Healthcare and treatment have always been closely entwined with technological innovation and learning. Knowledge of the body, as well as treatments and procedures which medics perform, have been made possible by the development of stethoscopes, X-rays and MRIs amongst myriad other technologies. However, recently there has been a push for the use of digital data to develop treatment, particularly in its processing and analysis through the use of artificial intelligence. But the corporate dominance of data capture and processing means that the benefits may be skewed towards the interests of Google and Apple (i.e. big tech companies) rather than those of patients, society and medical knowledge.
Today’s tech giants have made no secret of their desire to capture more and more of our health and medical data both by encouraging us to track our daily activities and through acquiring access to medical records. Apple, Google and Fitbit (amongst many others) offer opportunities for self-tracking. The bigger players are also positioning their platforms as central hubs for managing not just data on our exercise or diet but all our medical history and records. Notoriously, Google negotiated access to 1.5 million patients NHS records through a deal with the London Free Hospital in exchange for developing an app for detecting early signs of kidney failure. Companies are hungry for access to NHS datasets which are regarded to be some of the most valuable, estimated at £9.6bn per year, due to the unique 10 digit identifier which follows patients around the system. Digital health companies are also attracting record levels of investment with many ballooning in value after recently going public.
But this drive for corporate access to health data comes from governments as well. UK Health Secretary Matt Hancock is a well-known proponent of increased access to health data for tech giants. He has been a big supporter of companies such as Babylon Health and their provision of app-based healthcare which he sees as a big part of the future of the NHS. Hancock also recently announced £250 million of Department of Health and Social Care investment in AI which, given his track record, will most likely go towards partnerships with tech firms.
No doubt helping individuals to monitor and understand their own health and exercise provides benefits to some people and new knowledge and understanding will be gleaned from the application of AI to medical datasets. But there could be more negative outcomes through a shift in the “division of learning in society”, as the sociologist Shoshana Zuboff calls it. She claims that tech firms and private enterprise are hijacking how knowledge is generated and directly influencing which intellectual problems are targeted for their own ends.
It is unquestionable that Google, Facebook and others have produced some transformative technological innovations and the vast amount of resources they have at their disposal have attracted many of the most celebrated and ambitious minds from many different fields. But around 90% of the business of both companies is advertising. This means huge amounts of money and intellectual resources are directed towards encouraging people to spend more time on Facebook or clicking on links rather than investigating problems of greater importance for the world.
We have already seen how the injection of private capital into the realm of healthcare can skew development in particular directions. For example, the Bill and Melinda Gates Foundation was established as a means of applying their Microsoft billions to tackling global public health problems. Such was the level of investment that they became the second biggest contributor to the WHO after the United States. But the foundation is known for favouring techno-fixes and pharmaceuticals over less glamorous but (in many cases) more effective approaches such as the provision of basic sanitation. Nevertheless, the level of investment they have stumped up over recent years has shifted the direction of policy and research towards their interests, rather than identifying the most pressing needs of populations at global or even national levels.
In this context, Tamar Sharon, a philosopher of technology, has highlighted the dangers of what she calls the “Googlization of health research”. Sharon shows how the values of the tech industry have crept into health research and its applications. Sharing personal health data through companies like “23andme” (an online genetic profiler) is pushed as a “public good” just as Facebook claims sharing on their platform is good for society. An engineering disposition is also being ported over to medicine from the tech industry with an assumption that technical solutions can be found to “broken systems” with precision medicine and efficient and early diagnosis the current watchwords. Underlying all of this is the broader philosophy that state-run systems and public funding are inherently inefficient whereas the private sector, and particularly data-driven tech, companies are fast-moving, innovative and disruptive (all of which are assumed to be good).
Private companies are trying to hoover up all the best thinkers, influence which health problems are targeted and access or control all the data on our health and daily lives. If they do this they might do more than nudge us into going for an extra run around the park; they could redefine health itself. Indeed, this is what Google are trying to do with their “Project Baseline” whose mission statement makes the link with Google’s domination elsewhere “We’ve mapped the world, now let’s map human health”. When our health (like many aspects of the natural or social world) are mapped, measured and quantified this makes them more amenable to exploitation for profit by companies. Even more so when the companies are doing the mapping themselves.
Tech companies want to have privileged access to our daily health behaviours and shape how we understand them. But knowledge of health and medicine is crucial for individual and population-level happiness and prosperity. It is too important to be left to the unaccountable decision making of profit-driven tech giants. Collectively (and informed by expertise) we can assess what are the most pressing health problems and openly interrogate the evidence to find the best solutions. But this might be impossible if the knowledge and intellectual labour are locked up inside, and controlled by, companies chasing monopolies and the approval of advertisers and shareholders.