My jaw dropped when I heard the news on Thursday that Amazon was buying One Medical, the office of the digitally-enabled primary care physician I have trusted with my healthcare since 2009. My mind raced: Will Amazon now use my medical records to push pills and broccoli? Will he tell my doctor if I drink too much beer? Will Amazon micromanage my doctor like its warehouse workers? Will he try to replace my medical care with questions and answers from Alexa?
So I called one of America’s foremost medical ethicists, Arthur Kaplan of New York University’s Grossman School of Medicine.
“I think you must be very nervous and a little depressed,” he told me. “Synergy makes a lot of sense for business, but can make lousy consumer sense for healthcare.”
(Amazon founder Jeff Bezos owns The Washington Post, but I view all technologies equally critically.)
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There have been rumors for some time now that mega-corporation consolidation is coming in healthcare. Insurance giant Aetna has teamed up with CVS. Amazon has shown interest by purchasing online pharmacy PillPack and developing products such as the Halo Band, a wearable gadget that collects information about the body and provides advice. And when Amazon starts a business, it doesn’t just stay on the sidelines.
“This is yet another opportunity to harvest a huge cache of personal data to use that data and those relationships to further cement Amazon’s dominance as an online intermediary for a plethora of goods and services,” said Stacey Mitchell, a sharp critic of the tech giant’s monopoly. authorities, who is co-executive director of the Institute of Local Self-Government.
Amazon’s cross-industry tentacles give data superpowers for unbelievable insights about people that it can use to find very precise ways to manipulate us and the economy. It’s probably not the best idea to have our streaming services and healthcare owned by the same company.
An Amazon spokesperson declined to answer my question about how giving one company so much of our data would be good for consumers or patients.
Amazon executives often say the company is driven by “customer obsession.” This may refer to a two-day grocery delivery, but I’ve seen little evidence over the past decade that the company prioritizes our privacy or that it has the kind of ethical culture that can make good choices about the human consequences. of its technology. Examples abound: Amazon eavesdrops on our conversations, Ring doorbells provide police surveillance on our doorstep, and Amazon Sidewalk siphons your internet connection without permission.
Amazon’s twisted priorities really struck me when a colleague and I reviewed Halo, its first health device — and by far the most invasive technology I’ve ever tested. He asks you to undress and put on a microphone so he can take 3D scans of your fat and control your tone of voice. No kidding, he has a computer that tells you if he thinks you sound “condescending”. It would be funny if there was not a very serious possibility that this company could soon take over my doctor’s office and get all my medical records.
What did you agree to? Physician registration software collects data about your health.
In order for patients like me to trust Amazon as the owner of One Medical, Kaplan came up with four big questions that we need to know the answers to. statistics.
- Will Amazon make a commitment to appoint a doctor in charge of One Medical? Amazon has said current One Medical CEO Amir Dan Rubin, who is not a doctor, will continue to manage it. Surely Amazon has enough of its MBAs – we need a doctor to protect our interests. One Medical should have a big city hall for patients to talk about it and answer our questions. Alas, on Thursday, One Medical didn’t even send an email to patients with the news.
- Is Amazon committed to putting up a firewall between patient data and many other Amazon tentacles? Amazon spokesman Dan Perlet wrote in an email: “As required by law, Amazon will never share personal health information about One Medical customers outside of One Medical for promotional or marketing purposes of other Amazon products and services without the express permission of the customer.” But the devil is in the details of that last sentence: yes, America has a health privacy law called the Health Insurance Portability and Accountability Act. But HIPAA was not written for the Internet age; as I have found again and again, many companies are finding perfectly legitimate ways to obtain personal health data for marketing and other purposes, with “consent” that few patients knew they were giving. “I’m concerned that the combination of a large product distributor and a seller with sensitive health data could lead to a tsunami of targeted advertising that you probably don’t want,” Kaplan said. I’m particularly wary of Amazon trying to lure patients into handing over their data to the e-commerce giant in exchange for discounts or even—just imagine—an Alexa-powered telehealth service.
- How does Amazon plan to ensure doctors and nurses fulfill their ethical responsibilities? Neither he nor One Medical answered my question. Medicine is no ordinary business: Amazon now has a duty to care. “Putting patients first can mean resisting a subpoena or, conversely, reporting gunshot wounds or abuse,” Kaplan said. In its press release announcing the deal, Amazon quoted chief executive Neil Lindsay as saying “we see a lot of room to both improve the experience and give people back valuable time in their days.” Is Amazon going to start treating doctors like fulfillment center employees whose workday is tracked to the minute and compressed for greater efficiency? Sounds like a terrible doctor’s visit, even if Amazon is more efficient at wasting time like sitting in the waiting room.
- What, if anything, is the government going to do to protect patients in a world of such horizontal mega-mergers? Will it update our aging health privacy law? Will this place any restrictions on how Amazon manages patient data? “This is not yet a settled deal,” Mitchell said. “The antitrust authorities will be watching this very closely.” But for all the talk about holding back big tech, Washington hasn’t been very good at it lately. On Thursday, Senator Amy Klobuchar (D-Minnesota) wrote an open letter asking the Federal Trade Commission to investigate the deal, saying, “Amazon has a history of doing business that raises serious anti-competitive concerns.”
I will give Amazon and One Medical a month to convince me to stay. After that, I will look for a new doctor’s office.
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