New York City Health Officials have engaged in “media spin” to shade public perception in favor of its involuntary A1C tracking program. Dr. Thomas R. Frieden, the New York City Health Commissioner, said in an interview that the aim of the A1C tracking program is to respond to an epidemic of a chronic disease with the type of surveillance and other tools that health departments routinely use to prevent and control communicable diseases. As he explained, “We have to get a better handle on what is really the only major health problem in the U.S. that is getting worse, and getting worse rapidly.” But Dr. Frieden is no friend to patient privacy (so much for the Hippocratic Oath he took as a physician).

The following statement was published a February 6, 2006 New York Times article regarding his view of informed patient notice or consent: “Dr. Frieden suggested that he wanted to do away with the written consent forms now required before any test is given by a health care provider, while still requiring spoken consent.” He has already helped undermine patient notice or consent for the A1C program in the name of diabetes prevention. But not all forms of diabetes can even be prevented (type 1 diabetes, which is an autoimmune disease, cannot be prevented at this time). Frieden obviously sees the aggressive approach being taken to address only one form of diabetes as justified in the name of public health. But in his effort to support the aggressive program, the NYC Health Commissioner's media spin has been less than truthful. In an interview with CNN, Dr. Frieden stated, “There will be some people who will say, 'What business of the government is it to know that my diabetes is not in control?'” The answer, he said, is that diabetes costs an estimated $5 billion a year to treat in New York and was the fourth leading cause of death in the city in 2003, killing 1,891. But Dr. Frieden's statement was very carefully worded to suggest that diabetes costs New York City far more than the city actually spends on the disease. Of the estimated $5 billion spent to treat diabetes in New York, private health insurance and the Federal government via Medicare and Medicaid pay the overwhelming majority of this figure, not New York City. As of February 2006, the NYC Health Department had an annual budget of just $950,000 allocated to diabetes and a staff of just 3 people. While the diabetes statistics cited are alarming, they do not render diabetes as a public health threat, but an economic one. By his own admission, Dr. Frieden wrote, “Case management of noncommunicable disease does not have the same societal imperative (prevention of transmission) that case management for infectious disease does. But improved prevention and management of chronic disease has societal benefits, including reductions in health care costs and increases in productivity.”¹ Economics may help to make the Health Department's story more convincing, but whether it justifies violating the U.S. Constitution is questionable and will likely be challenged in a court of law.