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Unhealthy Disclosure

As sensitive as credit reports are, medical records are even more so. But here, too, your privacy is at risk. The biggest repository of medical files in the United States and Canada is the Medical Information Bureau. This consortium of insurance companies maintains millions of records culled from insurance applications as well as from doctors' and hospitals' files. When someone applies for a policy, insurers scan MIB's computers for information about any preexisting conditions that might affect their decision to issue the policy or how much to charge.

MIB tries to be careful about who sees its files. But because every insurer in the United States and Canada has access to these records, information sometimes ends up in the wrong hands. Paul Billings, chief medical officer for a Texas health care network, wrote about such a case. He tells of a woman who was turned down for a job because her MIB file indicated that she had a predisposition for a muscular disease, even though she had no symptoms of the condition. Her prospective employer had obtained her records through the firm's insurance company.

Lately, marketers have gotten into the act, increasingly using medical records to target consumers. For example, Elensys, a company in Woburn, Massachusetts, manages electronic records for thousands of pharmacies and uses their customer files for marketing purposes. Developing mailing lists on the basis of prescription information, Elensys sends personalized letters--on pharmacy letterhead and sometimes paid for by drug manufacturers--reminding customers to keep taking their medicine or pitching new products to treat an ailment.

Elensys spokesperson Kathryn St. John defends the company's practice as a service to patients. She adds, "It's important to note that we don't sell the names in the database to other companies so they can market products."

But some critics aren't appeased. "It's a gross invasion," complains George Lundberg, a physician and the editor in chief of the Journal of the American Medical Association. "Do you want the great computer in the sky to have a computer list of every drug you take, from which can be deduced your likely diseases--and all without your permission?"