Self Health: Own your Biological Machine
Self Health: Own your Biological Machine
Getting real time data on the health and condition of your body has never been easier. The hardware of the quantified self has arrived: rudimentary biological computing interfaces are either already on the market, or in closed beta pending FDA approval. As the field evolves, we will not only be able to track and react with behavior changes, but all those things we throw at our problems – medications and supplements and lotions and potions – will finally have a feedback or data loop that tells us what’s working and what isn’t.
We already have access to basic sensors that track your sleep, step count, and heart rate. You’re probably familiar with the granddaddy of activity trackers, the FitBit , or the Jawbone Up (with the Up4 you can even pay for your post-run Bulletproof coffee via its Bluetooth connected wallet). These kinds of wearables are getting more beautiful and more consumable. The sculptural new Oura ring ingeniously hides its tiny sensors in its museum quality band. And we are digging that new Tory Burch band on the FitBit. Non-wearable devices, such as the investigatory Scanadu Scout, are using sensors to get information about temperature, blood pressure and oxygen levels.
Even your smart phone camera is an input for self-observation, giving a daily snap and dropping it into an app to help manage hair loss or acne or psoriasis or other conditions of the skin. Input devices are also becoming contextual. At last week’s Quantified Self conference, we saw a driver seat for the car demonstrated by Faurecia Active Wellness that alerts you to your biological condition in context: whether you’re stressing out from road rage, or falling asleep at the wheel . Even more subtle future sensors and input devices are in development – ones that might go in a contact lens, or inside the ear even embed into the outer layers of the skin, as a flexible tattoo sensor.
Increasingly, the data isn’t just coming from surface measurements. Sensors are now getting attached to biological outputs, measuring the makeup of your sweat, blood and urine, even your breath , to provide real time decision support on taking care of your body’s chemistry. You might strap on the new Electrozyme band which passively analyzes your sweat in real time to tell you if your electrolyte balance has been depleted. Or maybe you use a tiny pin-pricking pen to extract a daily drop of blood to test cholesterol or hormone levels, to manage menopause or fertility - or a digital strip to get data from your urine on everything from whether you’re glucose levels are right, to whether someone’s been smoking weed.
As the input devices get more sensitive and have broader inputs, the universe of what data can be collected, analyzed and displayed is expanding. The integration platforms are getting more capable in tandem. Both Google (Google Fit) and Apple have health integration platforms, which are rapidly evolving. For example, Apple’s Healthkit added APIs in June of 2015 to take in data points for hydration levels and oxygen levels. The Healthkit developer community has a long list of requests for types of data they want to integrate into their apps.
For those who have a chronic condition, such as diabetes, or heart disease, these measurements can be invaluable, although what is colloquially called patient compliance isn’t an easy problem to solve. That is to say you can prescribe a pill but can’t make someone take it. You can tell people to “drop 50 pounds or else” but you can’t enforce it. Even with all the data in the world, even with explicit instructions, people don’t always change how they act. Plus, we’re living with the inherited frame: the up-until now reality wherein we give up control of our health to the professionals. In the paternalization of wellness, doctor knows best. In fact, the FDA is internally churning to find the correct balance of our right to know and use our own data, and limiting our access to it. By calling these new sensors and data readers “medical devices”, they will be therefore regulated and limited to professional use.
So, do we trust people with their own health information, or is that better left to the trained medical eye? The bias going in seems to be to view the patient as a passive consumer. In an effort to not upset the FDA at this critical time in the shifting philosophy towards personal data, the devices are bowing and scraping in their marketing prose about sending data to doctors, about working with doctors, about you and your doctor having the data for proper diagnosis, which in a utopian world you will use together. We recently tried a genius mood disorder app, Ginger.io, but the patient interface was qualitative, with no data visible over time to the patient, cycles or usable data patterns. That, presumably, went to the doctor or the psychiatric nurse.
