From this week, if you have a medical issue – a migraine or flu symptoms, say – you'll be able to "ask Alexa" for advice rather than having to contact an NHS professional. The Department of Health says the partnership between Amazon and the NHS, which is being hailed as a "world first", will "empower" patients and could ease pressure on the overstretched health service.
It works by automatically scouring existing information on the NHS website when UK users ask for health advice, to answer questions like "Alexa, how do I treat a migraine?", "Alexa, what are the symptoms of flu?" and "Alexa, what are the symptoms of chickenpox?" (previously, it has based its health advice on online searches). Patients won't receive free Amazon Echo devices (which are priced from £24.99), but if they don't already have one they'll still be able to access advice through a free app. Partnerships with other companies like Microsoft are also reportedly in the works.
Campaigners who represent the elderly and people with disabilities have welcomed the partnership, claiming that voice search is invaluable for those with visual impairments and others who struggle to use the internet in the usual way.
"It cuts out all the searching online, which can be a traumatic experience for many people, especially those who are disabled or not familiar with technology," Adi Latif, from the charity AbilityNet, who is registered blind, told the Guardian. While "smart speakers such as Alexa are no doubt hi-tech," he added, "they are designed in a way which allows you to have a conversation with them, making them less daunting to use."
It could also be argued that by removing the need to physically meet a GP or pharmacist, the partnership could eliminate bias against people from ethnic minority groups, or those classed as overweight or obese which, evidence has shown, is rife in medicine (a benefit that also extends to the NHS 111 phone line).
Voice search is on the rise – with half of all searches predicted to be made in this way by 2020 – and if patients receive greater assurance and comfort from a human-like voice than they do from reading the same freely available information on a web page, where's the harm? Using these devices can also be marginally quicker than text internet search. Matthew Gould, the chief executive of NHSX, the new unit overseeing the use of digital tech in the NHS said it will direct millions of users to "simple, validated advice at the touch of a button or voice command."
But there are several potential downsides – not least if you're a woman. Women routinely claim anecdotally – and research has suggested time and again – that medicine, as it stands, is biased against them. The gender health gap is stark and life-threatening, with women experiencing many areas of medicine differently from (read: worse than) men. Their pain and concerns are routinely dismissed – studies have found that women are less likely to be taken seriously by medical departments than men, face longer waits in A&E and are less likely to be prescribed effective opioid painkillers than men.
The UK-based feminist blog Hysterical Women contains myriad stories of women feeling dismissed and failed by their doctors, and a 22-year-old woman in France died last year after emergency services dismissively mocked her concerns about acute abdominal pain. Women's symptoms of common, deadly conditions like heart attacks are also misunderstood, meaning they are less likely to receive the urgent treatment they need. A study just last month found that women were 9% less likely than men of the same age and socioeconomic status to be diagnosed with heart failure by their GP, and 13% less likely to be prescribed the two most important drugs in heart failure management within three months of diagnosis.
Alexa will also only be able to draw on the relatively small amount of existing medical research on women. "There is a clear gender bias when it comes to medical research. In 2016, for example, there were five times more studies on erectile dysfunction (ED) than premenstrual syndrome (PMS) – yet PMS affects 90% of women compared to only around 19% of men suffering from ED," Janet Lindsay, CEO of charity Wellbeing of Women, which funds research into women's health, told Refinery29 last year. "Women's health is still too often overlooked and underfunded," she added.
By simply parroting the existing, often flawed health information that's already out there, could the Alexa/NHS partnership even be accentuating the problem?
It is also worth remembering that female-voiced AI assistants, including Alexa and Siri, have been found to reinforce gender bias. A UN report last month ruled that digital assistants do this with their "deflecting, lacklustre or apologetic responses" to insults.
Refinery29 asked the Department of Health about the potential for gender bias and it directed us to health secretary Matt Hancock's statement that the aim of the partnership is to "empower every patient to take better control of their healthcare". It continued: "Technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists."
Concerns about privacy – which have been dismissed by Amazon and the government – and the potential for data breaches have been raised by campaigners and MPs, including deputy Labour leader and shadow culture secretary Tom Watson. Silkie Carlo, director of the civil liberties group Big Brother Watch, called it "a data protection disaster waiting to happen" and flagged instances of Amazon’s Alexa "record[ing] what people say, stores recordings in data centres we know nothing about, and exploits our data for profit."
The giant data monopolies want one thing: more and more data to drive their huge profits. Entrusting Amazon's Alexa to dispense health advice to patients simply opens the door to the holy grail - our NHS data. This is the beginning of a Mission Creep.https://t.co/UXN05bHMZU— Tom Watson (@tom_watson) July 10, 2019
As with all doctors appointments that take place remotely – over the phone, by video call or even via email – there's also the risk that crucial non-verbal cues are missed, which could be particularly detrimental when discussing sensitive issues like miscarriage. Then there's the annoyingly circular problem that the service was introduced to address – if the takeaway from Alexa's advice is that you should see a GP stat, but you'd need to wait over a fortnight for an appointment (as a fifth of people do in England), what are you supposed to do? Chances are, if your symptoms were serious enough, you'd visit A&E.