The horse may already be out of the barn when it comes to confidentiality of patients' medical information.
That should give pause to any physician who is concerned about retaining the trust of his or her patients-a trust built on protecting privacy of sensitive health issues.
Many expect HIPAA regulations to solve the privacy problem by creating the first comprehensive federal standards for medical confidentiality. Privacy advocates cheered President Bush's decision on April 14 to start the two-year clock on implementation of the rules.
But while the president embraced the popular cause of medical privacy, he left the door wide open to further changes when he asked HHS Secretary Tommy Thompson to suggest "appropriate modifications."
His action guarantees a new struggle over details of the rules and their interpretation, and it's not clear who will end up the winner in that process.
Furthermore, marketing exemptions may make the rule too ineffectual to stop the flow of patient information to data miners and other interested parties.
In our April issue, reporter Joseph Conn described how drugmakers and drug marketers have been working for years to create a conduit that will bring together the personal information found on patient prescriptions--their name and the drug they are using--with the patient diagnostic code.
That information will help drug marketers pinpoint individuals with sexually transmitted diseases or cancer, for example.
Such loopholes must be closed if HIPAA is to achieve its goal of patient protection.