While working hand and hand with your doctor is a very a nice idea, few people feel like their doctor is their partner in anything. People respect and trust doctors, but the economics of medicine and the overall lack of a peer relationship between physician and patient are not a partnering dynamic. An office visit is usually a long wait in uncomfortable chairs, a wait in the exam room, some vitals by a nurse, a cursory visit from the doctor, targeted at a problem. So in short, the doctor and patient are not partners in a multidimensional, longitudinal practice of optimizing a patient’s wellness over the course of a lifetime, they just point to solutions for obvious problems. That may be slowly changing. Todd Hixon puts it succinctly, “The goal is clear: make medicine more proactive so that it can reduce chronic disease early, before the damage is done, and better manage the overall medical system on behalf of the customer, to take the right actions fast and reduce unnecessary procedures and cost.”
On the opposite end of passive consumer of health care, there are a host of people interested in actively taking personal responsibility for their own wellbeing. Maybe they are people who have a condition that needs monitoring, and they don’t want to leave it up to “the professionals”. But often it’s a new kind of thinker: The hyper well and the hyper responsible – those who see their body as an organic machine, where actively managing inputs and activity can lead to an optimized state; here even if they aren’t pro athletes, they are managing for overall life performance; here looking at hard facts is a welcome tool in improvement. These are the “Self-Healthers”.
If the body’s health can be instrumented (fat composition, blood oxygenation, cortisol levels) and then managed on a daily basis through a variety of data dashboards, and there is deep motivation, we are enabled to actually do self-care. Then, if something’s off, and requires a habit change or behavior change, there are all kinds of app based ways to manage it: does your data show you’re constantly dehydrated? Try the iDrate app, which reminds you to tank up all day long. Stressed out? A variety of mind training and meditation apps are at your disposal.
Health measurement company Scanadu’s slogan implies a promising future: “We are the last generation to know so little about our own health.” Yet, we do know a lot of things, we just don't act on them. People know cigarettes cause cancer and they are still smoking. People know about STDs and still have unprotected sex. People know 30 minutes a day of cardio is vital to their health, and still don’t go for that walk.
For the highly motivated, this emerging movement of the quantified self, wearables, self-tracking, mHealth and all the other tools that are coming to help us improve our health and even beauty will be revolutionary. Self-Healthers will take advantage of the data and take charge of their wellness. The doctor will be there to serve in the event that people face a problem they can’t figure out or can’t solve without professional help. And that is an immense shift in how we interact with healthcare providers.
For those that don’t want to pay attention, the healthy will continue to bear the collective cost of this ignorance and abdication for a while. If one of our fellow citizens does all the things that lead to chronic sickness (getting morbidly obese, being always sick or endlessly tired, smoking and drinking and drugging and stressing and fighting), we’ll bear the cost for some time longer. But that can only go for so long. Once the data is there, and you can measure activity and results directly, our own body’s performance won’t be a mystery. Chronic illness will be seen as an active choice, not something that happened to you as a result of genetics or social standing. What's genetic and what's behavioral will be evident. We will be able to take the mystery, spirits, voodoo, karma and other external forces out of our own poor health, face the facts and manage to those.
As the world of data-driven healthcare emerges, we will see a tidal shift in what’s expected of us as individuals in the management and leadership of the health of our own body and mind. Maybe NOT managing your health, refusal to manage your own health, will be seen as a new mind disorder in the DSM (Diagnostic and Statistical Manual of Mental Disorders).
What does “Self-Health” means for the business and practice of medicine? It's already having an impact on everything from how, when and where lab testing gets done, to making it more feasible to be being cared for in-situ instead of in a hospital, and to being diagnosed and treated via telehealth. It may become a single data flow that connects all parties - healthcare providers, patients, families, insurers. The cloud based health platform Validic is trying to do just that. By connecting patient-recorded data from apps, devices and wearables, and delivering it to hospitals and other healthcare companies, it’s also changing the dynamic between patient and medical staff. In the long run it will bend the economics in favor of prevention, which is good for all of us.
Stay tuned for another post on the consumerization of healthcare, IoT and Self-health, and what it means for physicians, providers and device makers.