To the editor:

A recent commentary on the health sector database in Iceland described some of the sovereignty and business aspects of this issue (Nature Biotechnology 17, 407, 1999). During the past few weeks there have been significant developments that may effectively prevent the construction and operation of the database that deCODE Genetics has championed.

First, Mannvernd1, an association for ethics in science and medicine, has filed a complaint to the EFTA Surveillance Authority, challenging the new law based on its infringement of monopoly agreements that Iceland is party to. Based on the European Economic Area Accord, it seems unlikely that the Icelandic government can award a single company an exclusive license to construct and run a health sector database.

Second, the World Medical Association Council, after hearing presentations from the Icelandic government and the Iceland Medical Association (IMA), voted to support the opposition of the IMA to the database2. The IMA objects to the database law on the following grounds: (1) invasion of privacy; (2) breach of patient/physician trust; (3) lack of independent review mechanisms; (4) abuse of patient consent; (5) disregarding of established scientific standards; (6) use of medical records as a commodity; and (7) creation of a centralized database of an entire population.

Consequently, a significant number of Icelandic physicians will not be sending their patients' data to the database unless a patient requests it in writing. Therefore, as a practical matter, the controversial database may never be constructed.