JUST THE FACTS. You are correct in assuming it is a personal decision to fill/not fill your prescriptions. But from the perspective of medical care, there is a definite need to know whether or not you did. Albeit, you need the absolute right to refuse to take a drug, for whatever reason. And albeit, it's nobody's right to look at what drugs you take, in order to make any decisions about you except on the basis of evaluating medical eficacy/medical care. My point:

1. We could gain immense knowledge by studying the overall care/treatment a patient receives in our efforts to combat disease. A key component of that is prescription drug usage. We can and should develop ways to use the data to evaluate drug compliance, but protect the patients privacy rights to not have that data used in punitive ways.

2. Perhaps more probematic, but if physicians had an objective way to evaluate a patients drug compliance, they could more effectively treat their patients. Patients always say they are compliant. If physicians had a way to evaluate true compliance, they could more effectively help the patient (Why didn't you fill your prescriptions? Because you can't afford it? Because you don't agree with the prescribed treatment? etc.)

I must count myself among those who find it amusing when self described conservatives fail to understand the difference between liberals and civil libertarians. Its especially ironic when self identified conservatives argue forcfully in favor of the nanny-state. They can't trust individuals to make decisions regarding their own bodies yet they are perfectly willing to trust a randomly selected government official with every available detail of anyones, medical history, buying habits, phone records and entertainment choices.

It is not quite correct to suggest that the Real ID Act was passed unanimously. This legislation is the brainchild of Rep. James Sensenbrenner (R, WI), chair of the House Judiciary Committee during the last Congress. He got it passed through his Committee and the full House in early 2005 (vote of 261-161, including 39 Democrats), then it didn't go anywhere in the Senate for several months.

At Sensenbrenner's insistence and with the support of the House Republican leadership, it was attached to the conference report for the FY05 Iraq/Afghanistan supplemental appropriations bill. The conference report was approved on a 100-0 vote, but the Real ID was never voted on by the Senate on a stand-alone basis.

>>Hi, Introvertgirl. ;-)

I think you are referring to Sybil Edmonds, FBI.<<

Thanks, LWM. My thoughts were, and are, so incoherent right now. Reading Glenn's great dissections has me grinding my teeth, but the chipping away of abortion rights today added to the surveilance information has my head exploding.

I love your comments about the piecemeal BS. We're getting to the point where even satire is helpless against the machine--all we can hope for is good science fiction to hold a mirror to our lives and show us how crazy it all is. Didn't Ray Bradbury write a great one taking equal opportunity to its absurd extreme?

That said, this is a fascinating thread; the comments about the practicalities of useful data mining are particularly interesting--and so true. Our capacity for creating algorithms that can find pertinent patterns in the randomness of the data is extremely limited. But, having the data at our fingertips, our capacity for making life hell for an individual or group doing something we dislike is limitless.

As a doctor who worries about civil liberties, I'm happy somebody keeps track of the Schedule II prescriptions, ambivalent about any tracking program for Schedules III, IV, and V, and opposed to Big Brother poking his nose into the non scheduled stuff.

Let me ask you this question - let's say I come into your office (I'm a mentally competent adult -- at least in our hypothetical) and tell you that I want to take a Schedule II drug (or Schedule III) for Problem X. You tell me that I shouldn't, that there is a high risk of addiction, that the problem doesn't warrant that treatment. I tell you that, after listening to everything you have said, I disagree with you and I want to take it anyway.

Why should your judgment prevail over mine for what I take? Why, as a competent adult, should I need your permission before I can take the substance I decide is best for me?

I ask that, in part, with reference to the attorney-client relationship. Often times in that relationship, there is as much at stake as there is in a doctor-patient relationship -- the individual's life savings, or financial security, or liberty, or even (in the rarest of cases), their life.

Yet the decision about what to do ALWAYS remains the client's. The lawyer can advise them, warn them, urge them in the strongest possible terms not to opt for Choice X because Choice X is stupid, self-destructive, risky, irrational, etc. But it is always an advisory role, never a parental role where the lawyer can override the client's choice for his own interests.

Why should the doctor have the ability to override the decisions of the patient? That really makes no sense to me, and for that reason, I am vehemently opposed to these prescription laws.

Beyond all of that, there is even less reason for the Federal government to be monitoring what substances I take. In addition to all the other reasons I listed in the post and commenters have added, I am also convinced - reading around everywhere today on this topic - that there are substantial numbers of people foregoing pharmaceutical treatments that they think they should have because they fear having that information registered in data bases with the government.

HHS Final HIPAA Privacy Rules
http://hhs.gov/ocr/part3.html

Section 164.502(f) - Deceased Individuals

Comment: One commenter asked us to delete our standard for deceased individuals, asserting that the deceased have no constitutional right to privacy and state laws are sufficient to maintain protections for protected health information about deceased individuals.

Response: We understand that traditional privacy law has historically stripped privacy protection on information at the time the subject of the information dies. However, as we pointed out in the preamble to the proposed rule, the dramatic proliferation of electronic-based interchanges and maintenance of information has enabled easier and more ready access to information that once may have been de facto protected for most people because of the difficulty of its collection and aggregation. It is also our understanding that current state laws vary widely with regard to the privacy protection of a deceased individual's individually identifiable health information. Some are less protective than others and may not take into account the implications of disclosure of genetic and hereditary information on living individuals. For these reasons, a regulatory standard is needed here in order to adequately protect the privacy interests of those who are living.

- - hhs.gov web site

If the prescription database is under the management of a "covered entity" (an organization covered by HIPAA), then unauthorized disclosure of P.H.I. (protected health information) is a violation of HIPAA, even after the patient is dead.