Wednesday, August 09, 2006

World Health Organization Nominee Dr. Margaret Chan

The sudden death of World Health Organization (WHO) director-general Lee Jong-wook on May 22, 2006 just 3 years into his term created a sudden vacuum in the organization.

Although Dr. Anders Nordstrom from Sweden is filling the position in the interim, the U.N. will hold a special election for a new director-general on November 9, 2006. China nominated a candidate who appears to have the inside track for the job: Dr. Margaret Chan, the WHO's current Director for Communicable Disease Surveillance and Response, and the organization's point person on pandemic influenza.

Dr. Chan studied medicine in Canada, obtaining her medical degree from the University of Western Ontario before returning to Hong Kong as the Director of Health there. While she is generally well-respected around the world for helping to fight bird flu and SARS in Hong Kong, the former health chief is not exactly fondly remembered in Hong Kong. Local newspapers ridiculed her for giving assurances that eating chicken was safe, just days before the government ordered a mass cull of poultry to get rid of the H5N1 bird flu virus at the end of 1997. She was also criticized by Hong Kong officials for failing to act quickly to tackle the SARS epidemic, which ended up killing nearly 300 people here. She identified weak surveillance systems across East Asia as a weak spot in worldwide public health.

However, Dr. Chan may do better in representing the interests of people with diabetes, who tend to be overlooked in favor of the drama associated with infectious disease. Dr. Chan said that she would focus on chronic diseases (which includes diabetes) saying that the world would do well to remember that chronic diseases were responsible for 60% of the world's mortality.

"Infectious diseases have the drama effect, the media effect ... the concentration is always on communicable diseases and this is something I would like to change a bit," Chan said.

Dr. Chan's experience in the West, where chronic disease is generally a bigger health issue than infectious disease may contribute to her outlook. Whether she can have any significant contribution remains to be seen, but the WHO director-general clearly has a number of important issues to balance in the interest of public health beyond simple solutions.

In particular, while surveillance is important to managing infectious disease, surveillance really has no history of success in chronic disease management, especially for diseases that cannot be prevented, such as type 1 diabetes, which is an autoimmune disease. Health surveillance systems are also something that has a lengthy history of abuse by corrupt, power-hungry dictators, and the WHO must take these concerns into consideration. But we must also acknowledge that abuse can occur almost anywhere, even in democratic counties.

A good example is Dr. Thomas Frieden, the Director of the New York City Department of Health and Mental Hygiene (NYC DOHMH), who recently pushed for the implementation of an involuntary diabetes registry without patient disclosure or provisions for patients to opt out. I wrote about this topic previously. This is an unnecessary and unacceptable abuse of public health tools. Whats more, there is no acceptable reason for not including provisions for patients to opt out of the registry for a disease that cannot necessarily be prevented. In fact, the NYC DOHMH does not even bother to collect data on diabetes type, something which is critical if you wish to assess how effective public health intervention actually is in preventing type 2 diabetes. Its obvious that Dr. Frienden doesn't give a shit about privacy or public health. He just wants to get his name published in medical journals and the popular press. In fact, his track record has not included any significant public health accomplishments, and in fact, he has a history of failure to effectively prevent outbreaks of infectious disease such as the West Nile (WN) virus.

The West Nile virus did not reach the Western Hemisphere until the summer of 1999. This North American WN virus was most closely related to a WN virus isolated from a dead goose in Israel in 1998. West Nile virus is transmitted to people by mosquitoes, and led to 44 hospitalizations and four deaths in 1999. It took over a year before the city sprayed for mosquitos and larvicide. We should question Dr. Frieden's failure there and his broader motives as Director of the NYC DOHMH.

Regardless, the issue of the WHO nominee Margaret Chan may bring more focus to the issue of chronic disease, but we also must be careful that she does not overlook the issues related to patient privacy, which is considered a cornerstone of medical practice given the oath of Hippocrates that virtually all doctors take. My conclusion is that Dr. Chan's nomination is largely symbolic, but she can help in bringing world focus to not only preventing, but also curing these diseases rather than simply accepting them, which would be a welcome change considering the fact that chronic disease is responsible for 60% of the world's mortality. A side note you may wish to note is the fact that I also posted an entry yesterday, so please read that one, too!

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