Sex and Other Sins: Public Morality, Public Health, and Funding PrEP

Guest Post by Nathan Emmerich
BMJ Blogs
Originally posted October 5, 2016

Here is an excerpt:

Consider the following thought experiments. Imagine a drug that could be taken to significantly lessen the risk that a smoker would develop lung cancer, or a drug that would lessen the risk of ‘at risk’ individuals developing diabetes. In such cases would we be inclined to refuse public funds for such drugs merely because such individuals could lessen their risks even more by giving up smoking, or by losing weight and eating a healthy or, at least, healthier diet?

There is, certainly, something regrettable about having to spend public money on a drug that offsets risks generated by an individual’s own behaviour. Nevertheless, from an epidemiological – and therefore public health – perspective, the notion that an individual makes a choice about whether or not to smoke, or to have a bad diet, is too simplistic, even when we place the issue of addiction to one side. Thus, even when smoking cessation programmes are available and even when nutritional advice is within easy reach (as it increasingly is), plenty of people still smoke and consume a less than healthy diet.

Smoking and bad diets are correlated with a variety of demographic factors, and our choices are always made within particular cultural and socio-political contexts. Even so, some have questioned if the NHS should be funding stomach-stapling operations for those who are overweight, or if smokers and non-smokers can expect to receive the same level of treatment and care.

The entire blog post is here.

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it.

By Sheryl Cash
amdnews.com
Originally posted August 26, 2013

The University of Pennsylvania Health System and its affiliates recently joined Cleveland Clinic and other hospitals in banning the employment of smokers. Proponents say such policies lower health care costs and improve employee and community health. Others believe these restrictions may be the beginning of a slippery ethical slope in which employees can be fired or banned for personal decisions and activities unrelated to their specific jobs.

The question is: Will and can private physician practices soon follow suit, banning or disciplining employees not only for smoking but also for other outside activities deemed detrimental to the image of the group? What about obesity, social media presence, hobbies and other after-work activities? Are there legitimate situations where the needs and mission of the practice, and the protection of its patients, outweigh the individual rights of the employee and potential employee? In general, are these types of bans legal and ethical?

The entire story is here.

Geisinger no longer to hire job applicants who use tobacco products

CONTACT: Marcy Marshall: 570-271-8081
Dec. 28, 2011
FOR IMMEDIATE RELEASE

DANVILLE, Pa. – Starting Feb. 1, 2012, Geisinger will no longer hire job applicants who use tobacco products, including cigarettes, cigars, and chewing or smokeless tobacco.

“Geisinger is joining dozens of hospitals and medical organizations across the country that are encouraging healthier living, decreasing absenteeism and reducing health care costs by adopting strict policies that make smoking a reason to turn away job applicants,” said Richard Merkle, chief human resources officer, Geisinger Health System. “Non-nicotine hiring policies are legal in 20 states, including Pennsylvania.”

This policy also affects any applicants receiving offer letters as of Feb. 1. During the hiring process, all applicants – including those seeking full- and part-time positions, flex, volunteers, and students enrolled in Geisinger-based schools – will be tested for nicotine as part of the routine drug screening.

The test will include screening for cigarettes, smokeless tobacco, snuff, nicotine patches, nicotine gum and cigars. The test only detects active nicotine users, not those exposed to second-hand smoke.

“Applicants who test positive for nicotine use will be welcome to re-apply in six months provided they are nicotine free at that time,” Merkle said. “A listing of smoking cessation resources will be provided to any applicant who tests positive for nicotine.”

Current employees are not affected by this new policy, but are encouraged to take advantage of the tobacco cessation programs offered through Geisinger’s Employee Wellness program.

Geisinger currently has a no-tobacco-use policy that extends across all of its properties.

About Geisinger Health System

Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development and implementation of innovative care models including ProvenHealth Navigator, an advanced medical home model, and ProvenCare program. The system serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.