Guest post by Dr. David Whitehouse, chief medical officer, UST Global.
Technology innovation is changing many fields dramatically but unevenly, and that is especially the case with the medical field. When I get into my car each morning and look at the dashboard, I know more about the health of my car than myself.
When it comes to health, we live our lives directed by our beliefs about health and symptoms. Beliefs drive us to strategically invest in aspects of our physical selves, from diet to exercise, to immunizations. What causes us to go to the doctors, for the most part, are symptoms: aches, rashes, pain, and general losses of function. Once we see a doctor, specifics about our health are further defined by numbers (temperature, blood pressure, cholesterol).
For the most part, I am aware of my symptoms, but not my numbers. Some with a chronic illness like diabetes use numbers to help pinpoint the ups and downs of their health. The majority of us do not keep track, because internally, automatic sensors measure and assay everything – glucose levels to direct the secretion of insulin, and blood pressure changes to alter our heart rate.
Homeostasis takes place unconsciously, as conscious knowledge of all these internal processes would be information overload. Certain manifestations like fainting, blushing, and dizziness, remain on the macro level to warn us that the system was in trouble.
Modernity has shifted the need for conscious measurement of our internal processes. The diseases that are killing us – obesity, metabolic disease, type 2 diabetes, hypertension, and heart disease – are ones for which our control systems are poorly evolved. These types of diseases do their damage silently and over long periods of time. Unable to correct imbalances well, these problems tax us physiologically but send us no symptomatic warning until it is too late and the damage is well on its way.
Additionally, static numbers may not tell the whole story in homeostatic systems. The goal of the homeostatic system, after all, is to do its absolute best to restore things to the range of normal. As a result, discrete measurements in time such as blood pressure in a physician’s office, shifts of monitored vital signs in a hospital, or a.m. blood glucose may give you a point reference, but cannot show the energy that the system is expending to maintain that homeostasis. Continuous monitoring, however, can show us how strong or weak this homeostatic system is getting. Just as we can increase the predictive capacity of “failure” sensors in airplane engines, products like Oxford Bio Signals’ ViSensia can offer much more sensitive and valuable predictive warning systems. The continual monitoring of our numbers may allow us to be aware of risks from silent killers before the manifestation of symptoms, which will hopefully influence our lifestyle and activities before it is too late.
This is beyond the quantified fitness movement, which is really only an early manifestation of the new quantified medicine wave. These earlier monitoring devices focused on easier engineering tasks (paces walked, sleep patterns, temperature, and heart rate). While helpful, the impact did not extend to the public health crises as a whole, since they were mostly adapted by fitness advocates who were already in good health. Many others bought them as novelties, often discarding them as their journey to weight loss or fitness proved more difficult than monitoring alone.
Adoption without public health impact has caused some to say the quantified movement is a bust. However, that is not the case. More than 40 million U.S. smartphone owners are active users of at least one wellness or fitness app, according to research from Parks Associates. The firm also reported that 25 percent of heads of household at homes with broadband use a mobile app to track their fitness or track their caloric intake, and an estimated 41 percent of caregivers used some kind of digital health device.
Allowing this adopting as well as new technology that continually monitors our functions gives us more power to direct our health. This empowerment and this investment in prevention and care rather than cure and repair would significantly limit the growth of the global epidemic and growing burden of chronic illnesses. This is the dream of the quantified self.
Already, results are coming in of true positive health outcomes, and physicians are beginning to recommend these devices to their patients. More significantly, bioengineering and material science are taking allowing for new tech, including glucose monitoring and real-time vitals data. These will be available cheaply not only through devices such as the Apple watch, but through low-cost tattoos that will be washable, replaceable, and disposable, that will use near-field communication to talk with watches or smartphones. The next step is to learn anew how to interpret this data.
The possibilities from this new wave of data are great. Our conceptions of “normal ranges” and the gross aggregation of averages to direct care and advice are going to change, as personal variability is going to have to be taken into account.
We will come to appreciate the impacts of aging and disease on the flexibility and resilience of homeostatic mechanisms. We will watch the different ways individuals respond to physical and emotional stress and how that taxes our bodies. We will understand physical resilience and emotional resilience in new ways. We will have a new set of health advisors who will help train us and guide us through interpretation of this data – and a new way to conceive our care. When is the tipping point to change my life? Quantified medicine will be a field unto itself.
If we are to survive the growth of chronic illness and its societal impact, we must embrace this movement and support the innovation of material science and biosensors. This will allow for the accelerated learning necessary to understand the meaning of continuously monitored physiological systems in an organism tuned into its own homeostasis.