The Origins of "Confidential Commercial Information" at the FDA.

This Viewpoint reviews regulations regarding FDA's handing of confidential commercial information, explains how these regulations serve as a barrier to disclosure of information in the interest of public health, and suggests how information could be carefully shared to improve health outcomes and advance research.

Secrets, lies, and disguise: The case of andy warhol.

The life and works of the great American artist Andy Warhol (1928-1987) are examined in the context of Warhol's compulsive and often gratuitous lying. Elements of early trauma-contracting St. Vitus Dance at age of 7, his father's death at age of 13, and the abject poverty in which he grew up as the son of immigrants-are viewed as central antecedents of his deceptiveness. The relevance of these dynamics to the clinical situation is examined.

[Politicians' Personal Physicians: careers and complications from King David until today]. / Leib- und Seelenärzte Karrieren und Komplikationen von König David bis heute.

Court physicians need to deal with a clientele posing particular personality problems (e. g. rex inutilis) in a difficult environment characterized by specific health issues (morbi aulici) and they may have to avoid serious risks or want to seek great opportunities (medicus politicus). Very few have been successful as King David, a former music therapist without a medical degree, or the dentist and president Gurbanguly Berdimuhamedow. Several became victims of fatal circumstances. Not all could resist temptation of questionable literary fame at the expense of confidentiality. All told, a career close to high profile leaders needs to be considered carefully as risks may outweigh benefits.

The Clandestine Operations Performed on President Grover Cleveland and the Rationale for Surgical Secrecy.

The 1893 operations to remove a maxillofacial tumor from President Grover Cleveland aboard a private yacht remained a secret until long after his unrelated death from heart disease. Many historical studies have suggested that Cleveland kept his health and surgical care confidential because of the fragility of the economy during the Panic of 1893. Although that observation is true, it does not fully address the underlying reason for why the public would react poorly to news about an operation on the president. The death of Ulysses S. Grant eight years prior unearthed the denial, stigma, and fear of cancer felt by many Americans. Despite revolutionary 19th century advances in anesthesia, pathology, and surgery, the social history of "cancerphobia" ran deep.

Adolescent Confidentiality and Women's Health: History, Rationale, and Current Threats.

Adolescent access to reproductive health services, mental health services, and treatment of drug and alcohol use depends on teens' rights to consent and confidentiality in the state in which they live. This article reviews the history, current practices, and potential challenges to confidentiality, including Title X funding, questions about brain development and ability to make autonomous choices, and meaningful use practices in electronic records. Resources are provided for professional position statements and individual state regulations.

The end of medical confidentiality? Patients, physicians and the state in history.

Medical confidentiality has come under attack in the public sphere. In recent disasters both journalists and politicians have questioned medical confidentiality and claimed that in specific contexts physicians should be compelled to communicate data on their patients' health. The murders of innocent individuals by a suicidal pilot and a Swiss convicted criminal have generated polemical debates on the topic. In this article, historical data on medical confidentiality is used to show that medical practices of secrecy were regularly attacked in the past, and that the nature of medical confidentiality evolved through time depending on physicians' values and judgements. Our demonstration is based on three moments in history. First, at the end of the 16th century, lay authorities put pressure on physicians to disclose the names of patients suffering from syphilis. Second, in the 18th century, physicians faced constant demands for information about patients' health from relatives and friends. Third, employers and insurance companies in the 20th century requested medical data on sick employees. In these three different situations, history reveals that the concept of medical confidentiality was plastic, modelled in the first instance to defend well-to-do patients, in the second instance it was adapted to accommodate the physician's social role and, finally, to defend universal values and public health. Medical secrecy was, and is today, a medical and societal norm that is shaped collectively. Any change in its definition and enforcement was and should be the result of negotiations with all social actors concerned.

President Franklin D Roosevelt (1882-1945) and Doctor Frank Howard Lahey's (1880-1953) dilemma: The complexities of medical confidentiality with World Leaders.

In the months before the Presidential Election of November 1944, there were serious concerns about the health of President Franklin D Roosevelt. He had lost considerable weight and his once robust appearance had given way to a tired and haggard look. Despite these worrisome observations, Vice-Admiral Ross T McIntire, who served as Franklin Roosevelt's personal physician from 1933 until Roosevelt's death, lied when he proclaimed Roosevelt to be in 'excellent condition for a man of his age'. The truth about Roosevelt's health was further obscured when Roosevelt's medical records disappeared.

[The "secret book" of Dr Friedrich Benjamin Osiander: anonymous births in the Göttingen Accouchierhaus, 1794-1819]. / Das "Geheime Buch" des Dr. Friedrich Benjamin Osiander: Anonyme Geburten im Göttinger Accouchierhaus 1794- 1819.

