““Every Breath You Take, Every Move You Make…” How Much Monitoring Is Too Much?” in the Scientific American by Hilda Bastian points to a common prejudiced view of Quantified-Selfers.

My thoughts:

“Since then, medical self-monitoring has galloped along. And somewhere along the line, using sensors feeding data into computers became a normal part of life for high-performance athletes. Now, many of our friends are clocking their every step. There are people using apps to monitor their sleep, food, weight, heart-rate and moods – and even some people without diabetes are buying blood glucose monitors”

I find it funny to read the line “some people without diabetes are buying blood glucose monitors” being published in the Scientific American in 2013. Of course diabetics aren’t the only people who can benefit from knowing their blood sugar levels but as testing becomes ever easier and non invasive (eg. think of a next generation mobile integrated Dexcom Seven Plus) must we continue to regard this information to be something that is only ever accessible to diagnosed diabetics?

As we increasingly witness the convergence of medical tech to mobile phones it’s going to be only a few short years before a smartphone can monitor your blood sugar (probably by monitoring the optical rotation of polarized light being reflected through intraocular fluid) and then a statement like Hilda’s would be akin to pointing out that “even some people who aren’t obese are buying weigh scales”.

“If the enthusiasts of the ‘quantified self’ movement [3] are right, this mash-up of health, fitness, gadget and data-crunching crazes is just the beginning of a very big wave that will carry most of us along. [4] And they rather fervently believe that the more people juggling more data, the better. [5] We’ll prevent illness, identify the causes of any ills or irritations we do have by constant cross-analysis of our very own big data, and generally hit any number of health and fitness targets. What could possibly go wrong?”

I think there’s a confusion here about data and information. A Patient’s mobile connected smoke/CO alarm is processing plenty of data but because the system is designed properly the user or monitoring carers aren’t aware of it until they get information (eg a bleep or a SMS) alerting them to the need for a battery replacement or emergency response.

It surprises me that a Scientific American article would be confused about this as this is common to a whole raft of sensory systems that we use everyday eg. safety restraint systems in automobiles are no brainers today but if you were a car manufacturer in the 1960’s and someone told you they’d be putting hundreds of data generating sensors into a car to achieve this you’d probably laugh them out of the room.

“Professor Paul Glasziou, author of Evidence-Based Medical Monitoring, [6] is taking stock this week at Evidence Live [7] in Oxford. Medicine has come a long way since Clara Lowy’s first foray with a patient monitoring her own blood glucose. Glasziou pointed out that billions are now spent annually on blood glucose monitoring. And while it’s valuable for people with diabetes that are pregnant and/or using insulin, it isn’t going to improve the health of those who don’t use insulin.[8]”

Prof Glasziou is wrong. Professional sporting teams have shown that the performance of athletes (a direct measure of their health) and their nutrition can be optimised through awareness of accurate blood glucose levels. To understand the wider health impact this will have you need to appreciate it’s potential to create personalised diet regimes through an appreciation of the link with BG and appetite eg. so that you can make diets more scientific and achievable for Patients who are having trouble trying to lose weight (gastric bypass operations reportedly cost the NHS £85 million a year and are up 5 fold in the last 6 years).

“How valid and accurate are the tracking devices for healthy people? It’s clear that even the basic ones still have a long way to go on this score. [9] Using two trackers on the same day yielded a count of 7,116 steps from one device and 2,192 steps for one enthusiast who conceded this isn’t yet going the way you’d like. [4] Whichever pedometer is used though, there’s an underlying problem in the assumption that they will improve health. Pedometers may help you walk more when you start using them, but improvement hasn’t been solidly sustained over time. [10] The same problem may hamper the hopes people have for benefiting from monitoring their weight. [11]”

I think it’s important to look beyond dated technologies before drawing conclusions. For millions of senior citizens who already have native pedometer apps on their mobile phones the ability for their carers to see at a glance their wake/sleep hours and activity levels can be very useful.

