haps even their Social Security numbers. Given the importance of
fighting cancer, if such a search is limited to a sample of the patients,
and if the data collected are properly protected, such a proposed re-
view board may well allow such disclosure. This does not mean that
everyone wishing to conduct a longitudinal study would gain such an
exemption. The review board might find that some other procedures
that violate privacy to a lesser extent could be used to the same effect.
And, of course, with every year that passes more data will be coded
with UPNs, rendering such forays less necessary.

Telemarketers, employers, and credit organizations who seek to use
medical data for their profit-making activities are likely to experience
a loss when they are no longer able to target the ill. This is a side ef-
fect we can learn to live with.

Medical privacy is full of abnormalities. It is in a fundamentally differ-
ent condition than the other four areas of public policy studied here.
Although there is an imbalance here, too, it tilts in the opposite direc-
tion: Privacy is unnecessarily compromised without serving any
important common good.

The violations of privacy we have seen are not those that have at-
tracted much attention--unauthorized uses of medical information by
some rogue individual--but highly systematic and authorized abuses
of personal information.

The violators are not the individualists' usual culprit, the govern-
ment, but are mainly privacy merchants, profit-making companies
that grow rich by selling information about people's medical condi-
tions to all comers.

The most effective treatments to shore up medical privacy cannot
rely on the legal fiction of informed consents by millions of patients
for every use of every piece of information about them, but on new
privacy-enhancing technologies (e.g., audit trails) and institutional
arrangements (e.g., changing reimbursement systems).

Above all, we need to rethink the public policy, normative, and con-
stitutional assumptions that underlie our conception of privacy, the
subject of the next, concluding chapter.

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