Issue link: https://nnumagazine.uberflip.com/i/765771
These are the conditions that precipitate Ensign's own homeless- ness, unique in one sense, but similar to what triggers homelessness for so many. When the very network, family, and job you most depend on for support reject you or when you are compelled to reject them because they are abusive, you are left with few options. If you want to find out what happens, you'll have to read the book! In the book's introduction, Ensign writes, "Stories analyze us if we pay attention to what attracts or repels us while reading or hear- ing the stories, and if we reflect on why that is so. Stories we easily understand are stories we easily forget." I highly recommend you read this book. You won't forget it. —Martha Wallner Healthcare and Big Data: Digital Spectors and Phantom Objects By Mary Ebeling Palgrave Macmillan US, 2016 In Healthcare and Big Data: Digital Spectors and Phantom Objects, author Mary Ebeling investigates the birth of what she calls her phantom "market- ing baby." This phantom baby's digital birth in a marketers' database coincid- ed with her very real miscarriage. Ebeling's phantom baby returns to haunt her everyday life, resulting in an endless, emotionally draining stream of mailings, sales calls, and online advertising that she receives after being wrongly tagged as a new mother by some unknown, but influential marketing database. Healthcare and Big Data's aim is to show "how patients and users of healthcare in the USA are subject, with or without our consent, to massive data surveillance, collection and commodification." The book examines how a large, yet nearly invisible industry of data brokers col- lects and resells hundreds of data points gleaned on each of us daily from both online and off-line behavior. When a service on the internet such as email, a search engine, a social media platform, or a website such as WebMD, is offered to you at no cost, that means that you and the data you generate are what is for sale on the back end. Data brokers collect information on individuals from more than 50,000 sources that are packaged into an estimated 200 records on average for every U.S. citizen. This vast trove of records collected in massive databases that grow larger by the nanosecond is what is meant by "Big Data." Big data is sold to the public as a means to revolutionize health- care and improve our lives and our health. But big data is a huge business enterprise intended to generate profits from what many of us believe mistakenly is our personal health information. For Ebel- ing, big data "means mass surveillance, and intrusion into what we consider private." Ebeling argues that patients in the United States do not give informed consent to how their information is used or shared and that "the power over health data and digital personhood has never been in the hands of the patient." While many healthcare providers think of the goal of HIPAA as being to keep patient data confidential, Ebeling points out that HIPAA was designed to facilitate the sharing and disclosure of patient data. In many cases, all the care that a nurse may take to protect a patient's individual privacy is rendered meaningless with the act of entering the patient's data into an EHR! This is because many EHR companies require hospi- tals and physicians to sell or release patient data to the vendor, making all the information input through the software the vendor's property, which the vendor can resell to data brokers or other third-parties. This means that EHR vendors operate essentially like Facebook when it comes to owning and controlling the data we generate. While the public is continually assured that our personal health records have been scrubbed of the data that would identify us, Ebel- ing calls this faith in de-identification a "collective delusion." Ebeling cites studies where privacy scholars have demonstrated conclusively that supposedly anonymized hospital records can be re-identified with individual patients using just a handful of data points. For example, privacy scholar Latanya Sweeny's 1997 and 2013 studies re-identified the hospital records of individual patients at rates of 87 percent and 43 percent respectively. Ebeling and others believe that credit bureaus and other data brokers are seeking to combine social media behaviors, health risk factors, and ethnicity in credit risk scores and similar reporting. If such data is combined with our re-identified medical records, and all our credit card and ATM transactions, this data can become even more threatening to our health, privacy, and financial well-being. Healthcare and Big Data provides the reader with a wealth of ref- erences and resources for further study, but parts of the book read like they were rushed to publication. While the chapters focusing on HIPAA and the role of EHRs are written much more clearly than oth- ers, useful information often lies amid impassable thickets of academ- ic writing. Even so, the book complements other recent books that explore the endangered species that is individual privacy in a high- tech world, such as Frank Pasquale's Black Box Society (2015), and Cathy Oneil's Weapons of Math Destruction (2016). —Nate Johnson Medical Cannabis: What Clinicians Need to Know and Why By Gregory L. Smith, MD Aylesbury Press, 2016 Timing is everything! In 1996, with the passage of Proposition 215, California became the first state in the nation to approve the use of cannabis as a medicine. Although medical cannabis has been legalized in 23 states and the District of Columbia, many clinicians continue to hold onto misconceptions about its addictive risks and reputation as a "gateway drug." Most recently in the November 2016 elec- tion, California legalized personal marijuana use for people over age 21, so the more knowledgeable a clinician is, the better. According to Dr. Gregory Smith, 11 other states are in the process of enacting, or are likely to enact medical and/or recreational cannabis laws with varying kinds of restrictions, by the November 2016 election. Rapidly expanding scientific data regarding the bene- ficial and therapeutic effects of medical cannabis gives credence to decades of anecdotal reports made by patients and their caregivers. Topics include a brief history of the human use of cannabis, con- ditions and symptoms that respond to medical cannabis, cannabis 16 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T | S E P T E M B E R 2 0 1 6