Blog | Tuesday, May 5, 2015

Indiana: 1 out of 2


Indiana passed a “Religious Freedom” law last week, signed by Governor Mike Pence.

Reaction to the law has been swift and furious. The law purports to enhance religious freedom by allowing business owners to cite their religious beliefs as a legitimate reason for discrimination. Many national organizations, both religious and commercial, have declared their intent to cease doing business in Indiana.

Judging by the news cycle and social media reactions to the law's passage, you could say Governor Pence has made a very poor choice.

Interestingly, the same week, he went against his own stated principles and made, from a public health viewpoint, a resoundingly good and evidence-based choice about another matter affecting his state.

Rural Scott County, in southeast Indiana, has reported more than six dozen new cases of HIV in 2015 alone. In public health terms, this is an epidemic spread, given the very low population density of the county. In a typical year, Scott County might see five new HIV cases. In just the first quarter of this year, the county's reported a nearly 16-fold increase over the annual rate, leading Governor Pence to acknowledge that Scott County is facing a “Public Health Emergency.”

To combat the spread of HIV, which is due to the sharing of needles for injection drug use, Governor Pence's emergency order permits public health officials to immediately begin a clean needle exchange as per CDC recommendations.

Pence has spoken out against a statewide or permanent needle exchange program, instead limiting the effort only to Scott County on a temporary basis. NPR quoted the governor as follows: “I don't believe that effective anti-drug policy involves handing out paraphernalia to drug users by government officials,” he says. “I reject that.”

It's easy to see why someone could reject clean needle programs on the basis of not wanting to subsidize or potentiate illicit drug use. Yet when faced with such an emergency, Governor Pence has yielded to experts wielding scientific evidence.

That's what public health is all about. We may not like people's behavior or habits, but in truth, preaching or punishing has shown to be of limited (if any) value. Acknowledging that there's a problem without resorting to judgment, and designing programs to protect the public's health, is sound medicine and policy.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.