Correspondence

The Privacy of Medical Records

N Engl J Med 2001; 345:1576-1577November 22, 2001

Article

To the Editor:

In his editorial (Aug. 2 issue), Dr. Welch addresses the misuse of private medical records and states that “no other developed nation would tolerate this abridgment of individual rights.”1 In a harmless but frightening way, the AstraZeneca pharmaceutical company sent two personal letters to my home that urged me to ask my physician about prescribing Nexium and offered a free seven-day trial. This occurred because I occasionally have heartburn.

It is perfectly legal for pharmaceutical companies to buy prescription data from pharmacies and insurance companies. With an unprecedented degree of cynicism, Lisa Schoenberg, the product director of AstraZeneca, calls this “permission marketing.”2 Physicians' waiting rooms should carry warnings that everything you tell your doctor in confidence could be sold to the highest bidder. As Dr. Welch comments, this practice “prevents sick people from seeking the treatment they need, it undermines clinical care, and it obstructs research.” How long will American physicians and their organizations pretend to be blind to who is reading their patients' medical records?

Juan N. Walterspiel, M.D.
4410 Pinehollow Ct., Alpharetta, GA 30022
wadbc@aol.com

2 References

1. 1

   Welch CA. Sacred secrets -- the privacy of medical records. N Engl J Med 2001;345:371-372
   Full Text | Web of Science | Medline

2. 2

   Schoenberg L. Quoted in: Sears L. Unleashing the power of Nexium. PharmaVOICE. July/August 2001:43.
   

Author/Editor Response

Dr. Welch replies:

To the Editor: Dr. Walterspiel correctly identifies marketing as a major source of nonconsensual disclosure of identifiable health information. Insurance companies and pharmacies are currently free to sell patient lists to pharmaceutical and equipment vendors for the purposes of marketing. Unfortunately, those lists are unprotected and can go elsewhere without any notification to the patients on the lists. The Health Insurance Portability and Accountability Act1 will create comprehensive privacy protections starting on April 14, 2003. The largest gap in the federal privacy rule, however, is the failure to put a stop to these marketing practices. The federal rule explicitly allows release of identifiable patient records for the purposes of marketing, without the patient's consent or notification. The task of closing this enormous loophole now falls to state legislatures, and many states are currently crafting legislation to address this and other weaknesses of the federal rule. It is imperative that state medical societies take an active role in the crafting of additional protections for patients at the state level.

Charles A. Welch, M.D.
Massachusetts General Hospital, Boston, MA 02114
cwelch1@partners.org

1 References

1. 1

   Department of Health and Human Services. Standards for privacy of individually identifiable health information; final rule, 45 CFR Section 160-164.
   

Citing Articles (1)

Citing Articles

1. 1

   Margaret G. E. Peterson. (2005) Privacy, Public Safety, and Medical Research. Journal of Medical Systems 29:1, 81-90
   CrossRef