Great stuff today:
Here:
The new “International Classification of Diseases, 9th Revision, Clinical Modification” for 2003 (or ICD-9-CM, for short), the federally mandated bible of medical diagnosis and treatment codes, includes a rather regrettable new category: Section E979, which describes deaths from terrorist acts, including nuclear attacks.
and here
Those who put together the APHA Guiding Principles, which were, in part, meant to help spark interest in increased funding for public health interventions, saw these as the top 3 public health priorities (at least, that’s how they numbered them in the report):
1) Address poverty, social injustice and health disparities that may contribute to the development of terrorism.
2) Provide humanitarian assistance to, and protect the human rights of, the civilian populations of all nations that are directly or indirectly affected by terrorism.
3) Advocate the speedy end of the armed conflict in Afghanistan and promote non-violent means of conflict resolution.#4 was strengthening the public health infrastructure, workforce, and other components of the public health system.
Do I think the public health community can serve as a voice for issues 1 through 3? Sure. But I would argue that, when the foundation of our own house needs to be completely refurbished, that describing those three priorities as our top 3 priorities will not only hinder our effectiveness in taking care of what needs to be done in case of a bioterror attack, but also may hamper our efforts to advocate for, acquire and maintain funding for other non-terror-related core functions of public health.
All the soccer moms and dads who thankfully voted “yes” on B and took a step toward saving the trauma system didn’t vote to support airy generalizations about social justice and conflict resolution.
Those issues are certainly damn important, but in a world where institutions are failing to deliver on their basic goals, and more importantly where their legitimacy is compromised by their failure to deliver, this is a awfully stupid thing to do.
Selling politics as “public health” is more and more common–my favorite example being treating handguns as a “virus” that must be “eradicated.”
Doctors, at least in their official capacity, need to focus on fixing broken bodies, not social theorizing.
Thanks for the great plug, AL, and congrats on the ballot measure passing!
I understand your concern, Rob. There is a difference between health care delivery and public health, although they commonly intersect. For example, the administration of childhood immunizations: obviously, a direct service by a health care provider, but with massive public health ramifications. Same with preventive health measures. We can’t in good conscience say that one’s social situation does not impact one’s ability to receive health services, or we would also have to believe every patient that comes into a doctor’s office fully understands the information they receive from their provider and is able to pay for the drugs they are prescribed.
A couple weeks ago, I had an opportunity to meet and talk over breakfast with the Surgeon General, Richard Carmona. His background is as a trauma surgeon, however, over time, after years of treating victim after victim, he began to ask himself, “Why are these people getting injured?” and then “Can anything be done to reduce the number of accidents that lead to trauma care?” In essence, he came to realize, by taking a greater interest and focus on public health issues, he could work toward putting himself & many of his colleagues out of the trauma care business.
There are obviously places where use of the “public health” model may be stretching things too far, but it is a delicate balance. And politics is inescapably intertwined with health care and public health, as political decisions (from health insurance regulation to FDA protocols to seat belt laws to medical savings accounts to bond referendums to keep open area nursing homes) shape human behavior.
I see no problem with doctors, as private citizens, becoming involved in efforts to, say, encourage seatbelt use.
I see a big problem with doctors using their white lab coats (and the authority and presumed knowledge they represent) to push for, say, reduced speed limits.
A trauma surgeon does not necessarily know anyting more about traffic laws than a auto-body shop owner. Neither one of them necessarily knows more about traffic laws than I do. But if the three of us appear in a televised debate, the surgeon is guaranteed to say “I see the results of traffic accidents every day,” and that “experience” will lend his desire for lower speed limits an aura of authority with much of the audience.
My point is not that doctors should be unconcerned with how their patients came to be sick or injured. My point is that doctors’ training and experience gives them specialized knowledge only in healing and repairing trauma, and at best limited knowledge in preventing it. Immunizations are fine with me. But for a doctor to start making defense policy recommendations as a doctor is a dereliction of his duty to do no harm, not to mention laughably arrogant. It is perfectly possible for a doctor to also be an diplomacy expert, but the fields are not closely intertwined.
I can speak with some authority on physics, and know more about nuclear bombs than most people (though I am not a weapons specialist). I have never once tried to claim that, because I know physics, I know the best way to deal with North Korea’s nuclear weapons, which are a diplomatic, and not a scientific, challenge. For a doctor to say “I stitched up bullet holes in Chicago, therefore I know all about war in the Middle East (or gun safety)” is similarly preposterous.
Of course, every doctor is entitled to an opinion on war with Iraq, gun control, and red-light cameras. And of course, the opinions of doctors on the politics of medicine–Medicare and HMOs–are valuable and useful. But to brandish a stethoscope as though it gives you great insight into Arab culture and domestic criminology is flat-out unethical, and doctors should know better.
That’s the feeling the APHA resolution gives me. “Social injustice,” “human rights” and “non-violent conflict resolution” are all loaded words, which in many contexts end up meaning “America is BAAAAAAAD,” by implying that someone, somewhere (presumably the White House) is in favor of injustice, violence, and rights violations. The language mirrors the language of many a Guardian editorial, and I simply can’t believe that’s an accident. Maybe I’m being unfair, but they could have chosen different words.
Overall, this makes me cringe. It looks like “Doctors Endorse Ancient Euro-Leftist Cliches.” I think that’s damn dangerous for doctors, and damn annoying for the rest of us who have to put up with it.
I see where you’re coming from, and can agree that, absent research and training in public health, making public health-related pronouncements is unadvisable. However, I should point out that while many of the 50,000 APHA members are health professionals, a signficantly smaller share of them are physicians. It’s a pretty diverse body that includes researchers, health service providers, administrators, teachers, and other health workers. And most of the work is done by committee, with a great deal of accommodation of disaparate interest groups, which means that policies that start out looking like horses end up looking much more like camels.