The authors comment
Sharing of user data is routine, yet far from transparent. Clinicians should be conscious of privacy risks in their own use of apps and, when recommending apps, explain the potential for loss of privacy as part of informed consent. Privacy regulation should emphasise the accountabilities of those who control and process user data. Developers should disclose all data sharing practices and allow users to choose precisely what data are shared and with whom.They note
Mobile health apps are a booming market targeted at both patients and health professionals. These apps claim to offer tailored and cost effective health promotion, but they pose unprecedented risk to consumers’ privacy given their ability to collect user data, including sensitive information. Health app developers routinely, and legally, share consumer data with third parties in exchange for services that enhance the user’s experience (eg, connecting to social media) or to monetise the app (eg, hosted advertisements). Little transparency exists around third party data sharing, and health apps routinely fail to provide privacy assurances, despite collecting and transmitting multiple forms of personal and identifying information.
Third parties may collate data on an individual from multiple sources. Threats to privacy are heightened when data are aggregated across multiple sources and consumers have no way to identify whether the apps or websites they use share their data with the same third party providers. Collated data are used to populate proprietary algorithms that promise to deliver “insights” into consumers. Thus, the sharing of user data ultimately has real world consequences in the form of highly targeted advertising or algorithmic decisions about insurance premiums, employability, financial services, or suitability for housing. These decisions may be discriminatory or made on the basis of incomplete or inaccurate data, with little recourse for consumers.
Apps that provide medicines related information and services may be particularly likely to share or sell data, given that these apps collect sensitive, specific medical information of high value to third parties. For example, drug information and clinical decision support apps that target health professionals are of particular interest to pharmaceutical companies, which can offer tailored advertising and glean insights into prescribing habits. Drug adherence apps targeting consumers can deliver a detailed account of a patient’s health history and behaviours related to the use of medicines.
We investigated the nature of data transmission to third parties among top rated medicines related apps, including the type of consumer data and the number and identities of third parties, and we characterised the relations among third parties to whom consumer data are transmitted.They conclude
The collection and commercialisation of app users’ data continues to be a legitimate business practice. The lack of transparency, inadequate efforts to secure users’ consent, and dominance of companies who use these data for the purposes of marketing, suggests that this practice is not for the benefit of the consumer. Furthermore, the presence of trackers for advertising and analytics, uses additional data and processing time and could increase the app’s vulnerability to security breaches. In their defence, developers often claim that no “personally identifiable” information is collected or shared. However, the network positions of several companies who control the infrastructure in which apps are developed, as well as the data analytics and advertising services, means that users can be easily and uniquely identified, if not by name. For example, the semi-persistent Android ID will uniquely identify a user within the Google universe, which has considerable scope and ability to aggregate highly diverse information about the user.
Taking a systems view of the mobile ecosystem suggests that privacy regulation should emphasise the accountabilities of third parties, known as “data processors,” in addition to first parties or “data controllers.” Currently, within the “big data” industry, users do not own or control their personal data; at minimum, regulators should insist on full transparency, requiring sharing as opposed to privacy policies. The implementation of the GDPR in the European Union resulted in greater transparency around data sharing relationships among some developers in our sample. However, as big data features increasingly in all aspects of our lives, privacy will become an important social determinant of health, and regulators should reconsider whether sharing user data for purposes unrelated to the use of a health app, for example, is indeed a legitimate business practice. At minimum, users should be able to choose precisely which types of data can be accessed and used by apps (eg, email, location), and to have the option to opt-out for each type of data. More effective regulation, however, might focus instead on third parties engaged in commercialising user data or the companies that own and operate the smartphone platforms and app stores