Panel Examines Privacy Issues

On a night when students unabashedly took to the yard au naturel, unconcerned with their personal privacy during the Primal Scream, professors and experts of the Internet and the law gathered at the Business School's Pound Hall to discuss ways of protecting confidential personal information in the age of the Internet.

The Wednesday-night panel discussion focused on "Privacy and Cyber/Spaces: Government Databanks and Identification," and many of the participants came from medical backgrounds.

"The key issue was the effect on confidentiality in medical care when there are government databanks that are accessible to people other than doctors," said Philip Caper, lecturer in the Faculty of Public Health, who is also Chairman and CEO of the Codman Research Group.

Richard Sobel, a fellow of the Berkman Center for Internet said Society who organized and moderated the discussion, pointed to legislation proposed by the Clinton administration that would make it easier for police officers to obtain patients' medical records, sometimes without their consent, as an example of the kind of infringement on personal privacy that could accompany the advent of information technology in medicine.

"If you have confidential healthcare data that's available to law enforcement without procedural protection, you don't have much privacy protection," he said.

The problem is an immediate and practical one for practicing doctors, said Medical School professor Harold J. Bursztajn, who is co-director of the Program in Psychiatry and the Law.

"[Privacy] comes up a good deal of the time, for example, when we have to fill out insurance health care forms," he said. "Many of the patients I see at my private practice come to me because they value privacy; they would never see me at the medical school."

Bursztajn and others said wider access to medical data can benefit doctors, who may use the information to improve the way they deliver services to students.

"I think there are tremendous benefits to the use of data in our medical care, not so much at the individual patient level, but at the system-wide level," said panelist Denise Nagel, a doctor who is Executive Director of the Coalition for Patient Rights.

"Through my clinical work, I became alarmed at the demands for access for personal medical information from lots of different entities now that we have the ability to utilize database technology," she said.

Bursztajn said the extent to which medical information is being used both properly and improperly has not been examined, and the loss of medical privacy on the Internet remains a fear, not a verified reality.

"The problem is there is no good data on databanks [and how they are being used.] What we do know is that managed care organizations have been using databanks to profile physicians based on cost," putting pressure on physicians to forsake quality of care in order to lower costs, he said.

More than simple an issue of comfort, privacy is often a prerequisite to good medical care.

"How can anyone gain a deeper understanding of themselves or have more freedom in their lives unless you have confidentiality and they know that they will have control over what goes out of my office?" Bursztajn said of his psychiatric patients. "If you don't have confidentiality, then you really are asking people to begin to systematically keep from physicians the information the [doctors] need to know."

Panelists said discussing issues of privacy on the Internet in an academic setting can provide an important opportunity for serious, thoughtful discussion.

"I think there were people in the audience who were very, very knowledgeable about these issues who came because the issues are very thorny, and in academic settings, the complexity is dealt with more seriously," said panelist John Roberts, Executive Director of the American Civil Liberties Union of Massachusetts. "I think a lot of the impetus [for legislative action] can start in academic circles."

Panelists said discussions such as the one on Wednesday can bring currency to a public debate that is often ignorant of the latest technology.

"The reason this whole issue is so contentious is that there are legitimate concerns on both sides," said Nagel. "The key is to navigate a course that doesn't throw the baby out with the bathwater."