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Privacy, please

Other editors say

Patients should be asked before their medical records are disclosed

Los Angeles Times

Medical advances and computerization of patient records can add up to this: a letter from your pharmacy, which is being paid by a pharmaceutical company to recommend a prescription drug for your chronic condition. What's next could be this: a letter from your employer denying insurance coverage to your newborn, who had a genetic test ' required by some states ' that uncovered a disorder.

There's some help against this invasion of medical privacy in rules that the Bush administration this month. They merely let patients correct errors in their medical records and require employers to get employees' permission before seeing their medical files. But even mild protections are an improvement over the current anything-goes system.

The rules, which would become binding on most health plans next April, are based on Clinton administration regulations that Health and Human Services Secretary Tommy G. Thompson tweaked, as he puts it, in several ways. Thompson's first change loosens a requirement that doctors, hospitals, pharmacists and other health-care providers obtain written consent before disclosing medical information. Thompson grants reasonable exceptions, for instance, to let a family member pick up a prescription and to let a primary-care doctor give an emergency-room physician the information needed to treat an accident victim. The new rules also would allow medical researchers to analyze patient information, but only after patient files were stripped of names, addresses, Social Security numbers and other direct identifiers.

At least two of Thompson's tweaks, however, leave patients needlessly vulnerable. The first grants an alarmingly fuzzy group ' health-care operators ' nearly as much access to patient records as medical researchers. The second lets drug companies, without a patient's knowledge, pay a pharmacist to recommend that the patient switch from one drug to another and continue to send product mailers to a customer for a particular illness.

That could stigmatize patients by revealing their medical conditions to neighbors or co-workers. In one recent example, a 59-year-old Florida woman with a history of depression brought a class-action lawsuit against drug maker Eli Lilly and three doctors after she received in the mail a free one-month sample of the antidepression medication Prozac and a note congratulating her on being on her way to full recovery.

Rep. Ed Markey, D-Mass., and Sen. Edward M. Kennedy, D-Mass., are working on legislation to tighten some of Thompson's privacy rules. They should let most of Thompson's changes stand. But they should yield no ground on one principle: Barring medical emergencies, patients should be asked before their health records are disclosed. Markey, Kennedy and Thompson should be able to find a way to preserve medical efficiency without declaring open season on health privacy.