who lead chaotic lives and walk around with both mental illness and communicable disease need to be helped in some way and the starting point is trying to get them to stick to a medicine regime.

The question you need to address is how you would deal with a growing HIV epidemic - how big does it get before you do something?. All Lerner was saying is:

‘In response, the health department has proposed several regulation changes. First, consent for H.I.V. testing would be simplified to get health practitioners to screen more aggressively. Second, the department proposes tracking H.I.V. in a manner similar to tuberculosis, monitoring patients and trying to ensure that they take their medications properly. These proposals have drawn fire from critics who point out that H.I.V. — unlike tuberculosis — is not spread through casual contact. They also fear that patients may be forced into unwanted testing or have their confidentiality violated. These are important concerns. But the relative quiet of today’s Bellevue tuberculosis ward, as compared with 15 years ago, speaks volumes. Giving the health department a chance will most likely save more lives. ‘

At http://www.nytimes.com/2006/06/27/health/27essa.html?ex=1189224000&en=0d95374870df8aeb&ei=5070