Healthcare’s ‘four horsemen’ and the great digital bait and switch

10 minute read

Facebook’s faceplant exposes a downside of the inevitable march of the global digital platforms towards the centre of our healthcare systems, which we need to start preparing for now.

“The world is all the richer for having a devil in it, so long as we keep our foot upon his neck.” – William James

Google said it wouldn’t be evil, and we believed it, for a while. Then, eventually, Google didn’t even believe it, and in 2018 removed the phrasing from its code of conduct.

In the meantime it practised a global data bait and switch on millions of small businesses.

One day it gave a business huge search visibility (and profitability) so it could capture its data and that of its customers, the next it changed its search algorithm, and destroyed those businesses and often many lives with it.

But we all moved on. Digital transformation progress apparently.

Facebook said that it just wanted to connect the world in one big happy community for the greater good. And we sort of thought that might be an OK idea.

It then pulled off the greatest heist in the history of digital commerce.

In its early years it seduced millions of businesses to build a network of followers (its customers) to increase their marketing reach. Then one day it turned around and told all those businesses that they had now to pay for the database that it had built to reach their own customers.


If we think Facebook’s decision to flick the switch on news and important non-profit and government sites last week just before the biggest vaccine rollout in the nation’s history was a bit much, we probably haven’t seen anything yet.

So we had better start getting cynical and politically active around how it operates in the context of healthcare.

Facebook’s decision to turn off both local and global news in its feed, when Australia (among the most vaccine-hesitant developed countries) is on the verge of starting its vaccination program, was scary ­– not for its arrogance or overt expression of power, but for how naive the management of this massively powerful global digital platform must be.

Facebook is the major means by which misinformation about vaccination and healthcare is spread in this country. Removing the news sources from its feed, the material that balances this misinformation, will almost certainly act to significantly amplify the impact of the misinformation.

It could easily kill people if it is allowed to continue in this reckless manner.

It’s difficult to comprehend how the management of Facebook came up with such a bad idea and such bad timing.

It almost feels like it didn’t even think of the problem of vaccine misinformation on its channel and the imminent rollout of the nation’s vaccine program.

It’s hard to think what would be worse: that it thought about the timing around our vaccination program and went ahead, or that it actually didn’t even think about it and it made the mistake of declaring its power at such a terrible point in time for our national health?

No matter, what the incident hopefully leaves no one in doubt about now is how much market power the company has built up, outside of appropriate regulatory oversight, and how much it is prepared to use that power.

Up to 40% of Australians get their news using Facebook.

A company that is prepared to let facts and news be sacrificed for money alone in such an important time for the nation’s healthcare is not a company you want forming any sort of monopoly data position in our healthcare ecosystem (not any sector for that matter).

Its decision has transformed it from being a somewhat dangerous company in terms of the healthcare of Australians, to an unacceptable risk to the healthcare of Australians.

It’s surprising, but apparently we are stuck in a situation where the federal government can do nothing about a company that is about to facilitate a mass of anti vaccination propaganda.

It’s still early days for the big global digital platforms and their intentions in healthcare so Facebook’s big miss might still end up being a good thing – presuming that Facebook comes to its senses and stops the nonsense, at least in the health sector.

It’s an important warning to us all about what is coming at us in terms of digital platforms with an intent to control and distribute vital data in our healthcare system into the future.

If we all think a bit more carefully about it now, we might stand a chance of avoiding the sort of problem Facebook has presented us with.

US based marketing guru Professor Scott Galloway calls Amazon, Google, Apple and Facebook “The four horsemen”. You can watch Galloway predict with reasonable accuracy the destruction that each company is likely to wreak over the coming year, early each year on YouTube. In May last year he came out with a “four horseman post corona” prediction that they are all going big time at healthcare.

That can’t be good.

Amazon, Google, Microsoft and Apple are all vastly more powerful and more capitalised than Facebook.

In January 2019 Apple’s CEO Tim Cook announced to the world “If you zoom out into the future, and you look back, and you ask the question: ‘What was Apple’s greatest contribution to mankind?’, it will be about health.

“We’re democratising it. We’re taking what has been with the institutions and empowering the individual to manage their health,” he said.

Sounds suspiciously just a little like that “bait” these platforms like to feed you to get your data, before the inevitable “switch”, to get your money. It’s important to realise that there is never a free lunch with these people. Never.

