OUT THE INBOX

The Health Sciences Institute e-Alert

April 21, 2003

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Dear Member,

Last week I heard a report on NPR about pending anti-spam legislation. This is sort of a hot button with me because, as I'm sure you can imagine, we do receive e-mails at HSI accusing us of sending spam. But we have a strict anti-spam policy: We send our e-mails only to members who have given us their e-mail addresses or to those who have asked us to send them the e-Alert through ours or another website.

The NPR coverage of spam early last week just happened to coincide with an e-Alert I sent you ("Orwell Redux" 4/14/03) concerning the new federal medical privacy rule that went into effect last Monday. And while comparing one to the other puts us a little bit in the apples/oranges zone, I couldn't help but make a connection that I think reveals just how much we Americans take our right to privacy for granted.

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Who needs it?
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I received quite a few e-mails last week in response to the e-Alert about the new medical privacy regulation that will do three things: 1) put into place a few useful measures to help protect privacy; 2) put into place a few superficial measures that will do little more than drive up medical costs by making expensive requirements of healthcare providers and insurance companies; and 3) actually weaken some of your control over your personal medical records.

On that second point, an HSI member named JP had this to say: "I am both the privacy officer and security officer at my chiropractic clinic. Having attended four separate HIPAA trainings offered by my State organization and a Chiropractic College this is the first mention of HHS requesting patient records. Access to records without patient consent will be considered unauthorized to each of my staff members. You are correct with your overview that this ordeal will be a pain for everyone (we providers hate it)."

It doesn't surprise me that JP might attend four HIPAA training sessions and still not know about certain provisions of the rule. This regulation is hundreds of pages long and written in typically dense legalese. I doubt if 14 training sessions would fully cover all the new and updated provisions.
Echoing JP's sentiment was this e-mail from Susan who works in the insurance industry: "You know insurance agents and brokers are also being asked to have their clients sign off on their medical information due to the HIPPA. Of course we have been asking clients to sign releases in the insurance business for a long time, this is just one more form and one more pain in the neck! I am sure the doctors feel the same way. Who needs it?"

This would seem to be a clear example of the government's need to regulate, even where regulation is unnecessary, taking priority over common sense.

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All in the numbers
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Several members took me to task over certain details, claiming that I was misinterpreting the new rules. One reader named Ruth (who received the e-mail from a friend) said, "I encourage you to actually take a look at the law and see the law and see that it is not about giving us a national id number."

I have read some parts of the Code of Federal Regulations title that contains the new rule. I don't claim to have read or understood all of it. As I mentioned above, it's quite long and difficult to decipher without legal counsel at your side to translate. But Ruth brings up a good point about the national I.D. number. In fact, this was one of the points that HSI Panelist Allan Spreen, M.D., singled out when I asked him about the new rule last week. Speaking specifically about the I.D. number, he said:

"That, to me, has the ominously similar ring of the old 'not to be used for identification' that we older types used to hear concerning our social security number (SSN). Try to do much of anything nowadays without your SSN, including opening a bank account, which of course should be nobody's business but your own.

"Once we give the slightest degree of power to government it slowly advances. I'd suggest being diligent and alert to any suggestions about 'streamlining' our medical record system, or whatever term is used for increasing control over your privacy. Should you choose not to have someone know about your HIV medication, your treatment for an STD, your desire not to have your kids receive a certain vaccination, or your decision for an alternative medical treatment - that may no longer be guaranteed to you.

"This sure seems to fit the pattern I've seen before concerning creeping government control. When the income tax was first 'passed' (unconstitutionally, by the way, but that's another story) only one person stood up against it. His argument, soundly trounced, was that the new tax of less than 3% would gradually edge up to much higher levels. What a ridiculous notion!

"Be careful what rights you give away - you may not get them back."

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Apple, meet orange
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To return to my original point (in comparing the new medical privacy rule to the various federal and state legislative plans currently underway to keep spam out of our e-mail inboxes), it just seems that somewhere along the line a few priorities were misplaced.

No one is more annoyed than I am when I find my inbox full of pointless come-ons for work-at-home jobs promising $1,000 per week to stuff envelopes, easy loans I don't need, and nude photos of celebrities who don't interest me, with or without their clothes on. But this is only annoying. It's not critical. I delete spam e-mails, unread, and move on. With an investment of 30 seconds my inbox is clean. And yet there are citizens out there organizing campaigns, putting in considerable time, money, and effort to put legislative controls on spam. They even go so far as to call this minor annoyance an invasion of privacy.

Meanwhile, genuine privacy issues have been compromised with the new medical privacy rule. Even if you don't believe government agents will start arbitrarily demanding and reviewing the files of psychoanalysts, or that officials from the Department of Health and Human Services will inform employers when an employee is diagnosed HIV positive, the language of the law leaves openings where isolated cases of these assaults on privacy could easily take place. It's not an evil government plot, but the framework for quiet, behind-the-scenes manipulation of an individual's medical history is now in place.

That's the real danger to our privacy. If only it could be deleted as easily as spam.

I hope you'll forward this e-Alert to friends who may also be interested in the real story behind the so-called Medical Privacy Act.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

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