U.S. Surgeon General Richard H. Carmona has a swell idea
for how we should spend the Thanksgiving holiday.
Hes declared Thanksgiving the first annual National
Family History Day. According to the Department of Health
and Human Services, Americans are encouraged to use
their family gatherings as a time to collect important
family health history information that can benefit all
family members.
As tempting as it sounds, I doubt that families
throughout America will be eager to put aside football
and the traditional reminiscing over turkey dinner to
catalogue the diseases that have afflicted their recent
and distant ancestors. But there is a much more serious
reason to be wary of Carmonas suggestion.
It is certainly a good idea to know ones family
medical history. As Carmona says, When a
health-care professional is equipped with a patients
family health history, he or she can easily assess the
inherent risk factors and begin tests or treatment even
before any disease is evident. But because the
government is so deeply involved in our medical affairs,
what is sensible in principle is folly in practice.
There was a time when what you told your doctor was
confidential. The information could not be passed on
without your consent. But no more. The federal
governments misnamed medical-privacy
rule changed all that. Now whatever you tell your
doctor can end up in lots of peoples computers
without your permission or, in many cases, your
knowledge. Under this rule, says Sue A. Blevins,
president of the Institute for Health Freedom, the
information can be shared with over 600,000 hospitals,
doctors, insurers, medical data-processing companies,
public-health departments, and others without the
individuals consent. Patients are not even
owed an accounting of how their personal information was
distributed for most purposes. All this is compliments of
a government that claims to be protecting our privacy.
According to officials, a thorough family medical history
includes not only heart disease, diabetes, cancer, high
blood pressure, and the like. It also includes so-called
mental diseases, such as depression and schizophrenia,
which actually are names for bothersome behavior and
statements, not bona fide physical ailments. A person who
confides to his doctor that his grandfather was depressed
or committed suicide could be compromising himself in
untold ways. The Bush administration is already pushing
to have general practitioners look for signs of mental
illness in all patients, including children. If this
happens, perfectly well people will be stigmatized and
possibly subjected to powerful drugs.
Government actions always have perverse and unintended
consequences. When people realize that they have no
confidential relationship with their doctors, they will
have an incentive to provide inaccurate information when
asked for a family history. What will the coming
comprehensive computerized medical databases be worth
then? Its hard to see how they will help make
people healthier.
One health-policy expert I know has a better idea:
I think the surgeon general has a duty to warn the
American public about how the so-called federal
medical-privacy rule is really a data-sharing rule because it
eliminates patient consent. Perhaps we need a surgeon
generals warning that says something like,
Warning: The Surgeon General has determined that
under federal law, anything you tell your doctor can be
shared without your consent or knowledge.
Those words should be posted outside every doctors
office.
Leave it to the government to turn prudence into
foolishness. Our wise leaders have left us at an
uncomfortable fork in the road: We can have doctor
confidentiality and accurate medical information or the
bogus federal medical privacy rule. We
cant have both.
Sheldon Richman is senior fellow at The Future of Freedom Foundation, author of Tethered Citizens: Time to Repeal the Welfare State, and editor of The Freeman magazine. Send him email.
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