Now technology — bold disrupter of industries from media to banking — is promising a brave new world of medicine. A world in which, as author and cardiologist Dr Eric Topol has it in his new book, “The Patient Will See You Now”.
Tech companies see healthcare as a new gold mine. Aggregating this information into big data will reveal patterns that will solve medical mysteries and lead to innovations, they argue. Last year, Google’s Larry Page predicted 100,000 lives a year could be saved if he could get his hands on all the data being generated by the medical industry. IBM has just announced it will be hiring hundreds of people to help analyse reams of health data with its Watson supercomputer.
Stolen healthcare information is worth 10 times as much as stolen credit card information. Criminals use the information to buy drugs and medical equipment to resell. It’s also some of the most, if not the most, personal information that we disclose and has traditionally been heavily protected.
So far the apps available and health trackers such as Fitbit and Jawbone are fairly primitive devices that count steps and measure exercise and calories. Now Apple is selling the Apple Watch — complete with a rapidly expanding suite of health apps — in a move it hopes will revolutionise the wearable tech market in the same way iPhones shook up the mobile phone market.
Google and Microsoft have their rival products on offer or in the works. The arms race is on and the Apple Watch is just the beginning. Smart pills are being developed that when swallowed will measure your health from inside your body, transmitting it to the cloud. Google is working on a contact lens capable of constantly measuring blood sugar levels — helpful for diabetics, but also a way to measure all our dietary choices.
In this brave new world the patient will be collecting their own data, algorithms will alert us when things go wrong and the doctor will only be a FaceTime away, if they’re needed at all.
But this shift is raising some big questions — questions that we will be asking for years to come. Do health apps work? “The British Medical Journal” questioned whether the apps now on the market do anything other than cause anxiety.
In the article, Dr Iltifat Hussain, editor in chief of iMedicalApps.com, a review site for medical professionals, argued that some apps “help people to correlate personal decisions with health outcomes” and “can help doctors to hold patients accountable for their behaviour”.
Dr Des Spence, a GP in Glasgow, argued that the apps were “untested and unscientific” and opened the door of uncertainty. “Make no mistake: Diagnostic uncertainty ignites extreme anxiety in people,” he wrote.
Health apps are in their infancy and at the moment are fairly blunt instruments. There may be little benefit in taking 10,000 steps a day if your diet consists of burgers, fries and cigarettes. But as the apps get more sophisticated and popular, the anxiety may only increase. It’s an issue that will be recognised by anyone who has Googled an ailment only to disappear down a rabbit hole of worry.
If I can just opt out, why does it matter? Choosing to opt out may become more difficult. Employers and insurers have become increasingly interested in wearable tech and health apps as a way to encourage healthy choices by workers and, the theory goes, cut down on sick days and insurance costs.
BP has been giving American employees Fitbits for a couple of years to measure their steps. Walking two million steps a year saves staff £800 (Dh4,442) in lower health-related fees.
Last year, US supermarket giant Safeway started offering health premium discounts of up to 20 per cent to workers who do not smoke and meet company benchmarks for weight, blood pressure and cholesterol.
Opting out may also be more difficult as the technology develops. If you think tagging yourself with a GPS fitness device is an issue, at least you can always take the band off. The next generation of health devices will be implantable, ingestible and injectable.
Biotech company Proteus has developed a “smart pill” that, when swallowed, can monitor health, including what pills you took and when, from inside the body. The pinhead-sized sensor is powered by the body and can monitor various health indicators, such as activity, respiration, sleep and heart rate.
The Gates Foundation and MicroCHIPS are working on an implantable device that can be filled with a 16-year supply of birth control. A remote control will turn the device off and on when required. Microchips can now be manufactured as small as a dust mote. The world’s smallest computer, the University of Michigan’s Micro Mote, is smaller than a grain of rice. All these devices are getting smaller and smaller, and most of them will be transmitting intimate details of our lives to databases where we have, at best, a confused understanding of how the data will be used.
No doubt, conspiracy theorists are already fretting about whether injectable tracking technology could be secretly implanted in vaccines or food, but the truth is we’ll probably willingly track ourselves. “Given our history and the path we’re on, we will openly invite technologies into our bodies that can without a doubt be used to spy on us,” says Jason Levy, senior vice-president at Saatchi & Saatchi Wellness.
Isn’t improved health and greater access to our own data a good thing? Levy, a futurologist of health, is a cautiously optimistic enthusiast of what he calls the “consumerisation of health”. His son has a recurring ear infection that often entails Levy taking a day off work to take him to the doctor. An app is already able to check the infection and soon he believes it will be common for people like him to check with a doctor online and have them prescribe medicine without the patient ever having to leave home.
“It’s like banking. Remember when we had to go to the bank, line up, write a cheque, withdraw cash? Many people were convinced we’d never move to online banking because of privacy and security issues. Now we are sending pictures of cheques via apps to deposit them in the bank. There are even more issues to face in healthcare, but it’s moving in the same direction,” he said.
While our lives may get more convenient for minor ailments, the bigger picture is more murky. Levy said there were so far no conclusive, independent studies to show that health apps make us more healthy. The data being generated could at some stage be invaluable to researchers, but right now all those companies using tracking data to reward — and penalise — staff are doing so with no scientific backing. And the major issue will be what happens to that data.
Others fear that the rise of data harvesting — what the commentator Evgeny Morozov has called the “perpetual electronic guidance of individuals” — threatens to undermine the search for collective, political solutions to social and health problems, leaving individuals at the mercy of corporations and insurance companies.
So what happens to all this health data? It’s a grey area. Much of the information being collected doesn’t count as health data. Collecting more sensitive information requires regulatory approval. Google’s Page and others are pushing for greater access to the medical data being collected by doctors, hospitals and other healthcare professionals.
“It’s a gold mine for the tech companies,” said Dr Deborah Peel, founder of Patient Privacy Rights. “In the US at least, apps are essentially not covered by any regulation.” As tech reaches into ever more sensitive areas, Peel predicts there will be a clash between patients, insurers, tech firms and governments over who owns the data. The UK’s attempts to build a central health database, the care.data programme, has already generated widespread anger over a patient’s right to opt in or out. “This isn’t just information, this is actually you,” said Peel.
–Guardian News & Media Ltd
