Koch's Comments: America's health system

On March 12th, a front-page story in The New York Times caught my eye.  The headline, "Sex Infections Found in Quarter of Teenage Girls," should make America's blood run cold. The article reported on a nationwide study of "four common sexually transmitted diseases among girls and young women [and] found that at least one in four are infected with at least one of the diseases."

The article went on to state that "Nearly half of the African-Americans in the study of teenagers ages 14 to 19 were infected with at least one of the diseases monitored in the study - human papillomavirus (HPV), Chlamydia, genital herpes and trichomoniasis, a common parasite. The 50 percent figure compared with 20 percent of white teenagers."  The article stated that each disease "can cause cancer and genital warts." The lead author of the report, Dr. Sara Forhan, extrapolating from the findings, "said 3.2 million teenage women were infected with at least one of the four diseases."

At the recent Inner Circle dinner -- which is New York City's version of Washington's Gridiron dinner where reporters lampoon politicians and the Mayor responds with a show of his own (I did 12 such responses, usually with the cast of a current Broadway show) -- I found myself talking to New York City's brilliant and dedicated Commissioner of Health and Mental Hygiene, Dr. Tom Frieden.

Dr. Frieden and I were chatting about new initiatives in the medical field and I said, "I have one for you," and I mentioned the New York Times article. He replied, "We are already testing in some of our high schools." He explained that these viruses can be detected through urine testing. I won't reveal what the tests showed.  I have a rule which has served me well since my days as a Congressman (1969-77). If you are reporting on a serious matter that involves numbers and those numbers are in the files of others, get the numbers in writing. Another part of that rule is that much of what anybody tells you is inaccurate or mistaken, not necessarily intentionally, as opposed to getting it in writing.

My own belief is that every child in the public school system and the private and parochial schools as well should be examined medically at the school every year or required to have a physician certify that an examination has been conducted. Of course there is a cost, probably a large one. However, this is one situation where cost should not be a barrier to progress. We are talking about the health of the city's children. We are talking about the possibility that many of these children afflicted with sexually transmitted diseases will lose the ability to bear children when they are adults because of the ravages of these diseases.

Also, the city has access to the coverage of Medicaid and the program known as Child Health Plus, a state-federal program of insurance for children who are not covered by Medicaid but whose family income is close to the poverty line. An effort should be made to cover the costs of examinations through the use of these programs. Private insurance companies are also involved, which may be helpful in paying for the new initiative. The annual medical examination by a physician of all school children will detect other serious medical conditions which when detected early, may be easily treated and save that child from a major medical problem at a later date.

I hope that Chancellor Klein and Health Commissioner Frieden give this matter their highest priority. Someone should be appointed to reach out to the federal programs and the private insurance companies to get their cooperation. If their funding cannot be put into place immediately, then city funds for the coming budget year should be allocated for this essential protection until the insurance coverage becomes available. I also believe the city's private doctors and those employed by the city would jump at the chance of volunteering their service pro bono to help the city's children. You never know until you try. Doctors Without Borders serve in Africa and the Far East and elsewhere serving children. There are doctors here in New York City who will want to do the same for our city's children, provided they are protected from liability.