Smart clinicians don’t need to see research to understand that a simple device like a mobile connected care monitor (with PIR sensor) can log nocturnal activity (and that awareness of this can help them manage nocturnal frequency – the biggest risk factor in the UK for Hip Fractures which is a leading cause of death) and as we make more sense of sleep monitoring via apps like Sleep by Motion-X (the world’s best selling medical app on iOS) and devices (like Biancamed’s non-invasive RF sleep monitoring tech that we will see integrated into smartphones in the next few years – see the Gear4 Renew SleepClock to get the general idea) this is going to have a massive impact on evaluating the effectiveness and side effects of a wide range of medications while helping citizens improve the quality of their sleep.

“All this skepticism doesn’t mean that I believe this is all a waste of time. Far from it. There will no doubt be ways that monitoring and monitoring technologies will help many people. There is, though, potential for harm, including unnecessary and pointless anxiety”

I think this is a common misunderstanding of how technology is adopted. Markets will naturally fix these issues in the same way that the automotive market has already eg. my car airbags don’t explode every time I hit a pothole, my Distronic Cruise Control doesn’t regularly cause me to perform needless emergency stops on the motorway, etc, etc.

“Footnote: Pew Internet researchers [17] estimate that 1 in 5 Americans is using some kind of computer technology to “self-track” their health”

I think this is inaccurate because Pew researchers don’t appreciate the value and use of online photos as a source of self tracking.

Perhaps this cynicism derives from a fixation on the Doctor office visit?

The evidence is clear that we can now use the Internet to sense information about a Patients health and present it in a structured way to a Doctor doing away with the need for most primary care in-office consultations.

If you can think beyond the in-office visit with a Doctor you’ll have a much better idea of how healthcare providers can turn the data being created by increasingly empowered citizens into information and positive health outcomes. Check out 3G Doctor to get an idea of how this is already starting to happen.

How Much Monitoring Is Too Much?

I suppose you could accuse me of being a “quantified selfer” so maybe this post is written in defence of my own actions but the health benefits that I get from doing this far outweigh the costs and as the monitoring tech I use is being integrated into mobile apps and hardware this is all going to become a something that billions of other people will do in the next few years.

To help you get the idea here’s a few things I do that create value for me:

> Mobile Connected Smoke/CO Alarms (I know the people and animals I care for aren’t in danger)
> Sleep monitoring with realtime audiovisual feedback (I know that I sleep and wake better than you)
> Security systems (I know the property/vehicles I own are secure which probably also helps me sleep!)
> Voice recording/processing (increasingly I don’t have to sit to use a keyboard or stare at a screen to communicate my thoughts)
> Smartphone pedometer app & calibrated weigh scale (I know how exercise/diet choices impact on my health)

There have been many attempts to personalise medicines but the reality (and the cost of bringing new drugs to market) means we’re going to have more success personalising the delivery of medicines so experiences like these that I use to generate moderate health benefits will in time be used to give patients extra years of life, save money and avoid the multiple complications that we tolerate in today’s one-size-fits-all approach to consuming medicines and going under the knife.

In my opinion asking how much is too much is missing the opportunity because as we understand more about data we will create new understandings about health and disease that will reframe our perceptions about treatment. In the journey quantified living has taken me on the most incredible thing I’ve noticed is the ability it provides me to quantify the value of placebo’s. The regulated healthcare industry doesn’t know how to even accept this opportunity even though they know that the power of a Doctor giving you a bright Orange Sugar Pill or a particularly bad tasting cough syrup can have more value than a prescription of the latest blockbuster drug.

There are drugs that generate Billions of $’s because Doctors use them as they seek to treat things like depression and sleep problems for their patients BUT it’s becoming increasingly obvious to those who understand medicine that millions of these Patients are receiving no health benefits from the medication. I think the Quantified Self movement will in a less than decade have us look at this aspect of current medical practice in the same way we today regard “medieval Doctors blood letting or putting people with schizophrenia in big swings“.

What do you think about the ‘quantified self’ movement?