Lecture #4: Medical record privacy
I explained that some of the problems given in the previous meeting's
homework assignment were inspired by Silk and Cyanide which I
had recently read. This book was a memoir of the author's experiences
as a cryptographer in World War II. Part of the book was devoted to
the author's untangling the errors introduced when "hand systems" were
actually used by British spies in Nazi-dominated Europe.
Then we had a discussion about medical record privacy. Things went
slowly. We discussed a number of the "talking points" suggested on the
medical records web page. I asked people to identify themselves a
number of times. I'd guess that about 80% of the students there spoke,
and about a third of them spoke several times. I need to actually
identify people, and to "keep score" -- record those who speak and use
a reference for their assertions. Things went better in the first
semester. That class had been smaller and I had prepared the
discussion session by asked the class to divide into two groups and
discuss among themselves opinions about the "talking points" below. I
should have done that again, perhaps.
I began the discussion by writing some assertions on the board:
I gave out the writing assignment [PDF|PS|TeX]. I gave out an
information sheet that people could use to do the secret sharing
contest [PDF|PS|TeX]. I also gave
out numbers for the contest [PDF|PS|TeX]. Note that the TeX
file has (after the /end command!) the answer to the contest and the
Maple language I used to create the numbers given.
- If I have had treatment for an STD or for emotional distress who
needs to know?
- How can an insurance company keep control of possible health care
fraud claims or be fiscally responsible if it needs to pay out and
make a profit without knowing lots about its patients and their
- What if drug companies and medical device companies want to know
who is "suffering" so they could distribute information about better
- What if you or a child of yours has a rare disease. Wouldn't you
want to know about different treatments and the success of these
treatments? Who owns such information?
- The real-life Gattaca (a recent movie about the
limitations that a genetically determined environment could bring):
currently the whole population of Iceland (restricted in number, and
historically immigration and emigration not great, and good
information about ancestry) is having its entire "genetic code" (DNA?)
recorded. Who owns this information? Wouldn't recording such
information be good (law enforcement, susceptibility to disease)?
Wouldn't it be bad (it could be used to restrict opportunities for
some people)? A former student sent in e-mail that "`Gattaca' is
composed of the letters used to represent the nucleotide bases which
make up DNA: Guanine, Adenine, Thymine, and Cytosine."
I wanted people to work together. I don't think I explained the rules
well enough, because I think that some people just took information
from others and worked out the answer by themselves. t wasn't clear
that they did this.