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News
1505
BMJ VOLUME 318 5 JUNE 1999 www.bmj.com
Doctors and pharmacists who
sell information about doctors’
prescriptions to a database com-
pany for commercial use would
breach patient confidentiality
even though the information
was anonymised, a High Court
judge ruled last week.
The case is the first in the
English courts to raise the ques-
tion of whether the use of
anonymised data breaches
patient confidentiality.
The ruling at the High Court
in London throws into question
the legality of the widespread
use of anonymised data from
patients’ medical records for
medical research.
Mr Justice Latham held that
pharmacists and doctors could
not lawfully take part in a
scheme to sell prescription
information to pharmaceutical
companies because patients’
implied consent covered use of
their data only for treatment
and related NHS purposes.
Source Informatics, a sub-
sidiary of a US company, had
challenged Department of
Health guidelines saying that
disclosure of details from pre-
scriptions would constitute a
breach of confidentiality which
could lay doctors and pharma-
cists open to legal action.
Source Informatics operates
a prescriber database for phar-
maceutical companies wanting
to target GPs more precisely with
promotions and information
about their products.
After the Department of
Health’s guidance in July 1997,
GPs had refused to allow their
prescription details to be sup-
plied to the database.
The judge was not willing to
pronounce on the legality of
using anonymised patient
records for research without
hearing evidence specifically on
the point, so this remains an
open question.
He said that there were two
possible arguments that doctors
or researchers could use if the
question arose: that patients had
given implied consent to the use
of their records for research or
that disclosure of the informa-
tion in these circumstances
would be in the public interest.
Source Informatics was given
permission to appeal to the
Court of Appeal after its coun-
sel, Sarah Moore, told the judge:
“This case raises issues of huge
importance for the law of confi-
dentiality.”
She added: “There is very little
authority on this point despite the
fact that material from patients’
records is routinely used for sta-
tistical and research purposes.”
Sale of prescription data breaches confidentiality
Clare Dyer, legal correspondent, BMJ
25, 110, 123
Cycle helmets
should not be
compulsory
Douglas Carnall, BMJ
223, 170, 2, 250
Cyclists are advised to wear hel-
mets but legislation to make
them compulsory is likely to
reduce the number of people
choosing to cycle and would not
be in the interests of health,
concludes the BMA’s Board of
Education and Science.
International evidence shows
that the compulsory use of hel-
mets results in a fall in the num-
ber of cyclists. The Australian
state of Victoria made the use of
helmets compulsory in 1990,
and in the following year deaths
and head injuries among cyclists
fell between 37% and 51%. How-
ever, 40% fewer adults and 60%
fewer children continued to
cycle after the introduction of
the laws.
About one in five cyclists in
Britain currently wears a helmet.
This proportion would have to
be increased by promotional
campaigns encouraging volun-
tary action before legislation
could hope to be effective.
Some cyclists are opposed to
wearing helmets. Research by
the European Cycling Federation
found that non-cyclists tended to
be most in favour of helmets. In
fact, a much greater number of
lives would be saved if pedestri-
ans and car occupants were
encouraged to wear helmets.
The board’s previous reports
have concluded that the benefit
to health of regular exercise from
cycling outweighs the British
cyclist’s comparatively high risk
of trauma. In countries such as
the Netherlands and Denmark
pedestrians and cyclists form a
much smaller proportion of
those injured or killed on the
road, though helmets are little
used. Instead, these countries
have concentrated on safety pro-
grammes to reduce motor traffic
speeds to 30 km/h in urban
areas and separate cyclists from
fast moving traffic.
Properly fitted helmets manu-
factured to accepted standards
can reduce the severity of head
injury in a crash, though the tests
on which these standards are
based mimic a fall from a cycle
rather than collision with a fast
moving vehicle, which is most
likely to harm an adult cyclist.
Children are more likely to
simply fall off their bicycles and
may therefore derive more ben-
efit from wearing a helmet.
However, the cost—between £12
and £90—and the necessity of
replacing helmets every few
years as the child grows may be
prohibitive.
The report recommends that
the government should consider
subsidising this cost, along with
other measures to promote hel-
mets manufactured to the high-
est standard (Snell B95). It also
recommends that every child
should be given the opportunity
to learn cycling proficiency and
that the driving test should be
modified to test specifically for
awareness of cyclists and other
road users.
Children may derive more benefit than adults from cycle helmets
15287
PETE SALOUTOS/THE STOCK MARKET
