Amazon’s purchase of One Medical could adversely affect patient privacy
My jaw dropped when I heard the news on Thursday that Amazon had bought One Medical, a digitally savvy primary care practice that I’ve trusted with my medical care since 2009. Broccoli? Will it tell my doctor if I drink too much beer? Will Amazon micromanage my doctor like its warehouse workers? Will it try to replace my health care with a Q&A from Alexa?
So I called one of America’s pre-eminent medical ethicists, Arthur Caplan of New York University’s Grossman School of Medicine.
“I think you should be feeling hyper nervous and a little depressed,” he told me. “Synergy makes a lot of economic sense, but for healthcare it can be lousy for consumers.”
(Amazon founder Jeff Bezos owns The Washington Post, but I review all technology with the same critical eye.)
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For some time now, it has been written on the wall that the consolidation of mega-corporations in the healthcare sector is imminent. Insurance giant Aetna merged with CVS. Amazon publicized its interest by buying online pharmacy PillPack and developing products like the Halo Band, a wearable device that collects body information and offers advice. And when Amazon gets into a business, it doesn’t just stay on the sidelines.
“This is another opportunity to amass a vast cache of personal data, to use that data and those relationships to further solidify Amazon’s dominance as an online intermediary for many goods and services,” said Stacy Mitchell, a Sharp Critic of the monopoly of tech giant Macht, who is co-executive director of the Institute for Local Self-Reliance.
Amazon’s cross-industry tentacles give data a superpower to generate incredible insights about individuals – which it can use to find very precise ways to manipulate us and the economy. It’s probably not the best idea that our streaming services and healthcare are from the same company.
An Amazon spokesperson declined to answer my question about how good it is for consumers — or patients — to allow a company to have so much of our data.
Amazon executives often say the company is driven by “customer obsession.” That might be true for delivering products in two days, 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 encourages making the right decisions regarding the human impact can hit its technology. There are so many examples: Amazon eavesdrops on our conversations, its Ring Doorbell puts police surveillance on our doorstep, and Amazon Sidewalk cuts your internet connection without permission.
Amazon’s skewed priorities really came to mind when a colleague and I reviewed the Halo, its first health device — and arguably the most invasive technology I’ve ever tested. It asks you to undress and put on a microphone so it can create 3D scans of your body fat and monitor your tone of voice. No joke, a computer will tell you if you sound “condescending.” It would be funny if there wasn’t a very serious possibility that this company could soon own my doctor’s office and all of my medical records.
What did you agree to? The doctor check-in software collects your health data.
In order for patients like me to trust Amazon as the owner of One Medical, Caplan proposed four big questions we need to know the answers to Stat.
- Will Amazon commit to having One Medical see a doctor? Amazon said current One Medical CEO Amir Dan Rubin, who is not a doctor, will continue to run it. Surely Amazon has enough of its own MBAs – we need a doctor who represents our interests. One Medical should have a large patient town hall where they talk about it and answer our questions. Unfortunately, One Medical didn’t even email patients about the news on Thursday.
- Will Amazon commit to building a firewall between patient data and Amazon’s many other tentacles? Amazon spokesman Dan Perlet wrote via email: “As required by law, Amazon will never share One Medical customers’ personal health information outside of One Medical for the purposes of advertising or marketing other Amazon products and services without the customer’s express consent. 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 wasn’t written for the internet age; As I’ve found time and time again, many companies are finding perfectly legal ways to collect intimate health data for marketing and other purposes with the “consent” few patients knew they were giving. “I worry that combining a giant product retailer and marketer with sensitive healthcare data could result in a tsunami of targeted advertising that you probably don’t want,” Caplan said. I’m particularly wary of Amazon trying to trick patients into handing over their data to the e-commerce giant in exchange for discounts or even — imagine — an Alexa-based telemedicine service.
- How does Amazon plan to ensure doctors and nurses can meet their ethical responsibilities? Neither es nor One Medical answered my question. Medicine is no ordinary business: Now Amazon has a duty of care. “Putting patients first can mean defying subpoenas or, conversely, reporting gunshot wounds or abuse,” Caplan said. In its press release announcing the deal, Amazon quoted CEO Neil Lindsay as saying, “We see many opportunities to both improve the quality of the experience and give people valuable time back in their lives.” Treating doctors like his fulfillment center workers, whose days are monitored to the minute and pushed for efficiency? That sounds like a terrible doctor’s visit, even if Amazon is more efficient at the time-wasting things like sitting in the waiting room.
- What, if anything, will the government do to protect patients in a world of this kind of horizontal mega-merger? Will it update our aging health privacy law? Will it impose limits on the way Amazon manages patient data? “It’s not a done deal yet,” Mitchell said. “The antitrust authorities will look very closely at that.” But for all the talk of containing big tech, Washington hasn’t been very successful lately. On Thursday, Sen. Amy Klobuchar (D-Minn.) wrote an open letter urging the Federal Trade Commission to investigate the deal, saying, “Amazon has a history of involvement in business practices that raise serious anticompetitive concerns.”
I’m giving Amazon and One Medical a month to convince me to stay here. After that, I’ll be looking for a new doctor’s office.