It’s an almost certain prediction that your patient’s important health data will be held on and transacted from their iPhone or Android device.

Android’s operating system is Google. So Google or Apple will be the major point of an individual’s health data acquisition and deployment, hopefully with the patient in some sort of driving seat on such transactions. This will almost certainly be a very attractive offer of convenience for patients as it will feel like it is for free.

They are paying however. With their data.

It’s such a sneaky little transaction. One person usually doesn’t mind their data being exchanged for a set of new and innovative time saving services. But once everyone gives their data up, and that is monopolised in one place? Then things get tricky for everyone: the government, regulators and the patient.

This is eventually what gave Facebook the gall to try on its bully boy tactic on the Australian government.

This all means by the way that the My Health Record, which our government has now spent more than $2 billion on, and which we are still persisting with – a re-platforming contract later this year with one of the big overseas tech vendors or consultants is due now – will be rendered mostly redundant in the not too distant future (some of its data and functionality will survive, but not enough to justify continuing to pile significant money on top of a mostly wasted $2 billion).

More than 18 months ago Apple health developers pivoted to a game changing new global healthcare web data sharing standard called FHIR (Fast Healthcare Interoperability Resource) and started building all Apple health applications around it.

The move signals that Apple intends to be able to talk to everything important in digital health data exchange and be central in that exchange. The iPhone will be the central point of exchange for most of our healthcare data.

Apple is working hard on this premise to make it to the top of healthcare.

Amazon comes to healthcare from a different position.

It has grown so fast into so many sectors, including cloud services, that there are very few industries it is now capable of disrupting which are big enough to feed the growth required to maintain its momentum and stock price.

Healthcare is the biggest remaining industry that can.

So Amazon is coming for health.

But far more stealthily than Apple. There have been no big announcements or visions. But there is clear direction and intent.

In September 2019, months before the COVID-19 pandemic started a mass move to virtual healthcare, Amazon launched Amazon Care, a program offering telehealth and virtual care, along with in-person follow-up care, to a subset of its Seattle headquarter employees. It’s a pilot scheme to get the company familiar with what it will need to do on a grander scale if it is to sit in the middle of healthcare data.

Haven is a not-for-profit, healthcare-focused entity created through a joint venture by Amazon, Berkshire Hathaway and JPMorgan Chase to make primary care easier to access, prescription drugs more affordable and insurance benefits easier to understand for all three company’s employees.

Haven is another pilot. Its website states that “We are looking at new ways to use data and technology to make the overall healthcare system better.”

There’s that digital platform “bait” again.

Amazon PillPack is a full service online pharmacy that delivers prescription meds to the patient’s door. It gets Amazon into the pharmacy business and aligns it next to EMR and internet connected device vendors.

Google has been dabbling in healthcare since 2006, sometimes with less than stellar outcomes, but in the last few years it has become very serious about developing a huge presence in the sector based on its advanced position in AI.

Google is betting that the future of healthcare is going to be structured data and AI so it is deploying its significant AI assets into disease detection, new data infrastructure, and better health payments and insurance systems.

Combine this with its distributed patient presence on Android phones and it’s very likely Google will be one of the major digital health data players in the near future.

Which brings us back to Facebook’s overt decision to demonstrate just how powerful a digital platform can be after it has spent years seducing its users into handing over so much data.

There is no question that platforms – distributed, mobile, cloud-based platforms – like Google, Amazon and Apple – will have much to offer both consumers and governments in terms of innovation, mobility and convenience. It will be seductive as it seeks to exchange such services for a right to become the collectors, distributors, analysers and gatekeepers of patient data.

But we need to all be aware that with the good in these digital platforms comes a fair share of bad. The sort of bad that Facebook revealed of itself last week.

Facebook’s attempted standover should serve as a warning to everyone in the healthcare sector of the power of these new digital platform behemoths, once they have vacuumed up enough data for patients and society to become reliant on them in one way or another.

It’s not clear what the solution to this dilemma is.

It surely isn’t just heavy regulation from the outset, as this is likely to significantly retard the good innovative elements of these companies.

But some clear thought and planning has to be undertaken by the government and our healthcare institutions starting now.

The four horsemen have saddled up and are riding hard for healthcare town. COVID-19 has surely expedited their trip.

We haven’t got long to get ready.

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