The New York Times
July 24, 1998, Friday
Section A; Page 21; Column 2; Editorial Desk

Hippocrates vs. Big Brother

By Bernadine Healy; Bernadine Healy, dean of the Ohio State University
College of Medicine and Public Health, was director of the National
Institutes of Health from March 1991 to July 1993.

 The Health Insurance Portability and Accountability Act of 1996 requires

that all Americans have an electronic code known as a "unique health

identifier." Assigned at birth, it would enable the creation of a national

data bank of all our individual medical encounters.

The identifier has been lauded as a means for rapid transfer of records

among different health providers or insurers, a more efficient way to bill

and a great boon to medical researchers, who would have access to unlimited

data on our diseases, test results and treatments.

The unease is that this would be an invasion of an individual's most

intimate personal life -- and be open to abuse.

"Privacy" may seem an overused word these days, but the demand for honoring

secrets between a patient and doctor is one that transcends discipline,

time and place. There is perhaps no greater invasion of privacy than what

occurs when people, because of mortal need, allow doctors to intrude into

every facet of their lives, ask sensitive and deeply probing questions

about their emotional and physical health and that of their families, and

examine their naked bodies from head to toe.

Countless sensitive issues can arise in the course of caring for patients,

including information on sexual practices, sexually transmitted diseases,

impotence, abortion, depression, suicide attempts, alcohol abuse, illicit

drug use and a range of potentially prejudicial illnesses, procedures and

medications.

The only purpose of the intimate portraits that doctors obtain is to gain

knowledge to help their patients. Indeed, the promise -- affirmed by every

doctor when stating the Hippocratic Oath -- "that whatsoever I shall see or

hear of the lives of men, which is not fitting to be spoken . . . I shall

keep inviolably secret" is not for show. It is about the privileged human

encounter inherent in the practice of medicine.

If that encounter becomes a threat to an already vulnerable patient, both

the doctor and the patient are tempted to subvert the record to protect a

confidence.

As doctors, we are all concerned about modern-day assaults on these sacred

secrets of the patients in our care. The recognized need for health care

workers within medical centers to review charts for medical oversight, for

billing and to provide select information to health maintenance

organizations or insurance companies has raised concern about the potential

for abuse and the need for stricter regulation of the use of medical

records.

To use the force of law, regardless of the wishes of the patient, to

command the entire contents of a medical record and place it in a single

database under Federal control only increases those concerns. The

Government does a lot of things well, but keeping secrets is not one of

them.

Recent history shows a track record of abuse of F.B.I. records, I.R.S.

files and Government personnel records, with little or no avenue for

individual redress. Furthermore, most people see the Government as simply

too remote, too large and too impersonal to have the medical secrets of its