The problem of anonymous or confidential deliveries, a subject of current controversy, has a long history. Some maternity hospitals offered the possibility for "clandestine" births as early as the 18th and 19th century. A recently emerged source about the maternity clinic of Göttingen University allows insight into the motives that led to keeping a birth secret and the consequences of such a clandestine birth for mother, father and child. The director of the institution, a professor of obstetrics, wrote case reports on the women, who paid a handsome sum for his help and the in-patient care they received. In return, these women could be admitted under a pseudonym, and thus falsify their child's birth certificate; moreover they were not used as teaching material for medical students and midwife apprentices, whereas "regular" patients had to give their names and, in return for being treated free of charge, be available for teaching purposes. The ten cases that have been painstakingly investigated reveal that the reasons that led the women and men to opt for an anonymous birth were manifold, that they used this offer in different ways and with different consequences. All of these pregnancies were illegitimate, of course. In one case the expectant mother was married. In several cases it would be the father who was married. Most of the women who gave birth secretly seem to have given the professor their actual details and he kept quiet about them--with the exception of one case where he revealed the contents of the case report many years later in an alimony suit. Only one of the men admitted paternity openly, but many revealed their identity implicitly by registering the pregnant woman or by accompanying her to the clinic. If the birth was to be kept secret the child needed to be handed over to foster parents. By paying a lump sum that covered the usual fourteen years of parenting, one mother was able to avoid any later contact with her son. In most cases contact seems to have been limited to the payment of this boarding money. One of the couples married later and took in the twins that had been born clandestinely out of wedlock. One mother kept close contact with her son through intermediaries. All of the women who gave birth in this clandestine fashion received practical as well as financial support, often from the child's father or from a relative. Few of them came by themselves. In those days, only women who used the maternity hospital free of charge would have been as isolated in the difficult perinatal period as are women today who choose to deliver their babies anonymously.

Biological warfare warriors, secrecy and pure science in the Cold War: how to understand dialogue and the classifications of science.

This paper uses a case study from the Cold War to reflect on the meaning at the time of the term 'Pure Science'. In 1961, four senior scientists from Britain's biological warfare centre at Porton Down visited Moscow both attending an International Congress and visiting Russian microbiological and biochemical laboratories. The reports of the British scientists in talking about a limited range of topics encountered in the Soviet Union expressed qualities of openness, sociologists of the time associated with pure science. The paper reflects on the discourses of "Pure Science", secrecy and security in the Cold War. Using Bakhtin's approach, I suggest the cordial communication between scientists from opposing sides can be seen in terms of the performance, or speaking, of one language among several at their disposal. Pure science was the language they were allowed to share outside their institutions, and indeed political blocs.

Intimidad y propiedad intelectual en las redes sociales: el caso colombiano / Privacy and intellectual property in the social networks:the colombian case

Los abusos que se hace del derecho a la información en internet y especialmente en las Redes Sociales Virtuales (en adelante RSV) son constantes y la posibilidad de restringirlos es mínima. Todo parecería indicar que en el mundo virtual no existirá la censura, pero se evidencia todo lo contrario. Muchos grupos de presión, entre ellos quienes buscan la defensa de intereses económicos, han instado a los gobiernos, como el colombiano, y a las empresas de la web (incluidas las RSV) para que constituyan mecanismos de control de todo lo que se difunde por internet y evitar atentados contra el honor, la intimidad y la propiedad intelectual, pero los métodos (legales o de facto) que se han implementado se convirtieron en una forma de censura de las expresiones creativas que reduce la disponibilidad de información y paradójicamente la libertad individual. Para demostrar lo anterior, en escrito se utilizó técnicas de estudio documental en los que se pudiera constatar la influencia de las RSV en el Derecho.

Abuses of the right to information on the Internet and especially in virtual social networks (VSN from now on) are constant and the possibility of restricting them is minimal. Everything would seem to indicate that in the virtual world there is no censorship, but there is evidence of the opposite. Many groups, including those who seek the defense of economic interests, have urged Governments, such as the Colombian one, and the Web companies (including the RSV) so that they constitute control mechanisms of everything that is spread via the Internet and prevent the attacks against honor, privacy, and intellectual property, but the (legal or de facto) methods that have been implemented have become a form of censorship of creative expressions that reduces the availability of information and paradoxically the individual freedom. In order to prove this, techniques of documentary study were used, in which the influence of the VSN in the Law, could be established.

The Duchess of Kingston's Case, the ruling of Lord Mansfield and duty of medical confidentiality in court.

