Showing posts with label medical records. Show all posts
Showing posts with label medical records. Show all posts

Saturday, October 6, 2018

Dangerous Trend - Power Concentration in Canadian Society



State paternalism is a disease – that’s the only way to describe it. The state has a function, to facilitate human enterprise in a harmonious way. The challenge is, a relatively simple mandate gets highjacked by various powerbrokers – powerbrokers with one interest, to control. It isn’t so much the yearning for power that drives them, it’s the omnipresent self-interest that does.  There is a coalescence of state power and interest groups which merge the desire for interest groups to secure economic and other interests and the state to secure power (any given government at any given time); this makes state paternalism both powerful and lucrative.  The reason that state paternalism is a disease is that it steals freedom, quashes the individual and turns the state away from facilitating liberty to effecting control over people.

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For every action there is an equal reaction, one sees this play out often when observing nature, physical phenomena and in human discourse. So, it is logical to assume that when the state offers up a service that there is a reaction, or perhaps a cost. Or, when the state grants monopoly to a group to offer a service via regulation, that there is a reaction or a cost. It is often the case that under the pretence of “public protection”  regulatory frameworks come into place that restrict the supply of a service or offer a monopoly to a group for service provision; when this happens there is no competing offering and the cost of a given service rises. There are many examples of this throughout Canadian governance from medical services delivery, agriculture supply management, various professional groups bolstered by legislation – this list is endless. The fact that costs rise is punishment enough, it gets worse though because one's ability to choose whom to associate with is limited, one's choice of how to associate with others is limited and by extension control over your personal life is taken away and put into institutional hands. Please stop and contemplate your life and ask yourself, what part of your daily life is unaffected by government legislation and ask yourself what aspects of your life you retain control of.  In British Columbia, even something as personal as medical records are outside one's control, they are in public hands in a manner that fails to protect people’s privacy – with privacy goes freedom.


At some point, we have to limit the power of these monopolies over our lives because everyone knows that absolute power corrupts absolutely. The regionalization of the medical system in British Columbia is a classic example of the undue and unnecessary consolidation of power.  Regionalisation puts $13 Billion into the hands of 5 people in the province. Health Regions have become the sole provider of healthcare in areas so large that going to another region for healthcare is very difficult. The health regions are operated by crown corporations that have become very large and very powerful and nearly inaccessible to the average citizen relying on them for care. The health regions are just one example of many government (regional) monopolies. The education system is another; we have a single choice for the provider of education to our children. The CRTC, having been co-opted by the telecoms has effected an oligopoly in the telecom space and as a result, our telecom costs are some of the highest in the world.  We have the CRTC allowing policies that erode internet neutrality – the most democratising force to have ever come into play in human history is being challenged.

This trend toward the “totalitarian state” via the institutionalisation of society is very troubling because the “side effect” of the trend is the disempowerment of the individual.  This is in no way a call to end government support for people in need or to stop funding, it is a call to defuse power and to bring government to the point of facilitating people – that is to say,  to put power where it belongs with the individual. Increasingly, the power structures within these institutions are self-serving and they always seek to consolidate influence. 
The trend toward consolidation of influence, if left unchecked, is very dangerous, especially in our legal system, law enforcement and military. The RCMP, for example, is a far-reaching organization in Canada with a rank structure that is antiquated because it concentrates power to an apex of a person, rather than cellularizing or defusing power so that the apex of leadership is a creed.  

Most of our institutions preclude the existence of a competing entity and as a result, power concentrates.  This reality spills into the “real economy” in damaging ways as institutions pick winners, obstruct access to markets, reduce economic efficiency, increase transaction costs and create a Peruvian like economic structure. A Harvard Business School MBA class decided to do a case study on the Peruvian economy, they discovered it took 125 steps to licence a hotdog stand – turned out it was just easier to give the corrupt cop half your money.  We need to avoid this ever happening in Canada – unfortunately, it has; in many cases, when it comes time to do something, obstructive regulations are omnipresent - red tape is the arch-enemy of enterprise and innovation. 

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Monday, September 11, 2017

Privacy - What Privacy - Medical Records Gone Awry

Below is a Letter to Government sent several years ago at the outset of development of a medical record system in British Columbia - my worst concerns have come true. The data collected is considered the property of the government as opposed to being the property of the patient. People have no control over medical records, if you ask to have data removed they refuse. The records your family doctor keeps are electronic now, so what the doctor and perhaps one other person use to see - all medical personnel see now - what happened to patient doctor confidentiality. There are no easy means to opt out, you should have been requested to opt in. This is a part of a general erosion of privacy and liberty in British Columbia and Canada generally - we need to be alert and insist that our private lives remain private as we wish them to be.  



