Sex registers and pathology testing

I'm off to London to talk about pathology. On the way I have been listening to the latest Freakeconomics podcast on the economic cost of sex offending. It's big, and lifelong. Society exacts a high price, in a way that is unique amongst all offences. One of the biggest costs is associated with sex registers, which effectively proscribe offenders from even attempting to live a normal life. But this may be the price society exacts for a crime that is seen as most heinous.

What I find interesting, though, is the effect of registers on offending rates. Zero. I don't think this is very surprising. And perhaps it's also not surprising that registers have a wider effect on society. So house prices fall by 4% if you live within half a mile of a registered sex offender in the US.  But then there is the fear they engender. It suddenly becomes a lot easier to imagine your child becoming a victim. And of course it is fear of crime, rather than probability of being a victim of crime, that is the biggest problem, especially for those of us with enough time and resource to be able to search registers.

So the link with pathology? We have created an industry in monitoring of chronic disease which is supposed to make people feel safe, and cared for, but which has actually done the opposite. It has made people live in fear of deviation from the median, and encouraged treatments and health behaviours that lack evidence of actual benefit (as would be defined by the citizen); chasing arbitrary targets that are, at best, a step removed from the true purpose of what we're trying to achieve.

My response to this social disease of iatrogenic harm? I see it as my responsibility, as a pathologist with some degree of influence, to ensure that we act as stewards of pastoral care - only delivering testing when it makes people better. Not using testing to create layers of anxiety. The link here with crime? As a citizen, I see the main role of law enforcement agencies is to make me feel safe. This may involve tackling the causes of crime, but this can only be a part of it. Sex registers most definitely take you away from this purpose - even if they worked (they don't) they make you feel unsafe. The role of health care is similarly not to deliver a long life - it's to make me, as a citizen, feel cared for. We need to start remembering that.