In Cold War-era movies, nefarious despots were Snoops Par Excellence. They knew every movement, every act, seemingly every thought of citizens. We American movie-goers were smug: our Uncle Sam gathered only the minimal information necessary to pay us Social Security, but did not plumb our inmost lives. We were safe from Super Snooping.
Fast forward 50 years. Forget nosy totalitarian regimes. Today we all snoop. Thanks to technology, which has enabled aggregation of mountains of data, the innards of most citizens movements (not yet thoughts) are lodged in cyberspace: the clothes we buy, the debts we amass, the magazines we read, the books we read, the movies we see, the foods we love. Somebody somewhere can puncture our illusion of privacy.
Those modern-day snoops, moreover, no longer report to a Big Brother Government. Thanks to the freedom of the internet, a computer-savvy teenager, sitting for a few hours at a computer (maybe while sipping coffee at a Starbucks), can plumb the depths of most peoples lives. Some of the hacking is illegal; some, difficult, but legit. And thanks to a vigorous entrepreneurial spirit, anybody can go online and pay for much of the personal information that is supposedly private, or at least hard to access.
Medical records, though, are still private. At least we hope they are private. If Dr. X makes a diagnosis, recommends a treatment, and prescribes a slew of drugs for a patient, that information is relayed, electronically, only to the hospital, the consulting colleagues, and the pharmacist. The list of people in the loop is long, but the dissemination of the private medical record is crucial to treatment. Most of us blithely assume that the information loop ends there.
But the entrepreneurial spirit ever beckons. Pharmacies can and do sell the prescription information not grouped by patients. Patients remain unidentifiable. The information reflects physician prescribing patterns: Over the past year, Dr X has prescribed the following drugs, in the following dosages, to the following numbers of patients. The United States labor force has a new occupational title: data mining.
Until recently, drug companies could, and did, simply buy that information, which went directly to the firms marketing departments. The marketing departments want to identify the physicians to target for education, for samples, for visits, and for rewards. The pharmaceutical chains make money from mining the data; in return, the drug companies get data that help them sell their products.
Data mining is pervasive, not just in medicine. A lot of companies sell their lists consider magazine subscriptions, donors to charitable organizations, customers who buy travel packages Most Americans names and contact information are bartered about in cyberspace.
Three states recently objected: Vermont, Maine and New Hampshire. Vermont passed a law to curb the data-miners: companies would need the consent of a physician before distributing his/her prescribing pattern. The state attorneys general argued that access to those records would raise the costs of health care by encouraging physicians to prescribe fewer generic drugs, more of the costlier versions. Some physicians groups joined in the protest, concerned with this intrusion into the medical encounter. The US Justice Department backed the three states. The data-miners, along with the pharmaceutical chains, objected.
The Supreme Court is slated to decide (Sorrell v IMSHealth) early this summer. Cost is, of course, one fear: sophisticated marketers will be able to push their new expensive blockbusters more aggressively, especially to physicians who are prescribing cheaper alternatives. (The drug companies argue that marketers armed with data-miners spread sheets will be able to educate those physicians about newer, better drugs). Of course, regardless of the success of the states suits, even if physicians cannot refuse to let their prescribing patterns be clumped into a data-set, physicians can always refuse to listen to the sales pitches of pharmaceutical company agents.
Another fear, though, is the loss of privacy, as prescribing patterns start circulating through an entrepreneurial cyberspace. The states requirement that physicians at least consent to distribution is reasonable. Indeed, I wish patients were asked to consent as well before their medical records become one more item on Google.
Joan Retsinas is a sociologist in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, June 15, 2011
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