The Threat of Real ID

If you live or work in the United States, you'll need a federally approved ID card to travel on an airplane, open a bank account, or take advantage of nearly any government service.

The Real ID Act hands the Department of Homeland Security (DHS), the department that was responsible for the Hurricane Katrina response, the power to set these federal standards and determine whether state drivers' licenses and other ID cards pass muster. Only ID cards approved by DHS can be accepted "for any official purpose" by the feds.

The card will contain name, birth date, sex, ID number, a digital photograph, address, and a machine-readable technology to read that data. DHS is permitted to add additional requirements--such as a fingerprint or retinal scan--on top of those. We won't know for a while what these additional requirements will be but DHS has indicated that it may require radio-frequency identification (RFID) chips which would allow your ID card to be read remotely without your knowledge. (The State Department is already going to be embedding RFID devices in passports.)

Real ID demands that all driver's licenses or ID cards have pictures that can be read by facial-recognition technology.

The Real ID Act also requires states to interconnect their databases to a national database.

The machine-readable technology embedded in your ID card will make it possible for banks, retailers, airlines, etc. to demand your ID card and to easily collect all your personal data into their systems. This will clearly make identity theft much easier. And the data collected could be sold to commercial companies such as CheckPoint which have had large amounts of data stolen by identity thieves.

Cleveland Clinic Part I

Last December the Wall Street Journal ran a series reporting on the relationship among the Cleveland Clinic, the Clinic's CEO Dr. Toby Cosgrove, and medical device companies. The Cleveland Plain Dealer also commented on the controversy. The articles looked at how these relationships create a conflict of interest between financial and patient care concerns at the Clinic.

While at the Clinic, Dr Cosgrove sat on the board of the medical device maker AtriCure, was an investor in the company, and continues to receive royalty payments from the company. The Clinic itself invested $25 million in the company which makes equipment used in an operation to correct atrial fibrillation or heart flutter. Doctors at the Clinic performed the procedure on over 1,200 patients without informing them about the financial ties among the Clinic, AtriCure, and Dr Cosgrove.

Our society has longed recognized the corrupting influence of financial inducements that may conflict with the primary responsibilities of politicians and other government officials as well as many others who are entrusted with providing vital services to the public. The Governor of the state was convicted and fined for accepting a round of golf without disclosing it. Financial services firms pay huge fines for conflict of interest violations that may mislead investors.

Medical professionals, especially, carry a huge responsibility to avoid flirting with the possible corrupting influence of financial ties that may influence patient care. As the Hippocratic Oath says, "I will remember that I remain a member of society, with special obligations to all my fellow human beings."

Personally, I am stunned that Dr Cosgrove and the Clinic allowed themselves to be put into this position, if for no other reason than that it damages the reputation of the Clinic and the trust that patients place in their Clinic physicians. I suppose that, with a board of trustees consisting of about 90 members, many of whom are retired CEOs, no individual member feels much responsibility for the hard job of enforcing ethical behavior.

But if I were one of the 1,2000 patients who have undergone the AtriCure procedure, I would be feeling quite betrayed.