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Glenn D. Braunstein, M.D. Headshot

Can We Engage in Reasoned Discourse on Crucial Health Care Concerns Rather Than Invoking References to a "Nanny State?"

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To some nay-sayers, it's symbolized by a stalk of broccoli. For others, it's all about a gigantic soda. Or maybe what galls you is a motorcycle helmet or the interior of your car or letting that appearance-anxious teen daughter of yours tan her tender skin. I suspect bunches of you will go ballistic if the topics of cigarettes, guns or vaccinations get into the conversation.

But let's put an end, shall we, to the small-minded labeling of certain kinds of legislation as elements of creating a "nanny state."

I certainly acknowledge the difficulties in balancing our desire to maximize individual freedom with the societal need for some degree of governmental paternalism. And, I'd be among the first to oppose an Orwellian, 1984 state in which Big Brother controls all.

At the same time, it's crucial for our individual health and the health of our society to step away from easy labels and to dig into accurate, factual, scientific data derived from careful, logical research and to see what it means for public policy.

And, as much as anti-government and anti-legislation advocates would like to argue that excessive official intrusion degrades our lives and robs us of freedoms, history and facts disagree. In these quarrelsome times in which some people seem to carry the day just by talking fast, loud, repeating certain points and pounding the table a lot, it's worth pausing to see the benefit and benevolence in many of the public health efforts that some opponents so cavalierly categorize as aspects of the "nanny state."

These have changed and saved lives and as a physician who sees their effects daily, I want to catalog a few of these for those who all too easily forget.

'Nanny's' Lifesaving Actions on Our Roads

Let's start with one of the most prominent elements of our Los Angeles existence -- how we get around, whether in cars or on motorcycles or other types of motorized vehicles.

It's too easy to neglect the dramatic advances we've made as a society, especially since the 1960s, in making our vehicles safer. It wasn't that long ago that there were no padded dashes and steering wheels, when doors and ceilings crumpled like paper and when gas tanks were situated like explosives ready for easy detonation. We once thought it perfectly fine to go without any restraints in our vehicles -- whether seat belts, shoulder harnesses or child safety seats; it was accepted that windshields were made of glass that splintered into lethal, shards. We thought nothing of tossing down a few pitchers of beers or martinis and hopping on the road, racing at daunting speeds on roads that in some instances were barely beyond paved cow paths. Our cars also spewed a toxic, choking stew that regularly hung over Los Angeles, causing grave and widespread illness.

And you know what: it wasn't brutally efficient market forces or the goodwill of automakers toward customers that changed all this (look up Ralph Nader, if you don't already know), leading recently, among other things, to motor vehicle traffic fatalities dropping out of the top 10 causes of U.S. deaths. We should say, "Thank you, 'Nanny,'" to those who lobbied for laws and agencies to look out for the public good. We've still got miles to travel so the vehicular death toll drops even more. It's regrettable that the invasion of distractions -- including deafening sound systems and pernicious, pervasive technologies like texting -- are pushing backward some of the advances we've made in road safety. I regret that thoughtless motorists assert their "right" to post on Facebook as they pretend to control a complex, multiton vehicle while hurtling down the highway, even as "Nanny" protests they have no right to maim and kill others with distracted driving.

At the same time, the proven harm-reductions offered -- yes, by compelling motorcycle riders to wear head-protecting helmets -- is on the upswing. But this trend also has been eroded by, among other things, aging baby boomers insistent on enjoying the "freedom" from "nanny" legislation so they can feel the air race across their senior pates. Consider that the greatest increase in cycle fatalities is among those age 40 plus, that each motorcyclist death is estimated according to the most recent figures to cost society $1 million. If the costs of helmet-free motorcycle mayhem were borne exclusively by the riders themselves, I might concede that it's an individual right. But such recklessness costs the rest of us $4 billion annually. You have to wonder why this debate goes on.

For Our Own Good

I've looked back at some columns I've written and I see other examples where "Nanny" works. After seeing how lung cancer continues to sicken and kill millions, and with zero scientific repudiation as to how tobacco use can be a giant causative factor, yes, I'm with "Nanny" and I'm perfectly comfortable in seeing big taxes and penalties for smoking. Since it's summer, it's worth reminding you of the dangers of sun exposure and why, yes, teenagers especially shouldn't be frying themselves and increasing the already burgeoning risks of skin cancer by hanging out without parental knowledge in tanning salons. I've made the point that young folks who want to get piercings or tattoos benefit from laws calling for sanitary practices. I've devoted ink and electrons to the importance of our government in providing sound information on the effect of diet on health.

And speaking of diet and health -- and again because it's summer -- I've got to say that "Nanny" needs more help and resources from us all as her top experts, the folks at the Food and Drug Administration, the Centers for Disease Control and the Environmental Protection Agency tackle their increasingly complex and far-reaching responsibilities to our society not only in this area but a myriad of others.

Since the early part of the last century, we've asked the FDA to approve drugs and medical devices sold in the U.S. The process, involving animal testing, then tightly regulated human trials, can take eight years or more. The wait can be frustrating for drug manufacturers and for patients hoping for advances. And while mistakes and lapses still occur, the stringent scientific evidence the FDA requires before approving drugs and devices has protected Americans from tragedies.

