Healthy Skepticism Library item: 13709

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Neal KC.
Google Health: Organizing Your Medical Information
Bioethics Forum 2008 May 22
http://www.bioethicsforum.org/Google-health-electronic-medical-records-patient-privacy-advertising.asp

Full text:

The press and blogs have been talking about it for a while, but on May 19, Google finally launched Google Health, a service that allows those who sign up for it to create their own personal electronic medical record system. Users will be able to enter their health information, manage it, and access it anywhere they can get on the Internet. No more forms to fill out at the doctor’s office. No more lost records because of moves, changes in health insurance, or hard drive failure. Better ability to coordinate health care information between different providers. Automatic drug interaction alerts. Sounds great, right? And it’s all free. Well, so they say.

As with Google’s email service, GMail, which stores user email and shows advertising related to email content, perhaps the most obvious concern is privacy. The Google Health Privacy Policy promises that the user can control her information. Only the user can edit information and decide who sees it. She can “completely delete” it at any time. And Google Health says it “will not sell, rent, or share” the user’s identified or de-identified information to anyone without consent, although certain exceptions apply – like “when Google believes it is required to do so by law.” Privacy concerns about GMail have waned in recent years perhaps because there are so many free online email alternatives. Similarly, privacy turned out not to be the biggest problem with Google Health.

The real concern with Google Health is that it makes sales pitches from pharmaceutical companies part and parcel of medical decision-making. Google product manager Eric Sachs is the inventor on a patent application for the Google Health software. The title: “Method and apparatus for serving advertisements in an electronic medical record system.” It seems that just when pharmaceutical sales representatives are being restricted from medical schools, hospitals, and doctors offices, Google Health has stepped in to fill the gap.

The patent describes numerous ways of generating advertising revenue through its online electronic medical record system. For example, when a physician views her patient’s Google Health electronic medical record (with the patient’s permission), she also sees advertisements for drugs, devices, and services that may be relevant to her patient. If a health care provider conducts a search from within the Google Health record, she will see still more advertisements. According to the patent, users must enable this feature if they wish to share their medical record with anyone, including health care practitioners.

Google Health is not particularly useful by itself. Other medical service providers must collaborate if users are to automatically transfer prescription information, download test results, and the like. For that reason, Google Health is seeking partners who are willing to integrate their software with Google Health or to advertise. These include chain pharmacies, medical seminar providers, medical journal publishers, laboratory and diagnostic companies, medical consultants or specialists, insurance companies and others. Several partners have already signed up, and insurance companies are especially welcome.

The patent suggests that “Insurance companies can potentially become a huge source of revenue because they could use these targeting methods to let doctors know about their preferences for treating a patient, such as reminding them to prescribe a particular drug instead of immediately scheduling the patient for a surgery.” The Google Health patent application indicates that it should be possible to disable the advertising function, but it also says that insurance companies may raise premiums for those who choose to do so.

The value of electronic medical record systems is well known, and given the increasing complexity of medical care, providers, patients, and others may be grateful for assistance in deciding between the numerous drugs, devices, techniques, and services that are available. However, that information should not come solely from advertising. If Google Health becomes the industry standard, we might just have been better off with the drug reps.

Karama C. Neal teaches research ethics at EmoryUniversity and is the editor of So What Can I Do, the public service weblog promoting ethics in action.