Once a precedent has been set, it is hard to roll back the use of technology.
By Graham Titterington
21 Nov 2008
Google’s philanthropic arm, Google.org, has announced an intriguing initiative that promises to track the spread of influenza two weeks before the current procedures used by the US Centers for Disease Control and Prevention. A new Google site monitors the intensity of searches for selected keywords associated with the disease and its symptoms. While everyone will welcome the site in its current form, it raises the issue of privacy in the Internet age and highlights the narrow line between philanthropy and Big Brother.
Is this a significant advance for healthcare?
The questions are ‘does this deliver practical benefit?’ and ‘will it cope with major outbreaks such as the 2004 Asian Avian flu pandemic, or with other deadly diseases that affect fewer people?’ The answers are ‘probably yes’ and ‘probably no’. The benefit of earlier notification is real as it allows medical resources to be moved to where they are needed at the time of greatest need, and it allows business to prepare for higher rates of absenteeism. The inconclusive evidence so far is that it works in normal flu cycles. In less predictable situations many worried people will search for information even if they are never close to danger. For example, many people around the world looked for information about Avian Flu, but few outside South East Asia were infected.
Google likes to promote its friendly face to the public, and it has an active philanthropic programme. However, user privacy is an inherent concern. Its revenue model is based on targeted advertising that exploits the marketing information it extracts from its free-to-use services. It says, and we believe, that it does not sell personally identifiable information, but it uses individual user information to target advertising and it sells aggregated information. Governments claim the right to access search engine information in the fight against terror and the wider political agenda. Service providers have caved in to government pressure in the past. Most Internet users are unaware of the extent of the digital footprint they leave when they use the Internet, including search engines.
This initiative is an attempt to win friends and prepare defenses for future political battles around privacy. Google says that the site has been running internally for a year and has proved to be very accurate. It uses search data collected since 2003. It is based on the increasing tendency of people to turn to the Internet for diagnosis and first-line medical advice.
Where does the public interest lie?
When does helpful information collection turn into an invasion of privacy or unjustified control? Everyone will welcome this site as it exists today. However, the risk of a flu pandemic is regarded as the greatest threat facing most countries today – far greater than the risk associated with terrorism. To put it in context, 40 million people died in the 1919 flu pandemic. In the US the death toll exceeded the combined toll from the two world wars. Influenza, along with other diseases, is a deadly serious issue that could justify the use of any available powers. In the recent Avian flu pandemic temperature checks were added to the procedures that all passengers had to undergo at Asian airports. In many countries, including countries in the west, any known sufferers were quarantined. Again people generally welcomed these actions as a sensible means of restricting the spread of disease and protecting the main body of the population. The issue becomes controversial when we move from controlling sufferers to handling suspected or possible sufferers, and what level of suspicion justifies action against individuals. Next time, will the Google data be used to pinpoint suspected sufferers? Will certain search terms be treated as “expressions of interest” and others as “evidence of infection”? Google mainly works on the basis of the IP address of the computer; what level of association is drawn between users on the same IP address?
Will similar technology be used to identify people with other infections? Once a precedent has been set, it is hard to roll back the use of technology.
