My jaw broke when I heard the news Thursday that Amazon was buying One Medical, a digitally intelligent primary care doctor’s office I’ve trusted for my medical care since 2009. My mind raced: Will Amazon now use my medical records to pay for birth control pills and broccoli? Will you tell my doctor if I drink a lot of beer? Will Amazon manage my doctor like warehouse workers? Would you try to replace my health care with Alexa questions and answers?
So I contacted one of America’s leading medical ethicists, Arthur Kaplan of New York University’s Grossman School of Medicine.
“I think you must be feeling really nervous and a little depressed,” he told me. “Synergy has great commercial meaning, but it can make the consumer poor when it comes to health care.”
(Jeff Bezos, founder of Amazon, owns The Washington Post, but I review all technologies with the same critical view.)
We users want our technology to work. Here are our demands.
It’s been writing on the wall for some time that massive corporate consolidation is coming to the healthcare field. Insurance giant Aetna has merged with CVS. Amazon is best known for buying an online pharmacy, PillPack, and developing products like the Halo Band, a wearable that gathers body information and advice. And when Amazon gets into a business, it tends not to just stay on the sidelines.
said Stacey Mitchell, a fierce critic of the tech giant’s monopoly of power and co-executive director of the Domestic Self-Reliance Institute.
Amazon’s claws across the industry give the power of data to develop incredible insights into people – which can be used to find highly precise ways to manipulate us and the economy. It’s probably not the best idea for streaming and healthcare services 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 might apply to delivering products in a couple of 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 can make the right choices about the human repercussions of its technology. There are many examples: Amazon eavesdropping on our conversations, its Ring doorbells bringing police surveillance to our doorsteps, and Amazon Sidewalk pulling your internet connection without permission.
Amazon’s devious priorities really hit me when a colleague and I reviewed the Halo, its first health device—and tried out the most invasive technology I’ve ever tested. He asks you to take off and hook up a microphone so he can do a 3D scan of your body fat and monitor your tone of voice. No joke, it has a computer that tells you if it thinks you look “condescending”. It would be funny if there wasn’t the very serious possibility that this company would soon have my doctor’s office and all my medical records.
Did you agree to what? Doctor check-in software collects your health data.
For patients like me, who trust Amazon as the owner of One Medical, Kaplan suggested four big questions we need to know the answers to. stat.
- Is Amazon committed to appointing a physician responsible for One Medical? Amazon said One Medical’s current CEO, Amir Dan Rubin, who is not a doctor, will continue to run it. Amazon sure has enough of its own MBA – we need a doctor who protects our interests. One Medical should have a large town hall for patients where you talk about this and answer our questions. Unfortunately, One Medical did not send emails to patients regarding the news on Thursday.
- Will Amazon commit to putting a firewall between patient data and many of Amazon’s other tentacles? Amazon spokesperson Dan Burlett sent an email, “As required by law, Amazon will never share the personal health information of One Medical customers outside of One Medical for the purposes of advertising or marketing other Amazon products and services without the express permission of the customer.” But the devil is in the details of that last statement: Yes, America has a health privacy law called the Health Insurance Transfer and Accountability Act. But HIPAA was not written for the age of the Internet; As I have found time and time again, many companies are finding perfectly legal ways to obtain intimate health data for marketing and other purposes with “consent” few patients realize they were providing. “I am concerned that the combination of a massive and marketed product distributor 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’s attempt to lure patients into handing over their data to the e-commerce giant in exchange for discounts or even — just imagine — an Alexa-based telemedicine service.
- How does Amazon plan to ensure that doctors and nurses can fulfill their ethical responsibilities? Neither he nor a single medical person answered my question. Medicine is no ordinary business: now Amazon has a duty of care. “Putting patients first may mean resisting subpoenas, or conversely reporting gunshot injuries or abuse,” Kaplan said. In its news release announcing the deal, Amazon quoted CEO Neil Lindsey as saying, “We see a lot of opportunities to improve the quality of the experience and give people valuable time in their days.” Will Amazon start treating doctors like workers at the fulfillment center, whose days are monitored to the minute and pressed for efficiency? This sounds like a horrible doctor’s visit, even if Amazon is more efficient at dealing with time-wasting things like sitting in the waiting room.
- What, if anything, would the government do to protect patients in a world of these kinds of horizontal giants? Will our Aging Health Privacy Act be updated? Will it place any restrictions on how Amazon manages patient data? “This is not a done deal,” Mitchell said. “Antitrust agencies will look closely at this matter.” But for all the talk of reining in big tech companies, Washington has not been very successful lately in doing so. 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 engaging in business practices that raise serious anti-competitive concerns.”
I’ll give Amazon and One Medical a month to convince me to stay. Next, I’ll look for a new doctor’s office.