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

The application of powerful information technology tools to the practice of public health poses ethical, in addition to practical, challenges. Under a modern, electronic standard of care, it can be as blameworthy to apply such tools inappropriately as it is not to apply them at all. Certain ethical guidelines can help public health scientists make sound decisions about what users and uses of information technology (IT) are appropriate in public health. Even with these guidelines, however, there remain some gray areas, particularly with respect to maintaining the privacy and confidentiality of public health information. The power of modern IT tools renders obsolete some previously sacrosanct guidelines about maintaining privacy and confidentiality. It is therefore necessary for public health practitioners to exercise “progressive caution” in applying information technology to the practice of public health. Developments such as bioinformatics pose acute challenges to maintaining privacy and confidentiality, as does the use of powerful computer technology as support for decisions about interventions. 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 confidentiality 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.