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Altruism or Exploitation?

February 29, 2008
by James Feldbaum
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At HIMSS this week there was much buzz about Google's entry into the electronic health record arena. Google plans to supply a password-protected service that would store health records on Google computers with a directory that lets users import doctors’ records and their personal drug history and test results. Although Google will permit sharing of information between providers, control of all information will rest in the patient's hands. Google has initiated a pilot program at the Cleveland Clinic.

At HIMSS the Google booth was not on the main aisle. It was not giving away iPods or videogames - no free beer, pens, or trinkets. Still, it was so crowded that it took patience to make it to the front of the line.

At this early stage Google claims that this service will be advertisement-free. Yeah, right. How colossal is that loophole? I hate to be cynical, but the consumer of healthcare is a ripe target for advertising. You only have to watch the commercials during the evening news to get a sense of how vulnerable we are presumed to be to direct advertising. At times it seems that not only are drugs being pushed, but diseases and conditions as well. Even now, when I make a generic Google search I trigger targeted ads for advertisers in my local area. I don't blame Google - that's their business and it is a profitable model.

Our inaction as a profession to create an electronic personal health record and the halfhearted support from our government has left a vacuum that private industry could not ignore.

A private practitioner can not help but worry what a patient will do when they notice a laboratory value that is out of the normal range. While the result might be clinically and statistically insignificant, I predict it will prompt a patient to make Google searchs that will not be advertisement free. Such a search will, without a doubt, alarm a patient by raising the specter of terrible disease states which in nearly all cases will be irrelevant.

Our education system is recognized as being weak in the sciences. Most students have only superficial exposure to the biosciences and virtually no attention is paid to teaching Americans about their body in health and in illness. This naïveté is at the center of our vulnerability to manipulation.

One could argue that we will finally put personal medical information into the hands of patients who are clearly the rightful owners. But still, one must ask if we have altruistically begun the process of patient engagement in their own care or have we opened the doors to their exploitation.

What is the difference between unethical and ethical advertising? Unethical advertising uses falsehoods to deceive the public; ethical advertising uses truth to deceive the public.

Vilhjalmur Stefansson (1879 - 1962), "Discovery", 1964

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Comments

Jim,

Great blog entry...it's hard to imagine anything other than strict privacy until the players accumulate a critical mass of users/information then activate their business model once they have the hook set. Yes I know that's a bit cynical but microsoft and google aren't in the altruism business.

Here's some data to support your hypothesis about google applying/luring external ad searchs from the PHR. These are the sponsored ad links in the right margin of my gmails about my multiple myeloma and it's treatment.

1st email: discussion of kyphoplasty back surgery with my Oncology doctor.

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2nd email: an email to my caring community sharing my scores from a recent blood screening.

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Studies have clearly documented that direct drug advertising is effective. Prescription drug ads prompt nearly one third of Americans to ask their doctors about an advertised medicine, and 82% of those who ask say their physicians recommended a prescription according to a survey by USA Today, the Kaiser Family Foundation and the Harvard School of Public Health.
Airborne, touted as a shield from colds and flues, has just been ordered to repay $25,000,000 to the customers that it duped. What did people expect from a therapy that bragged that it was developed by a second grade teacher? My personal favorite scam is the Heads-on advertizing blitz: "Heads-on apply directly to the forehead". Someone really cashed in by selling millions of dollars of a substance that never even made a claim as to what it's for! People bought a tub of what, according to Wikipedia, is just wax.
Your personal illustration is particularly worrisome. Most of us search the Internet for factual information about medical conditions. Clearly, reliable information and disinformation share the same space. Profiteers find the worried and the ill ripe targets for advertising that promises easy cures for what ails them.
I am a fan of Google. Despite my cynicism, I am hopeful that with guidance from the legitimate medical community private industry will step in and responsibly fill the vacuum that we, as a profession, have been unable to fill. Still, there must be safeguards that prevent direct advertising that could derail legitimate therapy. In my opinion, the direct advertising to which you were exposed is an invasion of your privacy.

James Feldbaum

Jim Feldbaum is a physician consultant specializing in clinical transformation, CPOE, and...