By Dr. Alan Meyers
If you’ve been following the news for the last few weeks, you’re aware of two public health disasters here in Massachusetts: The state drug-testing laboratory scandal and the contaminated products from a Framingham compounding pharmacy that have now killed 28 patients.
Sad to say, I am not at all surprised. I take these two debacles as signs of the very dangerous times that we’re living in. Our political discourse seems to be in the grip of the simplistic and misleading notion that government spending is bad, and taxing anyone to raise the funds for government spending is also bad. This idea is based in ideology. Remember Grover Norquist’s famous admonition that government should be so small that he can drag it into the bathroom and drown it in the bathtub?
Yet it’s emblematic of our public schizophrenia that at the same time, if there is any role of government that everyone agrees on, it’s to keep the population safe. (When a super-storm hits, for example.)
That sentiment leads to widespread support for military spending, but consider: What do you think the chances are that you’ll be injured in a military or terrorist attack, the kind of thing that could be protected against with warships and missiles? Not very high, right? Now, what do you think is the probability that you’ll be injured by a preventable event that was not prevented because of a lax public health infrastructure? An uninspected drug, a food-borne illness, a disease spread by unvaccinated neighbors?
The current state public health budget is not adequate to protect us from certain known hazards. For example, the program to inspect for lead paint — not a major hazard but a well-known one — has been cut. There are not nearly enough government inspectors on the job to ensure our food supply is safe. People addicted to drugs and alcohol, if they get to the point where they are ready for recovery, may be turned away from treatment programs because there are not nearly enough treatment slots available. And where will the staff be found to inspect compounding pharmacies?
It’s not just that there are inadequate regulations, it’s that the regulations have been ideologically targeted, along with the government funding that supports them, as bad. And that’s just a dangerous notion.
There is evidence that compounding pharmacies were advised by their professional organization to obstruct government regulators, because they were bad for business. We have to decide as a society: Do we want to avoid regulating businesses that are potentially dangerous to consumers so that their profit margins will be protected? What’s more important, the public’s health or profit margins?
If we want to protect public health, that means regulations have to be written and on the books, and the federal government has to be in charge of this because the states are starved for cash. The states don’t have the budgets to fund inspections, as shown by what just happened.
As for the state drug lab, we’ve seen this throughout the health care world: As revenues shrink and are diverted, more is demanded of the people who do the work.
I’m scratching my head, as are many people, about how this scandal around chemist Annie Dookhan could have happened. But if you have an inadequate staff with a large quantity of material that needs to be tested, the person who’s cranking through large numbers of tests more rapidly than her colleagues is going to get praised until the bottom falls out.
So the general pattern is gong to be: People under stress, doing more with less, and so there will be individuals who figure out ways to cut corners and be more “productive.” It’s incredibly corrosive.
Over the last few fiscally tight years, public health has been cut disproportionately, and much of its funding has been diverted into militarized budgets in which public health is considered important mostly as a defense against bioterrorism.
Many public health departments have had to bend over backwards to try to fit their regular, daily necessary activities into this framework of defense against terrorism — such as rapid response teams against the threat of a smallpox attack. Some of us have gotten up at meetings and said, ‘This is crazy.’ We have systems we need to have working to get our patients immunized against things we know they’re at risk for, like pertussis, that actually do make people sick and in some cases kill them. It’s a predictable disease burden and we have to keep our resources focused on it, not on a theoretical bogeyman diverting our attention, not to mention our resources.
Bottom line: Public health stands on its own as a public good. and we can’t have it on the cheap. When it comes down to it, we’re going to get what we pay for. I would hope people would see these two recent public health failures as warning shots, and mobilize to prevent such failures in the future. But I’m not optimistic that this kind of thing won’t happen again.
Dr. Alan Meyers is a professor of pediatrics at the Boston University School of Medicine.