Healthcare is often paternalistic,
but it's rarely associated with Big Brother. That could
change, though, if the new technology of implanted radio-frequency
identifier chips takes off. The chip, which recently entered
the US market, enables healthcare professionals to access
a patient's medical records using a scanner.
The July 28 issue of the New
England Journal of Medicine recounts the experience
of one doctor who decided to try such a chip for himself.
Dr John Halamka, an emergency physician at the Beth
Israel Deaconess Medical Centre in Boston, now carries
a device called a VeriChip in his posterior upper arm.
The chip contains tiny electronics in an unbreakable
glass capsule about the size of a grain of rice. A portable
reader can retrieve a unique 16-digit number from the
chip. Using that number, the authorized health professional
can access a secure website containing the chip carrier's
medical records.
WILL
IT STICK?
The chip is coated with a substance that adheres to
body cells. Although it was approved for medical use
by the FDA last October, a letter the FDA sent to the
manufacturer listed potential complications including
adverse tissue reaction, migration, compromised information
security, electromagnetic interference, electrical hazards,
and magnetic resonance imaging incompatibility. But
Dr Halamka's admittedly unscientific one-man experiment
turned up no such problems.
The biggest obstacle to widespread
use of the chip is its cost, at about US$200. A handheld
reader costs about $650 US. Dr Halamka recognizes that
the device has undeniable utility — it would make
fast work of identifying unconscious patients in the
ER, for example. But he does worry about privacy concerns.
As well as selling handheld readers, the manufacturer
sells "portal readers" that can scan the number
of anyone passing through a doorway, without the subject's
knowledge. Without access to the secure website, this
won't enable the reader to determine the chip carrier's
identity, but that doesn't mean it can't invade your
privacy.
"Without any interest in who
I am," worries Dr Halamka, "a scanner in a
mall could record my presence when I make a purchase
and, on a later visit, display a personalized message
on a large screen - 'Hi there! You were here three months
ago and purchased a fountain pen. We're having a special
on ink today.'" If that were the worst scenario,
then most people would probably be okay with the VeriChip.
But the manufacturer, Applied Digital Systems, sees
uses for its technology that go far beyond medicine.
Applications are being touted in airport security, access
to restricted areas and electronic payment systems that
do away with credit cards. In Barcelona, trendy young
things at the Baja Beach may jump the queue by walking
through a portal with their implanted VeriChips, literally
paying as they go.
PRIVACY
PROBLEMS
More worryingly, the technology has been sold to airports
and governments in Europe and Latin America. By making
passengers walk through a portal at passport control,
governments could potentially link the chip's number
to a tourist's name, and then track that person's movements
as they passed through other portals at other transport
hubs.
Canada is going to have to address
these privacy concerns, because while Applied Digital
Solutions has yet to apply for Canadian approval, the
company has made clear its intention of expanding here.
They already have a large Canadian market presence with
their livestock and pet chips. "On basic principle,
I don't think there's anything wrong with such a device
from an ethical point of view," says Margaret Somerville,
director of McGill University's Centre for Medicine,
Ethics and Law. "But there are many potential ethical
problems in implementation. If such a device were to
become widely accepted, consent might begin to be influenced
in ways that are coercive. For example, a nursing home
might only accept patients who agreed to carry a chip.
That would certainly be a problem ethically."
NO
HAVEN FROM HACKERS
Dr Jeff Blackmer, director of ethics for the Canadian
Medical Association, agrees that the chip has valid
potential uses, but worries that medical information
on the internet might be available to hackers. "They
seem fairly adept at breaking into even the most secure
websites. And could somebody build his or her own reader?
It wouldn't surprise me," he says. "The problem
is more serious when the same chip has other potential
applications, like electronic payment or airport security
information. We certainly wouldn't want to see that
data stored alongside medical records."
The chip might well be useful in
emergency room situations where a patient is unconscious,
he says, but since emergencies are unpredictable, this
sort of coverage would require everyone to carry one.
For more limited coverage, of Alzheimer's patients for
example, there's nothing the chip can do that couldn't
be done by a bracelet or tag carrying the necessary
information, says Dr Blackmer. If all Canadian citizens
were implanted with VeriChips, it would cost an initial
outlay of about a billion dollars. Some might brand
the VeriChip an expensive and potentially unethical
solution to a pretty rare problem.
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