Medical Privacy: The Challenge of Behavioral Ad Targeting in Healthcare

The latest piece in the medical privacy jigsaw puzzle is online behavioral advertising.

Last week, the Federal Trade Commission (FTC) received comments from the Network Advertising Initiative NAI on the agency's proposed principles for OBA. As part of this filing, the NAI has published in draft its own approach to behavioral ad targeting in health, included in the Self-Regulatory Code of Conduct for Online Behavioral Advertising

Online behavioral advertising OBA is the process whereby the online consumer's search behavior is analyzed across multiple websites and then categorized for use in advertising online.

NAI's members are reputed to cover 95% of the online advertising market. NAI's membership includes 24/7 Real Media, Acerno, Advertising.com (an AOL company), AlmondNet, Atlas (a Microsoft company), BlueLithium (a Yahoo! Company), Doubleclick (a Google company), Media6degrees, Mindset Media, Revenue Science, Safecount, Specific Media, Tacoda (an AOL company), and Yahoo!. Furthermore, NAI is processing membership applications from Undertone Networks, Google and Microsoft.

Toward the end of the NAI's Code you will find a section called, "The need for common understanding by industry," in which the NAI lists the "minimum restricted and sensitive consumer segments" that online advertisers should avoid targeting.

The list includes:

1. Certain medical/health conditions–
A. HIV/ AIDS status
B. Sexually-related conditions (e.g., sexually transmitted diseases, erectile dysfunction)
C. Psychiatric conditions
D. Cancer status
E. Abortion-related.

2. Certain personal life information–
A. Sexual behavior/orientation/identity (i.e., Lesbian/Gay/Bisexual/Transgender)
B. Criminal victim status (e.g., rape victim status).

The NAI goes on to list other "potentially restrictive or sensitive" areas such as addictions, disability, and philosophical beliefs, among personal characteristics.
The NAI offers the value proposition for behavioral ad targeting as follows:

Advertising is fundamental to the accessibility, affordability and dynamism of the Internet. Online advertising underwrites the rich variety of online content choices available to consumers at no cost or at a far lower cost than would otherwise be possible – similar to what we see in television and radio.  More relevant advertising creates a win-win for both consumers and companies, because consumers find more of what interests them and companies spend less on ineffective advertising.  
 

Jane's Hot Points: The NAI recognizes in its self-policing guidelines that, with respect to behavioral ad targeting, health is something different than, say, information on autos, fashion, or coin collecting. The organization concedes that,

"self imposed constraints help achieve the balance needed to preserve consumer confidence...Even where there is reduced privacy impact in use of anonymous or anonymized data, the NAI recognizes that consumers will only trust and continue to engage with advertisers online when there is appropriate deference shown to consumers’ concerns about the privacy of their web-surfing experience."  

Some health care citizens will want to opt-in to receive relevant ads and information; some won't. Some of these citizens who choose to opt-in will be people managing HIV and AIDS and depression and breast cancer; some will be caregivers. People are already taking advantage of Web 2.0 tools, on their own terms, in managing their and their loved ones' health.
However, our own terms are predicated on transparency and trust and a comprehensive approach. The NAI's list of sensitive and restricted medical areas reads fragmented and ripe for parsing.

A useful model for data protection and search engines was adopted by the European Union on 4 April 2008 which could be a good precedent for the FTC to consider.

The NAI is calling for comments to their draft principles. You can review details and leave comments for the NAI here.

-- Jane Sarasohn-Kahn