My jaw dropped when I heard the news on Thursday that Amazon was purchasing One Medical, a digitally savvy primary care doctor’s office I’ve trusted with my medical care since 2009. My mind raced: Will Amazon now use my medical records to push pills and broccoli? Will it tell my doctor if I’m drinking 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 up one of America’s preeminent medical ethicists, Arthur Caplan of the New York University Grossman School of Medicine.
“I think you should be feeling hyper nervous and a little bit depressed,” he told me. “Synergy makes great business sense, but it may make lousy consumer sense 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 some time that mega-corporate consolidation is coming to health care. Insurance giant Aetna merged with CVS. Amazon made its interest known by buying online pharmacy PillPack and developing products like the Halo Band, a wearable gadget that gathers body information and dishes out advice. And when Amazon gets into a business, it doesn’t tend to just stick to the sidelines.
“This is another opportunity to gather up a huge cache of personal data to use that data and those relationships to further cement Amazon’s dominance as an online intermediary for lots of good and services,” said Stacy Mitchell, a sharp critic of the tech giant’s monopoly power who is co-executive director of the Institute for Local Self-Reliance.
Amazon’s cross-industry tentacles give a superpower to data to develop incredible insights about individuals — which it can use to find very precise ways to manipulate us and the economy. It probably isn’t the best idea to have our streaming services and health care come from the same company.
An Amazon spokesman 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 frequently say the company is driven by “customer obsession.” That might apply to delivering products in two days, but I’ve seen little evidence over the last decade that the company puts a priority on our privacy — or that it has the kind of ethical culture that can make the right choices about the human ramifications of its technology. There are so many examples: Amazon eavesdropping on our conversations, its Ring doorbells bringing police surveillance to our doorsteps and Amazon Sidewalk siphoning your internet connection without permission.
Amazon’s twisted priorities really hit home for me when a colleague and I reviewed the Halo, its first health device — and hands-down the most invasive tech I’ve ever tested. It asks you to strip down and strap on a microphone so that it can make 3D scans of your body fat and monitor your tone of voice. No joke, it has a computer tell you if it thinks you sound “condescending.” It would be funny if it wasn’t a very serious possibility that this company may soon own my doctor’s office and have all my medical records.
You agreed to what? Doctor check-in software harvests 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 stat.
- Will Amazon commit to having a physician in charge of One Medical? Amazon said One Medical’s current CEO, Amir Dan Rubin, who is not a doctor, will continue running it. Surely Amazon has enough MBAs of its own — we need a doctor protecting our interests. One Medical should have a big patient town hall where it talks about this and answers our questions. Alas, One Medical didn’t even email patients about the news on Thursday.
- Will Amazon commit to putting up a firewall between patient data and Amazon’s many other tentacles? Amazon spokesman Dan Perlet emailed, “As required by law, Amazon will never share One Medical customers’ personal health information outside of One Medical for advertising or marketing purposes of other Amazon products and services without clear permission from the customer.” But the devil is in the details of that last phrase: 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 again and again, lots of companies find completely legal ways to grab intimate health data for marketing and other purposes with “consent” few patients realized they were giving. “I’m worried that the combination of a huge product distributor and marketer with sensitive health data could lead to a tsunami of targeted advertising that you probably don’t want,” Caplan said. I’m especially wary of Amazon trying to lure patients to hand 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 doctors and nurses can live up to their ethical responsibilities? Neither it nor One Medical answered my question. Medicine isn’t an ordinary business: Now Amazon has a duty of care. “Putting patients first may mean resisting subpoenas, or conversely reporting gunshot wounds or abuse,” Caplan said. In its news release announcing the deal, Amazon quoted executive Neil Lindsay saying that “we see lots of opportunity to both improve the quality of the experience and give people back valuable time in their days.” Is Amazon going to start treating doctors like its fulfillment-center workers, whose days are monitored down to the minute and squeezed for efficiency? That sounds like an awful doctor’s visit, even if Amazon is more efficient on the time-wasting bits 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 megamergers? Will it update our aging health privacy law? Will it put any limits on how Amazon manages patient data? “This is not a done deal,” Mitchell said. “The antitrust agencies will be looking very closely at this.” But for all the talk of reining in Big Tech, Washington lately hasn’t been very successful at doing it. 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 anticompetitive concerns.”
I’ll give Amazon and One Medical a month to convince me to stick around. After that, I’ll be on the hunt for a new doctor’s office.