Saturday, April 2, 2011

Big PhARMA or Big Brother?

An American federal law known as the Health Insurance Portability and Accountability Act of 1996 (HIPPA) was supposed to address the concerns of medical and psychiatric patients that sensitive private information about their health might be released to strangers or the public, without their knowledge or consent, by various providers and insurance companies.  While the law increases paperwork for doctors and therefore increases costs, when it comes to privacy protection, it has holes in it big enough to drive a multi-national corporation through.

Accoding to the Privacy Rights Clearing House, "Your consent is not necessary when your information is used by a business associate of your health care provider or plan. Services provided by a business associate can include: legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, and financial. These business relationships are established with a written contract. Your personal medical information can be used to carry on the business association, but you are not a party to the arrangement."

We all know how trustworthy medical insurance companies are.  Government is really more interested in protecting big business interests than your privacy.

A possible new threat to your privacy has recently come to light.  Pharmacies have long been able to compile data on the prescribing habits of various physicians and then turn around and sell the data to drug companies, who want to know who is prescribing their medications, how their salesmen are doing, and also how to shape their sales pitches to the proclivities of the individual physicians.  This process is referred to as data mining.

Of course, they are not supposed to include any information about specific patients, but according to a new article in BNet, The CBS interactive business network, "A new lawsuit alleges that CVS Pharmacies sold its lists to Eli Lilly, Merck, AstraZeneca and Bayer 'by name, date of birth and medications taken.' If true, that’s sobering in terms of patient privacy — do you really want Lilly knowing that you take Prozac?"

They added, "CVS has a lousy history when it comes to [protecting] patient data. In 2009 it paid the FTC a $2.25 million fine for improperly disposing of patient data in a dumpster."

Individual physicians, through an American Medical Association (AMA) website, can elect to "opt out" of allowing their prescribing data to be sold by the pharmacies.  However, many physicians either do not really care if their data is mined, or have not taken the time to opt out.  Many others may not even know that pharmacies do this sort of thing.  They don't teach you about this in medical school.

Busy docs have other things on their minds - it took me longer than it should have to track down the website and take care of this task. 

Of course, it would work a whole lot better if physicians had to opt in in order for pharmacies to sell their information.  But limiting the number of opt-outs is why this is done the way it is done.

I urge everyone to bug your personal physicians to opt out.  They do not have to be AMA members to avail themselves of the opt-out service.  You can even hand them the web link to the correct site to make it easier for them.

The push to use electronic medical records - which might eventually be available on the internet - while helping physicians to gain easy access to important prior  patient medical records, is going to be another big threat to privacy.  This will especially be true for psychiatrists, who deal with the most personal information of all. 


  1. EMR's "on the Internet" (in the cloud) have been available for years. Check out Practice Fusion which is one of the largest and is free.

    Even if you are a covered entity under HIPAA ethical considerations and state law sometimes constrain record release more than HIPAA. You cannot assume that all you need to comply with is HIPAA.

  2. Thanks for publicizing the AMA PDRP opt-out link. I, too, urge all physicians to use it. Regarding "They don't teach you about this in medical school"... I don't know, I personally believe this is something that should be taught in residency, when we're handling "real world" patients on our own for the first time. Med school is where critical thinking skills should be taught... like how to read a paper or to understand pharmacology. Skills which both appear to be vanishing rapidly, BTW.

    Re: "Government is really more interested in protecting big business interests than your privacy." Minor addendum: they really don't care about protecting your health, either.

    Re: "[D]o you really want Lilly knowing that you take Prozac?" Frankly, that wouldn't bother me, because at least they'd leave me (and my doctor) alone. Now, regarding Pfizer, BMS, AstraZeneca... they're the ones I don't want to know I take Prozac. :)

    Last but not least, not to be nitpicky, but that woman in your first picture looks way too happy to be working in health care.

  3. "The push to use electronic medical records - which might eventually be available on the internet - while helping physicians to gain easy access to important prior patient medical records, is going to be another big threat to privacy."

    There are those ads on Canadian TV and I'm not even sure who funds them or if there is even accreditation on those ads.

    They are probably going to kill a lot of people through mistakes by making a computer, the primary "trustworthy" care giver but I'm sure it will be cost effective. Talking to a real person is at least a safety check.

    "Threat to privacy " an understatement -those ads make me shudder - they will pigeonhole the opportunities of people's lives and make them victims for all forces powerful than themselves.
    Those ads - the smiling smarmy faces of evil - they pretend they are all so "concerned" and doing the best for people, while they are doing the worst for them and the best for some corporation.

    When our essential life becomes propaganda , nothing is real - so there is another use for modern psychiatry - to help people "adjust" by medicating the reality of their experience of life to the reality of what propaganda says it is.
    The concern for privacy can probably be fixed by using the proper medications. It'll probably be a defined illness in the DSM-VI.