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October 13, 1997

Bound to Gag

Author Affiliations

Department of Medicine Cambridge Hospital and Harvard Medical School 1493 Cambridge St Cambridge, MA 02139

Arch Intern Med. 1997;157(18):2033. doi:10.1001/archinte.1997.00440390015002

O WHAT physicians heard from patients was kept secret, scientists rushed to disclose discoveries, and ethicists criticized physicians for not telling patients the whole truth. Now insurance clerks routinely read medical charts, scientific breakthroughs are becoming trade secrets, and health maintenance organizations (HMOs) assert their right to tie our tongues.

The redefinitions of medical secrecy reflect and reinforce new commercial relationships that govern care. Physicians and scientists increasingly report to employers and insurers, who in turn answer to investors. Gag clauses make news because they too nakedly reveal who calls the shots in corporate care, contradicting the smoke screen rhetoric of market-driven accountability. Just as a car salesman works for the dealer, a gatekeeper works for the owner of the gate.

In this issue of the ARCHIVES, Brody and Bonham2 make the case that gag clauses are too raw a display of corporate power, and they are disturbed by

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