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October 29, 2019updated 23 Dec 2019 10:26am

Debate: can Alexa be trusted with our health questions?

In July, the UK National Health Service announced it has teamed up with Amazon to make NHS-verified health information searchable by voice on the company’s Alexa home assistant. The move could make it easier for users to access reliable answers to their questions, but does this come at a cost? Two editors lay out the arguments for and against this digital partnership.

By Chloe Kent and Chris Lo

Chloe Kent: Alexa could be a powerful weapon against fake news in health

Misinformation about diseases and how to treat them is rife in the digital age, where misunderstandings and pseudoscience can be disseminated at the click of a button. Half of new parents are shown antivax propaganda on social media and seven of the ten most-shared health articles on Facebook are fake. Configuring Amazon’s Alexa home assistant to provide information solely from a verified source like the NHS could go a long way towards preventing this sort of potentially life-threatening confusion.

By 2020, it is expected that over half of all online searches will be made via voice-assisted technology like Alexa. As the form becomes increasingly popular, it makes sense for it to be set up to provide only the most stringently reviewed health guidelines.

These aren’t the only benefits to the Amazon-NHS partnership. Alexa has been credited by many blind, disabled and elderly people as helping them gain more independence, with the voice activated technology being much simpler to operate for people who struggle to use screens. As Alexa simulates direct conversation it can feel a lot less alien than a web browser for individuals who may not be as tech savvy as the younger generation and need a health question answered quickly.

Of course, many have had qualms about the security of this development, and rightly so. In April 2019, it was revealed that Alexa devices were funnelling short clips of recorded audio back to Amazon HQ for employees to listen to when developing new services, which many customers felt rightly violated by.

Civil liberties pressure group Big Brother Watch has since called the Amazon-NHS partnership “a data protection disaster waiting to happen”. The organisation has expressed concerns that extremely personal health information would be sourced from Alexa recordings, and could be targeted by data brokers.

Amazon has said it will not share health information with third parties or build a personal health profile on customers to enable targeted advertising, but his is something many may struggle to believe in an era when everyone seems to have a story about their smartphone listening to them.

However, whether or not Amazon has a dastardly plot to sell on personal information about Alexa users is, in this incidence, somewhat beside the point. If this data harvesting conspiracy really is more fact than fiction, then whether or not Alexa answers healthcare questions with NHS data or information from less trustworthy sources will have no bearing on the mining of that information.

This partnership between Amazon and the NHS will quell the spreading of dangerous fake news and allow vulnerable people to have easier access to reliable healthcare data. Concerns about the security of smart home devices are far from invalid, but those with serious fears Alexa is hanging on their every word can always opt not to buy one.

Chris Lo: NHS-Alexa partnership is a risk wrapped in a gimmick

On the surface, the recently-announced partnership between the NHS and Amazon’s Alexa looks like nothing to fear. Millions of Brits seek health information online every year – on their phones, their computers and via voice assistants – so where’s the harm in ensuring those searching by voice are accessing NHS-verified advice rather than gambling on the top search result?

On closer inspection, this public-private digital health collaboration looks like something of a gamble in its own right. A lack of transparency around the partnership has prompted concerns that it represents more of a PR boost for the NHS’s digitisation drive than a well-considered service to improve access to health information.

NHS Digital has said that more reliable voice searches via Alexa could improve public engagement with their health issues and lower the burden of unnecessary appointments at stretched GP surgeries around the country. And certainly there is potential for the partnership to empower users with visual impairments, for instance, to seek health information independently.

There are potential stumbling blocks in the implementation – the need for an Alexa device creates financial and technical barriers to entry, and some users may mistake the information provided for actual medical advice or a diagnosis – but many of these issues are shared with any health information service, however it’s delivered.

As the digital age whirrs to life, the use of data is unlocking new possibilities while raising difficult questions. In the case of the NHS’s Alexa tie-up, can we trust Amazon with our health data? While Alexa won’t interact in any way with medical records or anything other than public information, the recorded queries themselves are a potentially massive stream of health data. Does the British public trust Amazon to protect recordings of the kinds of sensitive questions they would usually ask their doctor in person? It’s impossible to know, because the decision has already been made for them.

Both Amazon and NHS Digital have made assurances that the company will keep the data confidential and will not use the recordings to sell or recommend products to them. But the doubters aren’t without reason. It’s already known that Amazon staff manually review Alexa recordings to improve the algorithms running in the background, and the company itself has clear ambitions in digital healthcare. People who go to Alexa for health information have a right to know the extent to which their queries are being used to train a machine learning platform for the commercial gain of a private company.

Many of these concerns could potentially be addressed if the exact terms of the partnership were clearer. But both partners have been cagey on the details, and medConfidential’s Freedom of Information request for a copy of the agreement, submitted in July, has yet to receive a response.

Of course, it could be argued that people with concerns are not being forced to make use of the new service. But to stop the conversation there does a disservice to an issue that will continue to raise its head until we come to a consensus on the acceptable use of digital data, especially where public

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