The aim of this article is to demonstrate that the ruling commonly cited as the original precedent(1) for the doctrine that, at common law, medical practitioners' duty of confidentiality to their patients does not apply to court testimony,(2) did not, in fact, establish any such theory. The ruling by Lord Mansfield was made in the context of cross-examination by the Crown of a medical witness in the course of the trial of the Duchess of Kingston (Duchess of Kingston's Case (1776) 20 Howell's State Trials 355; [1775-1802] All ER Rep 623; [1776] 1 Leach 146), and this article will look briefly at: (1) the fascinating life of Elizabeth Chudleigh, the Dowager Duchess of Kingston, and the main events that led to her trial for bigamy; (2) the cross-examination of Caesar Hawkins and the different perceptions of the scope of confidentiality held by 18th century lawyers on the one hand and medical practitioners on the other; (3) Lord Mansfield's ruling that witnesses cannot withhold from the court facts which the law considers to be in the public domain; (4) the subsequent wide interpretation, usually as judicial obiter dicta, of its final paragraph during the 19th century, including early jurisprudential responses to the principle of medical confidentiality; and (5) the influence of John Henry Wigmore's opposition to patients' evidentiary privilege at common law during the twentieth century.

Openness versus secrecy? Historical and historiographical remarks.

Traditional historiography of science has constructed secrecy in opposition to openness. In the first part of the paper, I will challenge this opposition. Openness and secrecy are often interlocked, impossible to take apart, and they might even reinforce each other. They should be understood as positive (instead of privative) categories that do not necessarily stand in opposition to each other. In the second part of this paper, I call for a historicization of the concepts of 'openness' and 'secrecy'. Focusing on the early modern period, I briefly introduce three kinds of secrecy that are difficult to analyse with a simple oppositional understanding of openness and secrecy. In particular, I focus on secrecy in relation to esoteric traditions, theatricality and allegory.

Mining Tacitus: secrets of empire, nature and art in the reason of state.

A new political practice, the 'reason of state', informed the ends and practices of natural study in the late sixteenth century. Informed by the study of the Roman historian Tacitus, political writers gathered 'secrets of empire' from both history and travel. Following the economic reorientation of 'reason of state' by Giovanni Botero (1544-1617), such secrets came to include bodies of useful particulars concerning nature and art collected by an expanding personnel of intelligencers. A comparison between various writers describing wide-scale collections, such as Botero, Francis Bacon (1561-1626), Jakob Bornitz (1560-1625) and Matthias Bernegger (1582-1640), reveals that seventeenth-century natural intelligencers across Europe not only were analogous to political intelligencers, but also were sometimes one and the same. Those seeking political prudence cast themselves as miners, prying precious particulars from the recesses of history, experience and disparate disciplines, including mathematics, alchemy and natural philosophy. The seventeenth-century practice of combining searches for secrets of empire, nature and art contests a frequent historiographical divide between empirical science and Tacitism or reason of state. It also points to the ways political cunning shaped the management of information for both politics and the study of nature and art.

From ciphers to confidentiality: secrecy, openness and priority in science.

I make three related claims. First, certain seemingly secretive behaviours displayed by scientists and inventors are expression neither of socio-professional values nor of strategies for the maximization of the economic value of their knowledge. They are, instead, protective responses to unavoidable risks inherent in the process of publication and priority claiming. Scientists and inventors fear being scooped by direct competitors, but have also worried about people who publish their claims or determine their priority: journal editors or referees who may appropriate the claims in the manuscript they review or patent clerks who may claim or leak the inventions contained in the applications that cross their desks. Second, these protective responses point to the existence of an unavoidable moment of instability in any procedure aimed at establishing priority. Making things public is an inherently risky business and it is impossible, I argue, to ensure that priority may not be lost in the very process that is supposed to establish it. Third, I offer a brief archaeology of regimes and techniques of priority registration, showing the distinctly different definitions of priority developed by each system.

Blacked-out spaces: Freud, censorship and the re-territorialization of mind.

Freud's analogies were legion: hydraulic pipes, military recruitment, magic writing pads. These and some three hundred others took features of the mind and bound them to far-off scenes--the id only very partially resembles an uncontrollable horse, as Freud took pains to note. But there was one relation between psychic and public act that Freud did not delimit in this way: censorship, the process that checked memories and dreams on their way to the conscious. (Freud dubbed the relation between internal and external censorship a 'parallel' rather than a limited analogy.) At first, Freud likened this suppression to the blacking out of texts at the Russian frontier. During the First World War, he suffered, and spoke of suffering under, Viennese postal and newspaper censorship--Freud was forced to leave his envelopes unsealed, and to recode or delete content. Over and over, he registered the power of both internal and public censorship in shared form: distortion, anticipatory deletion, softenings, even revision to hide suppression. Political censorship left its mark as the conflict reshaped his view of the psyche into a society on a war footing, with homunculus-like border guards sifting messages as they made their way--or did not--across a topography of mind.