Monday, October 12, 2009
Dr. Silva on The Gary Anthony Ramsay Blog Talk Radio Show
I was interviewed for the web radio show 'Mad in the Middle' hosted by Gary Anthony Ramsay. My co-panelist was Pulitzer prize winning journalist Karen Hunter. The interview itself starts at at 15:45, but the conversation really starts at 17:00. If you want to skip to the best part of the interview, go to 31:45 when the Ms. Hunter starts suggesting that we should reinstitute shame as a public health intervention. But it's an argument I've heard in different forms from both progressives and conservatives- that people need to control their behaviors, and others shouldn't be held accountable for the consequences. Yes, we should have better prevention and wellness programs that address people's behaviors. But not all diseases are solely related to behavior- diabetes often develops from a combination of behavioral and genetic factors, as well as socioeconomic factors that underlie behaviors (i.e. why is that I can predict someone's risk of many diseases by the zip code that they live in?). And the solution is not preventing access to health care services, especially to a physician that can often change behaviors by a simple honest conversation (which has been proven to be more effective than most other interventions for a number of risk taking behaviors). I can tell you this as a physician who works with teenagers in the area of preventative sexual health- shame will not change risky behavior, in fact, their shame and fear is what forced them to seek my services, so we can collectively come to a solution that ensures that they won't get pregnant, have an STD, or be in an abusive relationship (and I always encourage them to speak to their parents about their situation). Lastly, people should not suffer from the very dangerous consequences of renal failure because they ate too much salt over their lifetime. Diseases have consequences and suffering that are not consistent with the behaviors they are related to, and we should not punish each other for that. We should support each other in taking better care of ourselves and our future.