From the
President
Wayne Tuckson, MD
GLMS President | [email protected]
IS THE NANNY STATE So Bad?
W
e physicians are the front
line of health care. We see
the consequences of illicit
drug use, indiscriminant
and inappropriate use of
firearms, malnutrition and environmental
pollution. Though Cassius’ admonition to
Brutus may be right, there are cases where
the deck is so stacked against certain seg-
ments that they don’t control their own fate,
and they need help.
There is a role for government interven-
tion and protection of our lives. One may
call this the “nanny state,” but who else to
provide protection for those who are either
unaware or ill-prepared to recognize and
address the threats that lie before them.
How many of us will deny the benefits from
laws regulating speed limits, alcohol levels,
cigarette warnings, pesticide use, mosquito
control, and of course those wonderful signs
that alert us to the level of cleanliness at a
restaurant when we go out to eat.
Edwin Chadwick, the architect of the
first Public Health Act in England in 1848,
was chastised for recommending the con-
trolling of overcrowding, drinking water
quality, sewage disposal and building stan-
dards. In spite of initial opposition, 150
years later his invention of civic hygiene
and all of its regulations was voted as the
most significant advance in public health
and medicine since 1840. There is indeed
a role for an enlightened government in-
terceding on behalf of the populace over
those who seek short-term financial gains
over the long-term health and quality of life
of our community. It may be difficult, but
our current policymakers must, like those
who supported Edwin Chadwick, consider
the long-term impact of their decisions on
our overall health and not just short-term
political expediency.
Bioethicist Albert Jonsen said, “Our
moral response to the imminence of death
demands that we rescue the doomed. We
throw a rope to the drowning, rush into
burning buildings to snatch the entrapped,
dispatch teams to search for the snowbound.
This rescue morality spills over into medical
care, where ropes are artificial hearts, our
rush is the mobile critical care, our teams the
transplant services.” Prevention is not sexy.
It does not garner the same laurels as that
extended to the interventionist, the trauma
team or the transplant surgeon. There are
few headlines for the wise soul who builds
the fence at the top of the hill to stop people
from falling off the cliff. Sadly, there will be
no weekly dramas set in the corridors of the
Department of Health and Wellness.
The “rush to rescue” where we rush to
treat an identifiable person, dying from an
identifiable, albeit potentially preventable
problem, is clearly done out of compassion,
but is this expenditure prudent? What of
providing clean syringes to a drug addict to
prevent them from getting either hepatitis
C, or bacterial endocarditis? Is this not also
an act of compassion and perhaps a more
prudent use of limited financial resources?
We have large segments of our popu-
lation living in food deserts and suffering
from food insecurity. Most importantly,
many of these are children who through no
fault of their own suffer the consequences,
which include diabetes, mental illnesses and
other chronic conditions (not to mention
learning disabilities). We know that these
children, without intervention, will suffer
academically and will likely grow into adults
with cardiac, metabolic and other problems.
Yet, where is the investment in these young
people for year-round supplemental nu-
trition? Isn’t that a better investment than
having these children fed on foods that are
calorie rich, but nutritionally poor? I’d rath-
er we feed them right, now, than address the
consequences later.
There is tension between competing
constituent groups, and I do feel for pol-
icymakers who must navigate the serious
ethical and political difficulties associated
with deciding the winners and losers in
health care expenditures. However, they
and we must ask what is the most prudent
use of our funds? Clearly it will not be chas-
ing after the next catastrophic illness, or
latest specialized medication, or surgical
instrument.
We should take the long view, like Ed-
win Chadwick, and enact legislation that
at a minimum invests in our community
by providing health insurance, increased
physician access, prevention services, reha-
bilitation facilities and elimination of food
insecurity.
Dr. Tuckson is a practicing colon and rectal
surgeon.
OCTOBER 2018
5