This Nature perspective argues that consumer health AI from companies like OpenAI, Amazon, Ant Group and Anthropic is moving past answering questions and into routing patients through records, booking, pharmacies and payment. The authors say the public health stakes now depend more on who controls that pathway than on how accurate the models are.

• The concern is less about model performance and more about platform integration depth, meaning who controls the interface that interprets symptoms, routes care and handles payment.
• The authors say health outcomes in low-resource settings are often lost not because care is unavailable but because patients fail to complete the steps to get it, which is where these platforms could help or distort.
• They propose a pathway-level accountability framework covering evaluation, procurement, routing transparency, data governance and exit options, and argue existing regulation should cover care pathways and platform incentives, not just models.