My jaw dropped when I heard the news on Thursday that Amazon was buying One Medical, a digitally savvy primary care physician practice I’ve entrusted my medical care to since 2009. My mind raced: Amazon will it now use my broccoli medical records? Will he tell my doctor if I drink too much beer? Will Amazon micromanage my doctor like its warehouse workers? Will it try to replace my healthcare with a Q&A from Alexa?
So I called one of America’s foremost medical ethicists, Arthur Caplan of New York University’s Grossman School of Medicine.
“I think you should be feeling super nervous and a little depressed,” he told me. “The synergy makes a lot of business sense, but it can make poor sense to consumers for health care.”
(Amazon founder Jeff Bezos owns The Washington Post, but I review all technology with the same critical eye.)
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The writing has been on the wall for a while as mega-corporate consolidation happens in healthcare. Insurance giant Aetna has merged with CVS. Amazon has signaled its interest by buying the online pharmacy PillPack and developing products like the Halo Band, a wearable gadget that collects body information and gives advice. And when Amazon gets into a business, it doesn’t tend to sit on the sidelines.
“This is another opportunity to bring together a huge cache of personal data to use that data and those relationships to further Amazon’s dominance as an online middleman for many goods and services,” said Stacy Mitchell, acerbic criticism of the tech giant’s monopoly. power who is co-executive director of the Institute for Local Self-Government.
Amazon’s cross-industry tentacles superpower data to develop incredible insights into individuals – which they can use to find very precise ways to manipulate us and the economy. It’s probably not the best idea for our streaming services and our healthcare to come from the same company.
An Amazon spokesperson declined to answer my question about how allowing one company to have so much of our data was good for consumers — or patients.
Amazon executives often say the company is driven by “customer obsession.” That may apply to two-day product delivery, but I’ve seen little evidence over the past decade that the company puts our privacy first — or has the kind of ethical culture who can make the right choices about the human ramifications of their technology. There are so many examples: Amazon listening in on our conversations, its Ring doorbells bringing police surveillance to our doors, and Amazon Sidewalk siphoning off your internet connection without permission.
Amazon’s twisted priorities really hit me when a colleague and I reviewed the Halo, its first health device — and by far the most invasive technology I’ve ever tested. He asks you to strip naked and attach a microphone so he can perform 3D scans of your body fat and monitor your tone of voice. No kidding, a computer tells you if it thinks you look “patronizing.” It would be funny if there wasn’t a very serious possibility that this company would soon own my doctor’s office and have all my medical records.
What did you agree on? Doctor registration software collects your health data.
For patients like me to trust Amazon as the owner of One Medical, Caplan suggested four big questions we need to know the answers to. statistical.
- Will Amazon commit to having a doctor in charge of One Medical? Amazon said current One Medical CEO Amir Dan Rubin, who is not a doctor, will continue to lead it. Surely Amazon has enough MBAs – we need a doctor to protect our interests. One Medical should have a big town hall for patients where he talks about it and answers our questions. Alas, 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 spokesperson Dan Perlet emailed: “As required by law, Amazon will never share the personal health information of One Medical customers outside of One Medical for advertising purposes. or marketing other Amazon products and services without the customer’s clear permission.” 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 seen time and time again, many companies are finding completely legal ways to harvest intimate health data for marketing and other purposes with the “consent” that few patients realize they are giving. “I’m concerned that the combination of a huge marketer and marketer of products with sensitive health data will lead to a tsunami of targeted ads that you probably don’t want,” Caplan said. I’m particularly suspicious 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 he nor One Medical answered my question. Medicine is no ordinary business: now Amazon has a duty of care. “Putting patients first can mean resisting subpoenas or, conversely, reporting gunshot wounds or abuse,” Caplan said. In its press release announcing the deal, Amazon quoted executive Neil Lindsay as saying that “we see many opportunities to both improve the quality of experience and give people back valuable time in their days.” Will Amazon start treating doctors like its fulfillment center workers, whose days are monitored to the minute and rushed for efficiency? It feels like a horrible visit to the doctor, even though Amazon is better at the time-wasting parts, like sitting in the waiting room.
- What, if anything, is the government going to do to protect patients in a world of these kinds of horizontal mega-mergers? Will it update our aging health privacy law? Will this impose limits on how Amazon handles patient data? “It’s not a done deal,” Mitchell said. “The antitrust agencies are going to look into this very closely.” But for all the talk of mastering Big Tech, Washington hasn’t been very successful lately in doing so. On Thursday, Sen. Amy Klobuchar (D-Minn.) wrote an open letter asking the Federal Trade Commission to investigate the deal, saying, “Amazon has a history of engaging in business practices that raise serious anti-competitive concerns.”
I’m going to give Amazon and One Medical a month to convince me to stay. After that, I’ll be looking for a new doctor’s office.