You wake up at 7:29am and ask Amazon’s Alexa virtual assistant what the weather will be like. Within seconds, Amazon realises you sound unwell and offers you medicine to fix you up before work.
One hour later, an Amazon drone hovers over your garden to gently drop Amazon-made medicine onto your foxgloves. Meanwhile, Amazon has quietly adjusted its database so that tonight, when you sit down to watch Amazon Prime TV, you will see adverts for Amazon Basics hot water bottles and Amazon Fresh chicken soup.
As dystopian (and convenient) as this sounds, all this technology has already been announced or invented by Amazon. Like his rivals at Google and Apple, chief executive Jeff Bezos is treating healthcare as a new frontier, and his bets have begun to coalesce into what Sanchit Jain, an e-commerce expert at Enders Analysis, describes as a sweeping plan to “Amazonise” the medical industry.
In the UK, the company has made itself indispensable to the NHS, providing cloud computing muscle for contact tracing and virus research while delivering home Covid tests to essential workers.
The coronavirus pandemic has also caused a collapse in non-Covid hospital admissions, driving interest in the idea of digital healthcare.
Hospital admissions in lockdown
In the US, as catalogued in a meticulous report by CB Insights, it has planted flags in drug making, hospital supplies, insurance pricing, cancer screening, medical records analysis and beyond.
“It’s quite realistic to imagine a system where everything is handled by Amazon,” says Mason Marks, a US medical doctor and law professor who studies health tech.
“From the consultation – maybe even employing doctors as contractors – to handling the teleconferencing software, the prescriptions, manufacturing the drugs, and using its logistics and transportation networks to deliver the finished products.”
Start with Alexa, which is emerging as the potential linchpin for Amazon’s relationship with patients. Last month Amazon added features for family members to monitor vulnerable loved ones, and it has contracted with the NHS to answer simple medical queries.
Although Alexa is not yet fit for medical use – it does not comply with US health privacy laws, and cannot call emergency services – it can still serve as a rich source of customer insights.
Jeff Bezos is targeting the digital healthcare sector
Credit: Pablo Martinez Monsivais/AP
Jain says the company is “really serious about getting your health data in any way it can… it wants to make you as dependent on Amazon as possible.” He cites the company’s behaviour-monitoring new smart bracelet, Halo, described by the (Bezos-owned) Washington Post as “the most invasive tech we’ve ever tested”.
Similar ideas were laid out in a patent filed by Amazon in 2018, explaining how Alexa could scan customers’ voices for signs of coughs or sniffles and suggest they stock up on medicine, which could be sent to their home in an hour. Disturbingly, the patent says Alexa could recognise the sound of crying so as to discover an “emotional abnormality”. Musicians could pay to promote their albums to people who sound tired or bored.
Amazon’s great advantage over Apple and Google, which both have similar gadgets, is that it can plug Alexa into its gigantic delivery network – as well as its hundreds of Whole Foods supermarkets. The former will be the backbone of a new online drugstore announced last month, while Whole Foods boss John Mackey has mooted putting clinics in his stores, initially for workers and later for customers.
Even this may only be a start. Bezos likes to say that “your margin is my opportunity”, and few margins are fatter than the money that leaks out of America’s majestically dysfunctional healthcare system via wholesalers, benefit managers, debt collectors and other middlemen.
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CB Insights argues that Amazon could use its size and data-crunching nous to conquer the whole chain, covering every step between insurers and providers at lower cost. Indeed, it has just launched a system called HealthLake which pools and analyses medical records.
British healthcare is already centralised in the NHS, making government contracts the main game in town. Yet those are still a lucrative market, with NHS trusts under pressure to innovate and a national pool of patient data estimated by Ernst & Young to be worth as much as £9.6bn per year.
All of this assumes regulators and customers will welcome Amazon with open arms. So far it has faced stiff resistance from British privacy activists, who filed legal requests to uncover its contract with the NHS.
“It might sound like a conspiracy theory, but we were concerned about indirect uses Amazon could have with the data,” says Ioannis Kouvakas, a legal officer at the group. “What kind of public-private partnerships are we entering? And how far are we going to let these tech giants use our data for profit?”
Experts say Amazon will have a tougher time gathering information in the UK thanks to stringent regulations such as GDPR, which gives health data special protection.
Dr John Puntis, a paediatrician who co-chairs the campaign group Keep Our NHS Public, says private companies profiting from patient data would “erode trust in the health service generally”.
Still, he does not quite rule out some role for tech giants: “You’d have to have a very tight contract, and a prerequisite for that would be transparency.”
There are also signs of trouble at Haven Healthcare, Amazon’s joint venture with Berkshire Hathaway and JP Morgan Chase. After hiring many industry big hitters, it has lost at least six executives – including superstar surgeon Atul Gawande, who stepped down from chief to chairman and is no longer involved in everyday operations.
Yet Jain says that Amazon is far more powerful today than in 1999, when its first attempt at an online pharmacy ran into hardball tactics from incumbents. Instead, he suggests. it could end up doing more to reform US healthcare than the actual government.
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