New York, 2016
Your smartphone blasts you into semiconsciousness at 3:20 in the morning. As you shakily grab its sides blue and white neon flash across the screen – “Warning! You are at risk of heart attack. Consult your physician immediately.”
You stare at the messages, but the picture stays the same. Hit a few random buttons. The flashing does not stop. Finally you touch the icon for the app. Then press the big red button for “more information.”
“There is a 46-78% chance of heart attack within the next 48 hours. Please consult your physician.”
There’s little choice – that little chip they injected into your arm was your spouse’s expensive birthday present. You’ve never had any cardiac problems, any real medical problems for that matter. Yet your sister died suddenly last year.
The cardiologist on call for your medical group sounds even pissed off, but she starts to ask a lot of questions.
Yeah, you haven’t been feeling right since that cold last week. Yes, your chest did feel heavy. Yes, you had high blood pressure for two years, but it’s been normal for the last five without medication. Yes, your sister died suddenly. Yes, you’ve felt very queasy just below your breastbone the last three days, but you often feel like that after a cold.
Six hours later you’re prepped and ready for your cardiac cath. You’re out cold when the scalpel cuts your thigh.
The catheter threads in. A small bleb of plaque touches the catheter tip as it rolls up the abdomen. You wake four days later in the ICU. Your spouse is there but you can’t understand what she says. You belatedly realize three different people have been trying to tell you you’ve had a stroke. As you try to get up from the bed, two nurses restrain you.
Science fiction? Or just welcome to the future?
A friend recently sent me IBM’s tech predictions for the next five years. Sensors will be everywhere, particularly on and in your body. And here’s what Paul Jacobs, head of Qualcomm, told Charlie Rose last week (p. 37 in January 14th edition of Bloomberg Businessweek):
“There’s a researcher we’re working with who has an idea to put a tiny chip inside your bloodstream…and it’ll maybe lodge in your wrist and look for certain indicators that in two weeks you might have a heart attack. Can you imagine that? So your phone will ring and tell you to go your doctor.”
There are now a billion smartphones in the world. Jacobs predict there will be six billion in 2016. Each can quickly become a “health care monitor.”
Screening and Treating
Consider these few items:
1. PSA (prostatic serum antigen tests) have been used for decades to screen for prostate cancer. Present estimates are 30 to 100 people get treated unnecessarily for every “saved patient.” The billions spent on screening and treatment does not include the many thousands of men rendered impotent, urinary incompetent, or suffering burned-up GI tracts.
2. Mammography is practiced worldwide to screen for breast cancer. British government researchers argue three people are treated unnecessarily for every “effective treatment”. Researchers in Denmark argue that numbers are more like 10 to one. And that’s the data on mammography - one of the most universally accepted screening procedures.
3. Recent research argues that clinical trials are often skewed towards the positive for professional and profitable ends.
4. Doctors make far more performing procedures that talking to patients, examining them, educating them or discussing preventive health. Many income-decreasing docs will welcome new opportunities to procedurally screen and treat. So will hospitals, who recognize these “profit centers” programs keep their unprofitable general treatment programs going.
5. American health care already costs 18% of GDP. Mutliple new opportunities for mass use of diagnostic procedures and treatment can help bankrupt both the government and the national economy.
And there’s more.
The New Hypochondriacs
For years people have been talking about their cholesterol levels as if they were personal baseball scores, proud to have “achieved” low numbers. Yet most of these “achievements” have come not through diet but through ingesting statin drugs. And much of statin’s usefulness resides not in lowering cholesterol but stabilizing arterial surfaces. Too low cholesterol levels are also associated with depression, suicide, and increased death, but don’t tell that to happy consumers.
The coming increase in sensor technology will allow people to quickly and continually access their insides and outsides. Wireless technology will allow cellphones and tablets connected to the cloud to near instantly “learn” what the numbers “mean” and communicate them to health personnel.
Everyone can start watching. A society riveted by “reality” TV - and where tiny drones may soon allow parents to watch their backpack chipped children go to school - will now posses the chance for infinite entertainment. 24/7 you can observe "personal health information” fly across multiple screens.
And what happens when the numbers are “off” or simply “unclear” or “unreadable?” Simple. Do what the pharmaceutical ads suggest – “call your doctor.”
Much of the time she won’t know what to do. So she’ll test. And test so more. And follow up the tests, false positives included.
And everyone can worry and fear, while some make a lot of money.
There’s no reason to hold back the sensor-laden future. Smart technology may help save the environment we need for our survival. And sensors may convince the public of an important truth – that their bodies really are information systems which constantly “update” as they rapidly regenerate themselves. That’s how we get and stay healthy.
But before we rush from smartphones to smart homes and smart cities, let’s ponder smart policies.
First, health sensors will have to show their use is “safe and effective” not just individually but for the public health. Knowledge has consequences – including unnecessary procedures that provoke stroke or other morbidities and magnify climbing health care costs. Sensor use should require clinical trials that go out into the community and examine and follow “real” patients – not just the one disease at a time folk studied in academic and for profit research centers.
Second, rather than concentrate on the profitable, sickness oriented sensor screening market, let’s get actually smart. It should prove wiser – and more cost effective - to use sensors to promote health rather than hypochondriasis:
1. Sitting is hazardous to people’s health. Australian researchers claim every hour of TV watching equals 20 minutes off your life. Sensors can let people know – in amusing ways – that they’ve been plastered on their butts too long.
2. A whopping 3.5% of Americans aged 18-59 semi-vigorously move 150 minutes or more each week; the numbers reach 2.5% for older folk. The accelerometers in cellphones should be programmed to show people when they healthfully moved – and how and where.
3. Sunlight correlates well with the mood of populations. Monitors can be set inside phones to check ambient light and how much of it people actually get on their eyes, where it works its useful magic.
There are dozens of other potential, health expanding examples. But if we are to intelligently use “intelligent” technology we should be thinking about health, not sickness; self-empowerment rather than fear; and public good before private profit.
Maxwell Smart got smart. So should we.