In order to study the ethical and societal impacts of the increased presence of Big Tech companies in health and medicine, we focussed on several case studies. These included:
• the “Personalized Parkinson’s Project”, a collaboration between a university medical centre in the Netherlands and Verily, a subsidiary of Alphabet;
• Google and Apple’s development of an API for digital contact tracing during the COVID-19 pandemic;
• The use of Apple’s “ResearchKit” software for remote clinical studies by various medical researchers in the Netherlands and in the United States;
• Lobbying and other involvement on the part of tech companies (e.g. Microsoft and Huawei) in the development of the European Commission’s regulation on the European Health Data Space;
• Verily and Apple’s work on the development of a digital biomarker for Parkinson’s Disease.
Our main findings have been:
1) The presence of Big Tech in sectors such as health and medicine tends to be critically evaluated in terms of either privacy and data protection risks or platform and market power risks. We identified a number of risks that are not captured by these dominant critical framings. These include non-equitable returns (i.e. exploitation of public data without fair compensation); a gradual reshaping of the health sector in line with the interests and practices of tech actors; and the creation of new dependencies on tech corporations for the provision of health and medicine.
2) This means that existing conceptual and regulatory frameworks for assessing the growing involvement of Big Tech in health and medicine, such as the General Data Protection Regulation (focus on data protection), or platform power critiques (focus on the market power of Big Tech) are insufficient for grasping the breadth of impact of Big Tech’s encroachment into this sector. In particular, we found that the focus on privacy, by regulators, professionals and even the broader public, may facilitate Big Tech’s increasing presence in health and medicine; whereby as long as tech corporations comply with privacy laws, they are at liberty to expand in the sector.
3) We thus developed a novel conceptual framework – sphere transgressions – that can account for these risks. The framework is valuable for identifying, articulating and making sense of novel developments in all public sectors into which Big Tech companies are expanding, and which puts the relative autonomy and integrity of these sectors at risk.
4) We have also found that it is too simple to blame Big Tech’s increased influence and profit motivations for the potential harms of the Googlization of health phenomenon. Importantly, policy makers and medical sector professionals play an important role in this phenomenon, by welcoming or even soliciting the expertise of tech actors. This can be seen as part of a general societal discourse that views digitalization as a solution to societal needs, such as healthcare provision and advances in medical research.
5) We have thus paid specific attention to “technosolutionism” – the belief that complex societal problems have simple technological solutions – as part and parcel of Big Tech expansionism into public sectors such as health. We theorized technosolutionism as a mechanism, identifying how it works and what specific harms it raises when applied in public sectors. We further found that design ethics, which can be considered the dominant form of technology ethics today, is not well place to technosolutionism and its harms.
