Last month, in a Safeway supermarket in Casa Grande, Arizona, Akos Med Clinics opened the “medical clinic of the future,” which uses augmented reality, artificial intelligence, and telemedicine to treat patients who walk in. It was the 11th Akos clinic in the state, each one tucked inside of a Safeway.
The pairing of clinic chain and supermarket chain has been fortuitous, Akos executives say. To start, there is the natural parallel between the speed and efficiency of self-checkout at the supermarket and the speed and efficiency of the Akos clinics. Just as there is no cashier at self-checkout at Safeway, there is no doctor or nurse at an Akos clinic. Instead patients are guided by AR-enabled computers to record basic measurements of themselves—weight, temperature, blood pressure, and blood oxygen content—as well as images of their ear, nose, and throat, and sounds made by their chest, lung, and abdomen.
The results are relayed to the company’s headquarters, where a medical professional speaks to the patient via video linkup, so-called telemedicine, and is aided in diagnosis by artificial intelligence. There is an assistant at the clinic who can perform blood tests as a follow-up or call 911, if needed; prescriptions can be emailed to a pharmacy.
Akos has found Safeway supermarkets a good fit in another way too—the markets had plenty of clinic space available, recently built. A different company had abruptly abandoned its dream of using supermarkets and pharmacies to host its new medical technology. You may have heard of the outfit. It’s called Theranos.
Arizona was to be Theranos’ beachhead on the road to global domination. The business-friendly government was eager to nurture a Silicon Valley in Arizona and quickly paved the way for the company’s “miracle technology,” which purported to perform cheap medical tests from a single drop of blood.
State law had required a doctor’s approval for all but a few blood tests, but that would have defeated the purpose of Theranos’s quick and cheap testing devices. With prodding by the company, including testimony from its now-disgraced founder, Elizabeth Holmes, Arizona legislators drew up House Bill 2645 to remove the need for a doctor’s consent for any blood test. Theranos made agreements to reach customers through outlets at Walgreens pharmacies and Safeway supermarkets.
This was Silicon Valley-style disruption, defended by all the familiar rationales—belief in the empowered individual, suspicion of authority, faith that technology can cure grave inequalities. Heather Carter, the sponsor of the bill in the Arizona House, explained her thinking: “Why should I have to wait for permission from a physician, or in this case, the government, to go and be proactive about my wellness?” Carter was echoing the freedom agenda Holmes preached to members of the public, that they needed to recognize that there was a “basic human right to be able to get access to information about themselves and their own bodies that can change their lives.”
Theranos’s plan for global domination never got past Arizona, of course, thanks to incisive coverage of the company by John Carreyrou of The Wall Street Journal. There was no miracle blood-testing technology at the company, but rather a game of fake-it-till-you-make-it that put people’s lives at risk. By the time the fakery was exposed, Theranos had already opened 40 “wellness centers” in Arizona Walgreens pharmacies. The Safeway outlets never did open, but some were built, which has been a big help as Akos tries to grow quickly, according to one executive, James Bates, who was interviewed by The Arizona Republic.
Though one should be wary of comparing any enterprise to a fraud like Theranos, there is a reason that Akos Med Clinics also seeks a home in Safeway supermarkets. They both wanted to be where the foot traffic is as they disrupt medicine by shifting more responsibility to patients and computers. By reducing the role of doctors and nurses, costs are lower, visits are shorter, and the business has a chance to scale and bring in the big bucks.
The epic collapse of Theranos—told in a best-selling book, documentary, think pieces, a podcast series, a streaming series, and, soon, a major motion picture—has become the Silicon Valley cautionary tale of our times. The lessons, however, have been particular to the company and Holmes, its charismatic founder. They go something like: Beware of self-proclaimed visionaries promising miraculous new technologies, especially when they won’t show you how the new technology operates. This assumes that had the technology worked, Theranos would indeed have been the miracle that Holmes suggested.
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But as was noted by Faye Flam in a recent opinion piece in Bloomberg, “Theranos’s Empty Promise to Cure a Fake Problem,” Theranos was selling more than a particular transformative technology or the promise of universal health care but, rather, “the right to choose our own blood tests and interpret the results ourselves.” That is, a path to personal empowerment by navigating our way through a menu of tests, rather than simply consulting with a doctor or nurse about our health.
In a recent essay for ScientficAmerican.com, Elisha Waldman, a specialist in palliative care for children, made a plea that we not lose the human connection between doctors and patients, even as we rely on computers to make better assessments of a patient’s condition. “The impact of a human touch—literally a hand pressed comfortingly on an arm—cannot be replicated and should not be underestimated,” Waldman writes. “These are not cold calculations based on data, but rather real, nuanced decisions arrived at through careful and ongoing exploration of values.”
No doubt, doctors’ visits are too expensive for many people, as are medical tests; streamlining the process through new technologies can help lower costs. Telemedicine, in particular, can bring quality medical care to remote areas that are particularly underserved. But the efficiencies Akos is exploiting should also give us pause—relying on artificial intelligence to speed the diagnosis process; removing in-person assessments by medical professionals; making a visit to the doctor a lonely experience, like shopping at the supermarket.
These innovations assume that the problems with the medical system—the unaffordability, the lack of doctors in some areas—cannot be fixed through collective action (Medicare for all comes to mind), but must be cleverly managed.
In other words, medical hacks, masquerading as medical solutions.