by Craig Klugman, Ph.D.
How are you? How are you feeling? These used to be straightforward greetings with simple answers. “I’m fine.” I’m doing well.” “I had been feeling ill but am much better now.” Or even “I keep struggling with diet and exercise.”
However, in the age of accountability, our society has become less comfortable with fuzzy statements and prefers to quantify everything possible, irrespective of whether it’s meaningful. The same question today may elicit responses of “My cholesterol is at 265.” “My sugar is at 210.” “BP is 96 over 75.” Or even “I can’t talk right now, I still have 4,000 steps to go.”
Health has moved from describing a state of being to listing a collection of numbers. Most electronic conference shows in 2014 have featured wearable computing—devices that you wear on your body and often link with you computer or cell phone. And most of these devices work to track your health. Samsung has a new phone with a built-in heart rate monitor. Apple announced a new health app that can connect with external devices capable of monitoring your weight, calories consumed and expended, sleep pattern, blood glucose, blood oxygen level, elevation gain during exercise, and exercise time. Google has announced a new software home for all your fitness information and wearable devices.
The new goal is not to be healthy or to feel well, but to improve the numbers. And the presumption is that good numbers means good health defined as lacking morbidity and postponing mortality. However, this presumption has not yet been proven. In addition, the numbers themselves are fictions representing averages and ranges that may fit many, or even most, but not all people.
Thus, health has come to the accountability era. If you have constant feedback on your health indicators, then the presumption is you can control what those readings are through your behaviors. The meaning of “disease” then moves away from acquiring an infection or developing a condition as a result of genetics or environmental exposure. Instead, disease becomes the result of not keeping your numbers in line. Disease is no longer something that happens to you, it’s something that you cause. And if your numbers are good, then you don’t need the annual physical: After all, the phone says you’re healthy.
On the plus side, this trend is based on the idea that with more information, people will be motivated to take more responsibility for maintaining health, which theoretically presents disease. If little brother is in your pocket or on your wrist, offering rewards and reprimands, you are more likely to maintain a healthy lifestyle. Sneaking that late night cookie changes the day’s calorie counts. Skipping a day at the gym lowers your steps for the week. This is a big plus for people with chronic disease who will have better health outcomes with more constant surveillance. For example, diabetics have better health the more often they keep track of their sugar levels. New devices will even allow the cell phone to track sugar levels and give insulin when needed. These devices can make that easier. Will there be a benefit for the person who lacks a disease? The payback will be smaller and whether there will be increased longevity or increased healthy-aging remains to be seen.
On the opposition, one must wonder where all of this data and information goes? Are Apple and Google providing these fitness homes out of the kindness of their hearts? Doubtful. Most likely they are collecting this data (perhaps even anonymously) to mine it for targeted marketing. Consider also that these external devices communicate to your phone via Bluetooth and wifi and the phone connects with the internet via wifi and cell towers. It’s possible for someone to hack these connections and steal your information. Is this information worth the loss of privacy? What if your employer learns about your health? Can your insurer raise your rates if your wristband does not measure 10,000 steps a day? Might you be refused dialysis if an indicator shows that you neglected your diet?
Some apps even allow you to develop a group of friends so you can compete to see who has the best numbers. The idea is that if you reach desirable numbers, then you are healthy or at least practicing health-wise behaviors. The whole idea of competing against other people on your measures is to use peer pressure to encourage you to improve those numbers. At some point though, that peer pressure to motivate you can become peer pressure to judge (or bully) you for not keeping up. There could be stigma against those who do not meet health milestones or keep up with the averages.
Like auto insurance companies that offer discounts for using a device that collects data on your driving habits and sends that information to the company, your health insurance could do the same thing. And over time, that discount can turn into a penalty for not complying as happened with smoking and insurance: Discounts for being a non-smoker became penalties for being a smoker. The same could happen here.
I can imagine that after the initial boost to health behavior, that we’ll start lying to our devices. That midnight cookie? Just take off your device first. Not getting enough steps? Strap the device onto the dog and let him run around. As absurd as it sounds, people already do “cheat” to get their devices to display healthful numbers. Why would one cheat on a device like this? Because for some people who are in a contest their motivation is to win, or maybe the technology has begun to take over a person’s life.
As absurd as this notion seems, in a conversation at a hospital today I mentioned this and one person said “My numbers were due yesterday. Wish I had known about that.” A second person admitted to having cheated as well.
Just because we can count it doesn’t mean we should, or that the numbers matter, or that we actually are healthier.