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Controversies in Internal Medicine |

Rebuttal

Benjamin Littenberg, MD; Charles D. MacLean, MDCM
Arch Intern Med. 2008;168(8):802-803. doi:10.1001/archinte.168.8.802.
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Trief and Ellison argue against the use of registries for diabetes on the grounds that they are ineffective, undermine the physician-patient relationship, and are a violation of privacy. They present their sense that registries are “dangerous,” but they give no data that registries are anything but positive for patients, their families, and communities. They are concerned primarily about the outreach programs associated with registries, which they wrongly characterize as “mandatory.” In fact, public health registries have 2 major functions. The first is to measure the scope of an epidemic so that health care providers, payers, and the government can make rational policies about how to organize services, spend limited monies, and be held accountable for the well-being of the people they serve. They are correct that New York City is the only jurisdiction in the country (and to our knowledge, the world) where this is being done with the aim of comprehensively understanding the impact of diabetes on all its victims, not just those associated with a particular provider, payer, employer, or academic researcher. Therefore, the health code mandates that laboratories (not patients, physicians, or other providers) submit data. This use of the registry has already been effective in providing better data for New York City policy makers, has little bearing on the physician-patient relationship, and poses no danger to individual patients.

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