Viewpoint: The ethics of selling primary care next to Cheetos

Ethical dilemmas are on the horizon as more tech and retail companies enter the healthcare space, according to an Oct. 3 Forbes viewpoint piece by Sachin Jain, MD, president and CEO of SCAN Group and SCAN Health Plan. 

Nearly a decade ago, CVS Health made the decision to stop selling cigarettes. By walking away from $2 billion in revenue and millions in profit, the company sent a message to stakeholders that it was "truly in the business of health," according to Dr. Jain. 

However, the company continued to sell sodas and sodium-laden foods. At the time, CVS' CEO said foods with poor nutritional value are different from cigarettes because there is no amount of tobacco that can be considered safe, even in moderation. 

As more large companies — including Walmart, Amazon, Costco, Apple, Microsoft and Google — crack the healthcare industry, these tensions may be harder to dismiss, Dr. Jain says. It is counterintuitive for retailers to sell obesity-inducing food and alcohol, yet offer healthcare services; similarly, tech companies' platforms can have adverse effects on mental health and  help spread misinformation, making healthcare providers' jobs harder. 

"If we aren't comfortable selling tobacco to customers with lung disease, why are we comfortable selling sodas to diabetics? And alcohol to people whose health is compromised by it?" Dr. Jain wrote. "It's hard to justify being in both businesses without at least some more deliberate effort to resolve the moral tension." 

These decisions are rarely black and white, according to Dr. Jain. He recommends that retail and tech companies openly acknowledge the tension to build trust with consumers. By striving for balance — for example, adding fresh fruits and vegetables to shelves stocked with unhealthy snacks, and even discounting the healthier options — and setting ambitious goals to improve healthcare, companies can both increase revenues and improve health. 

"Don't pretend selling primary care next to Cheetos is 'normal,' or that promoting misinformation while selling healthcare devices and services is 'business as usual,'" Dr. Jain wrote. 

If retail and tech companies fail to acknowledge the paradox, "the more cynical among us might be right in saying CVS's grand bargain on tobacco was a meaningful exception and the diversification into healthcare isn't anything more than a revenue land grab," Dr. Jain said. "I hope they prove the cynics wrong." 

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