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David Katz, M.D. Headshot

Do Government Health Interventions Ruin Personal Liberty?

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I choose life.

I realize that's a bumper sticker slogan for the "right to life" movement, but that's not how I mean it. I mean that given a choice between a laissez faire path to unfettered wealth for the least scrupulous few, or the lives of many -- I choose the lives.

That might seem a non-controversial stance, but I know it to be anything but. I periodically visit the websites -- including this one, Yahoo's Shine, Prevention.com, and www.nhregister.com -- where my columns, blogs and interviews are posted. Among the comments to my posts, there are entries not for the faint of heart. They routinely impugn my opinions, my intelligence, my education, my ancestry and my religion or lack thereof (sometimes, both).

Because I choose life. Because I think basic health care access should be a human right. Schools should not provide "junk" food as the construction material for the growing bodies of our children; toxins such as trans fat should be banned from the food supply; and the federal authorities should do what's necessary to prevent the salt content of processed foods from pickling us all. The acrimony directed at me for my support of federal regulation of sodium levels in processed food is merely the latest addition of salt to long-festering wounds.

The objections to my stance, and the apparent justifications for everything from ad hominem assaults to anti-Semitism, are couched in the ideology of personal liberty: I don't need Big Brother to take care of me! Bud out, Dr. Katz!!

This is worth addressing at the level of principle rather than specific issue, because the fundamental naivete of this world view is a threat to the public health. Anyone who thinks that all government regulation is the work of nannies is, in a word, a ninny.

The nanny accusation is predicated on the notion that the government should keep its big mitts off of people's personal choices. And it invokes the proverbial slippery slope. If nannies like me can take salt out of your Chex, where will it end?

But if regulating health risks puts us on a slippery slope toward the public health equivalent of martial law, then not regulating them puts us on a slippery slope of its own toward nihilistic catastrophe.

Legendarily, Dr. John Snow curtailed a deadly cholera epidemic in London in 1854 by removing the handle from the Broad Street pump, responsible for dispensing infected water. The public had no idea how cholera was being spread, and thus could not reliably defend against it. Nonetheless, John Snow was a card-carrying nanny.

One of the greatest plagues of human history, smallpox, was officially eradicated in 1980 -- through a global and compulsory immunization program at the very pinnacle of nanny-hood. If mandatory immunization programs serve to eradicate polio from the globe, as they have from North America, it will again be thanks to a pack of nannies.

In the US each year, over 500,000 people are injured, and some 20,000 killed, in car crashes related to driving under the influence of alcohol. Laws against driving with a blood alcohol concentration above 0.08 are credited with reducing traffic deaths by up to eight percent. But prohibiting driving while drunk is certainly a constraint on personal liberties.

Putting folate in the food supply to prevent neural tube defects in newborns is nannyism. The addition of fluoride to water, and iodine to salt, bear the unmistakable mark of nannies as well.

Do we really need the governmental intrusion of traffic lights and stop signs? Can we not just rely on the prevailing judgment and good sense of our roadmates to determine when they should stop? Do we really need environmental standards for industrial toxins? Don't we trust large corporations to reduce their profits voluntarily for the sake of some vague and long-term benefit to the planet? Do we need a FAA? Can't we just let airlines compete to see who can cut the most cost-saving corners?

I rather doubt anyone ranting against regulation has actually paused to consider what world they would be living in -- or, more likely, dying in -- if we had no regulation at all.

Since a world with no regulation is just silly at best, quickly lethal at worst -- the questions of regulation are about when, what, and how much -- not whether. Much to the potential chagrin of all concerned, that hints at the possibility of common ground. I even dare hope it might attenuate the vitriol directed these days at the government to recall that the role of government is much less about setting the height of the ceiling, than it is about ensuring there is a floor.

For those who contend that there can be too much regulation, or that it can be done badly -- I agree, wholeheartedly. For those who contend that there cannot be too little, I say you are wrong. Common sense says you are wrong. Philosophers from Plato to Locke say you are wrong. And the abundant, egregious, and often lethal follies of history -- say you are wrong.

The right approach to the principle of regulation is not to pretend that every possible regulation is one too many, nor that every unregulated behavior is one too few. Rather, we should decide what criteria dictate the need for regulation.

For me, these are reasonably clear: when individuals lack the resources for self defense, or lack the information and expertise to make reliably informed decisions -- regulation should protect us. When the average person has the knowledge and power to defend hearth and home reliably, then the government can, and should, bud out.

The denigrations swirling in cyberspace notwithstanding, I have no desire to be my brother's keeper. I do, however, have a fervent desire to be my brother's good brother. And my sister's good brother, too. To be a brother who thinks stop signs are a reasonable idea, and appends to them a hearty 'look out!' when a car ignores one and comes hurtling toward my unsuspecting sibling in the crosswalk. To practice public health and preventive medicine, as I have pledged to do.

When it comes down to a clear choice, in other words, I choose life.

-fin

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