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Recently in Salon Health & Body

Sleepstabbing
The strange science of sleep behavior and one verdict: Guilty!
By Jeff Stryker
[07/08/99]

The big E
Doctors, law enforcement and ravers are scrutinizing ecstasy's possible long-term effects as the drug pours into the U.S. in record numbers.
By Dawn MacKeen
[07/07/99]

Urge
Weapon or toy?
One seasoned sex explorer gets more than he expected from a run-in with airport security.
By David Steinberg
[07/06/99]

Urge
Private dancers
From North Beach bars to the Mitchell Brothers' high-priced flesh emporium, she went in search of women to dance in her lap.
By Annalee Newitz
[07/03/99]

Column
Why doesn't anyone have dropsy anymore?
The 1899 Merck Manual is being released along with the 1999 version.   
By Mary Roach
[07/02/99]

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How about Citicorp? The House just did. While we were getting ready for Independence Day, it seems, the House of Representatives voted overwhelmingly to open our medical records to the businesses that profit from prying into them.

On the night of July 1, in a 343-86 vote, the House of Representatives passed the sweeping Financial Services Act of 1999, the first major overhaul of the finance sector since the Great Depression. The bill creates a legal framework for the coming megamergers of insurance companies, banks and other financial firms. But it also contains an amendment, under the innocuous heading "Confidentiality of Health and Medical Information," with potentially disturbing implications for medical privacy.

The amendment's sponsor, Iowa Republican Rep. Greg Ganske, described it as language to protect the medical records of people whose health insurance policies become accessible to banks through mergers. But a close reading suggests that it does just the opposite. The amendment prohibits the disclosure of patient information to anyone "without the consent of customers," then goes on to list a series of exceptions that includes just about any conceivable use of health records -- from insurance underwriting to research to bill-collecting to criminal investigation. In short, the amendment was written very loosely, enabling companies that hold medical records to release them to virtually anyone with whom they do business.

"This could, frighteningly enough, be the last word on medical privacy," says an aide to Democratic Sen. Patrick Leahy, the author of a liberal medical privacy bill that died in committee.

There are innocent readings as to how Ganske's amendment was passed, and there are conspiratorial ones. Medical privacy has become a hot-ticket item in Washington in recent years, as privacy advocates and ordinary citizens alike began to realize there were no federal laws to protect their health records. Indeed, such records have become commodities like any other in the information age, bought and sold by a variety of interested parties. Various research studies published in the past several years have shown that corporations routinely peruse employee health records in making hiring, promotion and firing decisions. Pharmacies sell patient information to drug companies, which use it for marketing back to the patient or his medical group. Managed care plans ogle patient files to find ways to refuse payment or to urge doctors to stop expensive procedures. Insurers look for ways to deny claims.

In the absence of privacy laws or universal health care, discrimination against the ill or potentially sick will grow more acute as genetic examinations become a more routine part of clinical science and DNA profiles enter medical records. A 1996 study by Stanford and Harvard researchers found 206 asymptomatic individuals who lost jobs or insurance coverage because of their genetic profiles. Other studies have cited cases where people, after innocently donating blood samples, were blackballed from jobs because of secret readings of their DNA sequences.

A study to be published next week in the journal Neurology indicates that many people who carry the Apo-E4 gene variant -- about a quarter of the population -- suffer progressive memory loss starting in late middle age. Imagine the discussions that could go on in boardrooms of companies that get their hands on this information: "Should we promote Jerry to VP?" "Nah, he's an 'E4' -- he'll be a bozo in 10 years."

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