Sunday, 20 April 2014

iWatch, the quantified self and the worried well

(image from 9to5Mac)

It seems almost inevitable that Apple will launch an iWatch later this year, and most pundits agree that “the quantified self” will be the main theme of this new device. An emerging tech trend, the quantified self connects wearable devices with online services to provide continuous monitoring of a user's health and fitness.

This new category has seen some growth, with devices such as Nike’s Fuel Band, Jawbone’s Up and Fitbit generating plenty of press coverage and modest sales. But as with tablets and smart phones before, Apple’s entry into the nascent category could redefine its purpose and massively broaden its appeal.

I’ve been involved in health and fitness tech for many years, both as a user (tracking my runs on Nike+) and as a developer (I co-created Reps & Sets, the gym logging app for iPhone). So I know from personal experience the tremendous potential that exists for using technology to support people in their health and fitness goals. 

But there’s something about quantified self products that troubles me. We often lazily bundle “health and fitness” into a single phase, but they are in fact two distinct things. After all, you wouldn’t get medical advice from a personal trainer any more than you'd ask your doctor to help improve your bench press.

Quantified self products cross the line from fitness to health, and in so doing, they pander to the “worried well”: those whose only symptom of illness is their anxiety that they may be sick. Oddly, as medical science has improved our health, this anxiety has steadily risen.

Be careful what you measure

As any self help book will tell you, it’s best to focus on what you want, rather than on what you don’t want. Fitness tracking products focus on positive goals. The best ones highlight our achievements and progress, providing us with encouragement and motivation to continue.

Quantified self products, on the other hand, medicalise us, tracking metrics such as blood sugar and blood pressure. These kinds of data may provide insights to qualified medical professionals, but will offer little meaning to the average user. Instead, they encourage us to anxiously obsess over inconsequential fluctuations in our body’s normal functioning.

In other words, the quantified self encourages us to look for problems rather than to look for progress.

Looking for problems can create problems

There are two main problems with this. The first is false positives. Health screening can be a highly effective intervention, but it doesn’t always follow that we should screen for every possible kind of sickness. Some types of screening result in high levels of false positives - where a healthy patient may be told they are sick and undergo unnecessary, unpleasant and sometimes risky treatment. Ultimately, scientists must study the data to determine whether the benefits of the screening for a particular disease outweigh these risks. 

No such determination is made with quantified self products. Instead, healthy individuals are subjected to endless ongoing tests for no apparent purpose, and presented with results that they are not qualified to interpret.

The second problem is the vicious circle - the kind of negative feedback loop you can get into when you obsess about your health. The anxieties created by worrying about non-existant health problems can result to very real stress-related health problems. As a result, the worried well may over time become the worried unwell.

Track your fitness gains, not your health problems

As a former cancer patient, I know what it’s like to have every aspect of your health monitored. Chemotherapy is not fun. But fortunately for me it was effective. Now I choose to focus upon the benefits of successful treatment, by pushing my body as far as it can go in terms of my fitness. And that’s what I choose to measure: the progress of my fitness.

Of course, my health is more important to me than my split times on a marathon. That’s why I still go for regular checkups at my hospital, who do all kinds of tests. But I prefer to leave the quantification of my health to qualified medical professionals who I trust.


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