Just a reminder for those who would undercut the FDA as "Nanny": I'd urge them to review the thalidomide disaster of the early 1960s, the worldwide catastrophe responsible for laws that strengthened the agency. Thalidomide was used worldwide as a tranquilizer and to provide relief for pregnant women from morning sickness. But in the U.S., an FDA official, Dr. Frances Kelsey, feared this drug had never undergone testing in pregnant animals and believed it needed more rigorous scrutiny before approval. Her science-based skepticism kept approval backed up long enough for evidence of the drug's dangers to surface. Thousands of babies born to mothers who had taken thalidomide throughout Europe and Australia suffered missing limbs, flipper-like appendages, blindness and deafness. Babies conceived and born in the U.S. were spared the tragedy, thanks to the nanny-like cautiousness back then of Dr. Kelsey.

Now, the FDA must sort through mountains of data not only on drugs but also on medical devices; the financial stakes in these two areas alone have soared, even as the scientific complexities and the burdens of decision- and policy-making also have increased exponentially. This is occurring even as we also charge this single federal agency with keeping our food safe and secure. In a time of global supply chains, when growers and producers pour thousands of tons of old and new chemicals on what we eat, when it's uncertain whether others share our interest and demand for quality and sanitary practices with foodstuffs and agribusinesses push the bounds every day with technological developments in the very genome of the plants and animals we eat, the workload and demands on this agency are crushing -- at the very time when some parties are demanding huge slashes in spending on domestic, government programs.

In a similar vein, the CDC works tirelessly to prevent new infectious diseases from decimating our population, as well as keeping track of and implementing strategies to combat some of our chronic problems. And yes, they recommend widespread vaccination of children, adolescents and adults, for the individual's own good as well as protecting society from epidemics of measles, whooping cough and other infectious diseases that can cause severe illness and death. The EPA is understaffed and underfunded to carry out its mission to protect our environment and keep pollutants out of our water supply and our homes.

Nuance matters in the "Nanny" argument and it is harder to advocate for actions such as New York Mayor Michael Bloomberg's proposal to ban sodas and other sugary drinks in sizes larger than 16 ounces. The proposed ban is limited to stadiums, restaurants, cinemas and food carts.

His efforts have been roundly criticized, especially by those who rightly note that, in the Big Apple, consumers still can make appalling nutrition choices such as buying 24-ounce glasses of beer, oversized hot dogs loaded with cheese and chili or cookies the size of hub caps. They can treat themselves to huge buckets of sodas and sweet drinks by buying them in grocery stores.

But it's not hard to understand why Bloomberg sought to provoke the tough conversation about sodas, sweets and obesity. The evidence is mixed, but some studies show a link between soda consumption and obesity. In one year-long trial, 644 students were divided into two groups. One group received nutrition education on carbonated sodas, while the other did not. In an educated group, consumption of soda decreased, while it increased in the control group. After a year, the number of obese children in the control group increased by 7.5 percent while in the nutrition education group, obesity decreased by 0.2 percent.

While sugary drinks aren't solely to blame for the bulk of U.S. obesity, evidence about their role has proven sufficiently convincing for the American Medical Association to recommend that any taxes on sugary soft drinks be used to help fight the obesity epidemic; the AMA stopped short at its recent meeting of recommending that those taxes be levied. Some 35 states are adding extra taxes on soft drinks sold in stores; 40 states add taxes to sodas sold in vending machines. Considering the success of the cigarette taxes on smoking behavior, it seems worth pondering taxes on sugary soft drinks -- and maybe other unhealthy food choices, like donuts, cinnamon buns and salty snacks -- all with big calories and little nutrition.

Yes, individuals have the right to make bad health choices. But the consequences land on all our shoulders in the form of soaring medical costs and health insurance premiums. So as we fight to preserve personal choice, let's balance it with penalties or taxes for conduct that affects us collectively.

It's a rational conversation our democracy must conduct -- with the utmost in civility in the days ahead. If our presidential politics allows, perhaps we will see this in the near future. It's disheartening, meantime, that partisans devolve our necessary, important disagreements into pithy points and phony labels, such as "Nanny state," or push only the instances of extremes (as they're known in science, the outliers). I'm a staunch believer in principles. But isn't it time to get off legalistic maybes and absolutes. Can't we ask why the Japanese can thrive with almost no handguns and related homicides, while our emergency rooms are crammed with the continuing tragedy of young people killing and maiming each other with all too easily accessible weapons? Why can even the erudite justices of the highest court in country, as well as the top legislative leaders in the halls of power in Washington, engage in the folly of all but ignoring the unsustainable cost and absolute crisis in the nation's delivery of health care so they can play with the hyperbolic notion that someone, sometime, maybe, might compel us all to eat broccoli? This is the "sliding down the slippery slope" argument carried to an extreme. As an open society, we are able to apply breaks to the slide based upon discussion, debate, data and the ballot box.

"Nanny" should send us all to bed without supper if we can't use our minds, look at facts and evidence, make reasoned arguments and look into our hearts to improve the world we live in and that we'll leave to our children.