In April 2018, Facebook sent the Yale cardiologist and researcher Freddy Abnousi on a strictly confidential assignment to liaise with medical groups across the country on behalf of Building 8, Facebook’s experimental research team. Building 8—which had originally been led by Regina Dugan, the former director of the Defense Advanced Research Projects Agency—worked on long-term, moonshot projects, such as developing devices that would allow people to type with their brain or hear through their skin.
Abnousi’s task was less radical: He was to get the Stanford University School of Medicine and the American College of Cardiology on board with a new project that would combine Facebook user information with hospital-patient data in order to influence patient outcomes. Facebook hoped it could leverage the cache of data users already give it—about their education, relationships, habits, spoken languages, employment status, and more, all of which have an enormous impact on health outcomes—to create a sort of subclinical health-care system, warning providers if, for example, a user recovering from surgery had a small support group.
Then came the Cambridge Analytica debacle, and with it a cascade of highly public inquiries and privacy revelations that resulted in the cessation of Building 8. But Facebook kept working on a version of its health-care project. In October, Abnousi, now the company’s head of health-care research, announced Facebook Preventive Health, rolling out to some U.S. users this month as a feature in the Facebook mobile app.
Facebook Preventive Health targets users in broad strokes using only two data points: age and gender. If you opt in to the feature, Facebook will send you checkup-reminder notifications and suggest nearby sites for flu shots, cancer screenings, and blood-pressure tests, among others. In an October blog post, Abnousi said the feature will also suggest free clinics for the uninsured.
A spokesperson for Facebook denied that the Preventive Health tool is related to the Building 8 data-sharing proposal. Preventive Health, like many of the health initiatives led by Silicon Valley, doesn’t fall under the purview of HIPAA, the 1996 federal law protecting private patient information. Many experts say HIPAA is outdated, because its narrow definition of data collection does not cover the way tech companies collect and process health information.
“Physicians swear an oath to keep an individual’s data confidential,” Jesse Ehrenfeld, chair of the American Medical Association Board of Trustees, told me over email. “There’s currently no such obligation for technology companies and data aggregators or the data brokers to whom they might sell information.”
When reached for comment, Facebook referred me to two October blog posts explaining that the Preventive Health tool’s data are never shared or sold to third parties. (A notable exception, however, is if users “like” a specific health-care provider, drug, or hospital. Those data are added to the company’s ad-targeting machinery.)
But for Facebook, the real value of the tool isn’t in direct monetization. It’s in becoming an integral part of yet another facet of users’ lives. Historically, this appears to be Facebook’s operating strategy: Move into a largely unregulated space, leverage the platform’s unmatched ubiquity to create a highly convenient product within that space, and then turn convenience into dependence into more time spent on the platform. Facebook hastened its ascent by monetizing social data and turning likes into massive ad revenue. Then it launched new products like Messenger, and grew its empire by acquiring Instagram and WhatsApp, both of which generated ever more data. What started as a spin on an online yearbook became new products, which attracted new users, and on and on it went. As Facebook moves into health care, its future success will probably look like its past success.
The Preventive Health tool is launching at a time when not nearly enough people have consistent access to preventive care. Many people usually wait until they’re sick before seeing a professional. As recently as 2015, only 8 percent of adults received the recommended “high priority” health screenings, according to a study from the Department of Health and Human Services’ Agency for Healthcare Research and Quality. Most people get some essential screenings, but very few receive all of them. The poorest Americans, especially those living in rural communities, have the least access.
This is where Facebook comes in. While traditional health-care outreach apparatuses struggle to help vulnerable communities, Facebook has already succeeded in reaching almost everyone: rich and poor, rural and urban, sick and healthy, Rust Belt retirees and Left Coast vegans. People already use the site to rate and review medical practitioners, organize demonstrations around health policy, form unofficial support groups, and mark themselves safe after natural disasters. The platform’s reach, ease of access, and pervasiveness make it a powerful tool for conveying localized information about preventive health.
That doesn’t necessarily mean people will gladly turn over to Mark Zuckerberg the date and location of their last prostate exam. But the sneaky genius of Preventive Health is that it builds only on reflexes that are second nature to us. People already check their phone’s notifications roughly 50 times a day; why not send a reminder for an eye exam? People already use it to find the nearest Italian restaurant, so why not the nearest free health clinic? This is why Facebook got so big in the first place: by making mission creep feel like convenience.
In this light, Facebook as health care almost seems obvious. That’s part of why it’s so unsettling. There doesn’t seem to be a way to make the app even slightly more pro-social or useful without also growing our dependence on it. Writing in The New York Times, Tim Wu, the author of Attention Merchants, declared convenience and dependence to be two sides of the same coin, noting, “Our taste for convenience begets more convenience, through a combination of the economics of scale and the power of habit. The easier it is to use Amazon, the more powerful Amazon becomes—and thus the easier it becomes to use Amazon.”
It’s important to remember that when convenience becomes dependence in tech, it happens on a scale of billions of users. When that many people reach for an app or download a program as part of a daily routine, it’s more akin to infrastructure. Consider how Lyft and Uber leveraged their own ubiquity to sign deals with cities and offer public-transit services in places like Dallas, L.A., and Denver. It’s true that many populations lack access to health-care or transportation, but it’s also true that filling that need creates a feedback loop that sustains Silicon Valley just as much as it serves users.
If the Preventive Health app catches on, it’ll be a quick and easy way to keep track of screenings and appointments, and the logic of convenience will likely prompt a slow shift back toward the Building 8 iteration of the project. Because Facebook is so simple and easy to use, it makes sense to hand over more data for a more personalized version, inevitably drawing in more users. The convenience becomes dependence. Socially, Facebook has already accomplished this. For many of Facebook’s 2.4 billion users, it’s hard to imagine navigating social groups and remembering birthdays and attending events and finding important photos any other way. Soon enough, maybe it’ll be hard to remember doctor appointments too.
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