Ethics, Information Technology, and Public Health: Duties and Challenges in Computational Epidemiology

Abstract

The use of powerful information technology tools in the practice of public health poses many interesting, diffi cult, and important ethical challenges. Under a modern, electronic standard of care, it can be as blameworthy not to apply such tools as it is to apply them inappropriately. Ethical guidelines can help public health scientists make sound decisions about what users and uses of IT are appropri- ate in public health. Even with these guidelines, however, there remain some gray areas, particularly with respect to maintaining the privacy and confi dentiality of public health information. The power of modern IT tools renders obsolete some previously sacrosanct guidelines about maintaining privacy and confi dentiality. Indeed, it may blur these distinctions to the point of complete confl ation. It is therefore necessary for public health practitioners to exercise “progressive caution” in applying information tech- nology to the practice of public health. Developments such as bioinformatics pose acute challenges to maintaining privacy and confi dentiality, as does the use of pow- erful computing technology as support for decisions about interventions. Moreover, the completion of the map and sequence of the genome of humans (and other organisms) is a technological accelerant for public health ethics. New genetic technologies have spawned an emerging fi eld – public health genomics— engaging the nature vs. nurture debate in new ways. Finally, the interests of ethics and sound public health practice collide in the application of such modern tools as meta-analysis and data mining to public health problems. Even the time-honored practice of using and publishing case studies in public health research presents challenges to maintaining confi dentiality of information as the World Wide Web and other communication and education tools make it increasingly possible for readers to identify the individual(s) discussed in a case.