The advantages associated with the development of centralized medical records are immense and as such, I am a reluctant supporter of their introduction. As an individual greatly concerned with the encroachment of government into peoples personal lives and having witnessed the miss-utilization of other legislation, the introduction of electronic medical records is being considered with extreme trepidation. When one considers abuses of such data, the recent loss of British medical data by loss of a hard drive or like Safeway's selling of pharmaceutical records to insurance companies in the United States, the examples are endless; this trepidation is most certainly justified. In Canada, we have enjoyed a relatively pristine history with respect to medical discrimination, yet present are a few skeletons in our national closet, such as state sterilization of person's afflicted with none - genetic handicaps. When we dare to cast an eye to Europe's recent history and imagine the implications of this information in the hands of people gripped by the most sinister ideology, one begins to wonder whether the exercise is prudent at all. It is only the presence of a massive volume of information that is presently remaining un-captured and the promise that information offers for our population's benefit that compels this action; paradoxically, in BC we have all the exposure to centralised medical records and none of the benefits. The people responsible for the design of the systems associated with the capture and storage of this most sensitive data must be cognisant of the fact that in the contemporary context, this exercise seems benign enough, but history is full of examples of the errant use of such information.


It is a most fundamental right to refuse medical treatment and by extension, one should be able to refuse to have medical treatment recorded. A citizen should be allowed to retain control of their medical data. At present databases administered by medical professionals provides some insight to how causally the stewardship of such sensitive data can be. Presently any prescription you purchase in British Columbia is captured in the Pharmacy database and any pharmacist in the province with your name can search your records. You can write a letter to the government for a copy of your medical billing records and they are sent to you via the mail, absent any verification of who gets them at the point of pick up. We need to extend at least the same level of security to medical data as we do our financial data. If people want access to my bank information they need my bank card and a P.I.N. The technology is in place to extend an individual control over their personal data and this technology must be accessed, especially in the case of sensitive medical information.  
At the risk of being cynical, I have little confidence that people are taking seriously enough the implications of such data systems in the context of the full backdrop of human history. There is complacency, a casual sense it will be ok by governments. This is most alarming. There is a generalised acceptance of paternalism on the part of the populous that prevents people from arousing from apathy to challenge these kinds of developments.  

Thursday, October 29, 2015

The Cloud - with privacy goes freedom


The “Cloud”, once a term of nature, is now a term that means the aggregation of the world’s data into a central database. As a means to share data, to make data available to people, the internet has been a wonderful addition to the world. The challenge that is arising, is that personal data, every aspect of our lives is being aggregated and tabulated in a manner that puts our private lives in the hands of a few, and most concerning, in the hands of government. Once you commit a piece of data to the cloud, an email, a telephone conversation, your calendar entries – it is in effect in the public sphere. We need to find a way, across platforms to isolate that which we want the world to see, from that which we want private.
The first incursion into my private space via the internet was in 1994, it was three in the morning. I went into my home office to do some work, I had left my computer on and I noticed the curser moving around my computer screen. I sat and watched as someone remotely accessed my personal data, they opened files, accessed my browser data – I used Netscape at the time. To this day I have no idea who it was, that is a violation of most obscene kind.

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The cloud facilitates this type of incursion into the private lives of people, the challenge has been the insidious advance of the capacity to be monitored – if in 1950 you said to my father the government was going to read every letter he wrote in route, he would have screamed blue murder – we all have in effect acquiesced to this very reality in 2015. There is no means in any of the instruments developed in the modern technological sphere to patrician inherently private information from the public.
If you have a digital device that plugs in, it can be hacked. People hack into washing machines and change cycles or effect “malfunctions”. The list is endless, and very few people have the capacity to protect themselves and government seems content to permit this to go on, government is more than complicit in this incursion, it is a willing co-conspirator. Government seeks wherever possible to collect data regarding our person – the Canadian Long Census Form for example – even asks what your sexual orientation is, or government tabulates your personal income and foreign entities hack Revenue Canada’s database.

Privacy is one of the keystones of democracy. The capacity to function as a free agent is dependent on anonymity, absent anonymity the capacity for centralized control grows. The cloud has much promise; somehow we have to find a means by which to have control of our private data - I had someone hack my blog and take down a NATO article I wrote AND delete it from my hard drive in the last 30 days, my cellphone was hacked and data lost last week. My personal experience from 1994 until now illustrates to me, and I hope you, just how vulnerable we are.