Bureaucracy is no cure

Bureaucracy is no cure
By Jane Orient, MD
USA TODAY Editorial

Avoiding panic is crucial, no matter what the threat. Mass panic can cause more casualties than the hazard itself. And bad laws resulting from overreaction can cause problems for decades to come.

In 2001, anthrax-laced letters caused a handful of deaths and illnesses, widespread anxiety, a spike in antibiotics use and enormous disruptions in mail delivery. This crisis was the pretext for attempts to enact the Model State Emergency Health Powers Act, actually written much earlier.

But this proposed law does little to protect the public from bioterrorism or epidemics. According to its author, Lawrence Gostin, in the January 1999 Columbia Law Review, its purpose is to change social norms through public health law so as to "create the conditions necessary for health."

This radical agenda — to change "the way society organizes itself, produces and distributes wealth, and interacts with the natural environment" — requires the power to override the legislative process and constitutional restraints.

And it didn't get far in most states. Lawmakers apparently perceived the difference between giving unconstrained power to unelected bureaucrats and increasing the government's ability to respond to disease.

If a public health department has antiquated communications systems, it shouldn't take a law to fix the problem. If suspect cases aren't reported fast enough, it's probably not because physicians are insufficiently terrified of being punished for failure to report. It's probably because physicians don't know what to look for or how to make a timely report. Demanding lots of mandatory reports will compromise patients' privacy and overload the system with trivia, hampering its ability to respond to what is really important.

Much can be done to improve our ability to survive disease outbreaks: Remove Food and Drug Administration and other government roadblocks to innovative therapy. Improve public awareness of ways to protect oneself. Develop and deploy sensors in public places to detect unusual immune-system activation in as-yet-asymptomatic patients.

Disease outbreaks such as SARS will come and go. Bureaucracies with dictatorial powers can't help you if you have respiratory distress. And they seldom, if ever, go away.


Dr. Jane Orient is executive director of the Association of American Physicians and Surgeons, based in Tucson.