Required reporting is part of the elaboration of the modern bureaucratic state. Early advocates of compulsory reporting of disease in the United States and Europe wanted to gather data for epidemiological analysis, identify patients to treat them, warn anyone who might be infected, and establish a new relationship between practicing physicians and public officials. The initiation of compulsory notification for any disease in a particular nation, State, or city was almost never a direct response to particular scientific advances. New York City provides a well-documented example of the role of politics in policy making regarding the reporting of diseases. In the nation as a whole, changes in public health practices and other factors made a reduction of the fragmentation of health affairs in the United States appear possible. However, instead of unifying public health and private medicine, the AIDS epidemic has highlighted many of the flaws in our health policy, including unresolved issues about the reporting of cases of disease. The central controversy in the surveillance of AIDS is how reports might be used, particularly whether confidentiality would be maintained. Some public health officials argue that traditional standards of confidentiality will not be violated, while others fear that confidentiality may not withstand the external pressures likely with respect to AIDS.