Posted on January 10, 2020 at 9:49 PM
by Craig Klugman, Ph.D.
This week Las Vegas hosted the 2020 Consumer Electronics Show (CES) where tech companies can show off the devices they hope we will all be buying soon. With an expected market share of $504 million in the next five years, over 200 Digital Health related companies were showing their wares at CES.
The FDA defines digital health as “The broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine”. These devices, apps, and programs are supposed to help us learn more about our health and take steps to improve it. At CES, digital health products were introduced to change our health across the lifespan.
Starting in utero, a new heartbeat monitor can keep track of fetus’s heartbeat including a record and playback feature so you can share with grandparents and through social media. From birth, new smart diapers, breathing monitors, and growth charting apps will make sure your baby has a good environment, has a working GI system, and is constantly monitored for breathing. A smart breast pump can collect information on time spent and productivity.
If you are concerned about getting good quality Zs, then the tech world has a lot of options to help you (none scientifically proven to work). There’s the smart mattress that adjusts to your body, changes temperature, and records your sleep (quality, duration). Or you might prefer training your brain to produce sleep-related waves: Only 20 minutes a day, 3 days a week.
Some people might have a New Year’s Resolution to exercise more (or differently) and to eat better. There’s an app for that! A new handheld device can tell you your stomach fat composition. For those who don’t like gyms, you can buy workout equipment that brings virtual trainers to your home and lets you compete with others. If perhaps you are more concerned about your stress level, a line of smart underwear will record ECG, sleep quality, activity level and temperature. You might prefer a bathmat that can weigh you and make nutrition and exercise recommendations. Mirror, mirror on the wall: A smart hygiene mirror can give you makeup advise, analyze your skin health, and track your toothbrushing. Or if a mood adjustment is what you are after, another tool uses music therapy to change how you think.
For those of us who are aging, several new devices claim to help us hear better, especially in crowds. There are pajamas that will track if you’ve slipped or fallen. The AARP will help you create a more senior-friendly environment with an app that scans a room and gives suggestions to make it safer. If vision is a concern, a new app can help people with macular degeneration to see smartphones better. Concerned about high (or low) blood pressure? A new wearable sensor can be inserted into other devices to monitor you.
With climate change and the rollback of environmental protection regulations, you might be concerned about the world around you. A new watch will measure pollution, sun exposure, temperature, humidity, and noise. The product aims to help improve your beauty and reduce skin damage.
The goal of these products is to make money for the companies that produce and sell them. Sometimes consumers demand them and other times the companies create the demands by inciting fear, or even creating new diseases and conditions. Many of these products are about tracking, measuring, comparing, and reporting. Some of them offer ratings of your activity (or in the case of sleep, lack of activity) with options to compete against others. The big ethical concern that these interconnected devices create is in privacy. As tech companies have reminded us for a few years now, they are not health care providers but only “business associates” and thus, do not fall under HIPAA protections (but do get access to private medical data). That means they can do anything they want to with the data that you are sharing (if the device collects it, then you are sharing it with the companies). There are also no requirements for encryption between your devices and the internet. Would this information destroy your life if it got out? There’s no way to know but I always try to err on the side of privacy.
Such tracking, charting, and rating also leads to an increase in “norming”. This is the idea that rather than helping people, we are encouraging people to act more like statistical norms. What is quality sleep may differ for everyone (I sleep with two pets so mine is likely more restless than many) but the devices will prime you to act toward a norm. You might need 9 hours of sleep or you might need 7 but if 8 is the norm, then you will be prompted to do that. You might exercise regularly but compared to the norm of people who are elite athletes (with a team of coaches, nutritionists, and physiologists) you may be a slouch or compared to those who use their bike as a clothes rack, you may look like an Olympian. In medicine, this is the idea of treating numbers, instead of patients. Not everything can be quantified, nor should everything be quantified. An arbitrary rating scale is meaningless, but people become competitive and stressed about reaching that number. While there are averages, we must remember that an average is a statistical number and few people will be exactly on that point.
A third concern consumer digital health products raise is that it puts impetus for being healthy completely on the patient alone. If a child dies of SIDS and it turns out the parents did not have an expensive breathing monitor on their child, will we start blaming the parents? If a person has an asthma attack, do we blame them for not checking their air quality wrist monitor or for not having one? Neither of these examples are within an individual’s control, but by having consumer-oriented devices that measure and track, the necessary implication is that we are all individually responsible for this “thing” that can have an effect on our health. Manufacturers often say that they are providing information or they are giving people more data so they can make their own choices. That might be true, but it won’t stop all of the problems I’ve laid out here.
There is an adage I often spout, “Can quickly becomes must.” Sure, your own air quality measurement device might make sense when we roll back regulations, but doesn’t it make more sense to just have strong regulations that lead to high quality air for everyone? We all cannot be experts in everything and we are reliant on each other for health infrastructure and healthy environments. These devices also increase social injustice: People who can’t afford these devices are simply left out of the equation.
I am not saying all tech is bad. I started my adult life as a tech journalist and attended many computer and electronic shows in that role. I love the new gizmos and gadgets. But we have to be aware of the implications and messaging that is behind them. If we build it, they will most likely come. But just because we can build it does not that we should.
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