The challenge of pervasive health monitoring

My piece on Apple’s glucose monitoring project spawned a number of interesting discussions, and that’s led me to think there’s another chapter in this story to discuss. That’s the downsides of our move into constant biometric monitoring, whether it’s the Apple Watch pulse monitor or the ability for someone to do 24x7 monitoring of our blood glucose.These things are boons for people that need access to this info, but they can become crutches and, beyond that, create problems for people who get too involved with the data.I’ve had a chance to talk about this with various medical people over the last few months. As I’ve mentioned previously, last fall we tried a change in my medications that I had a bad reaction to and ended up in the emergency room. What I haven’t talked about as much is that since that time, there’s been a gremlin in the system that we’ve been chasing, one that’s landed me in the emergency room a number of times since for reasons it’s taken some time to sort out.It’s been an interesting time. The good news is that I think we have it identified and fixed; it seems to have been tied to high blood sugar problems that started with the drug reaction. that’s why I switched to insulin a while back, because the other drugs simply weren’t controlling it well enough. The better news is that the other likely candidate, that I’d picked up a case of intermittent atrial fibrillation, seems to have been shown to be “no”, and it’s been a month since the gremlin’s shown up and six weeks since I visited my friends in the ER. All of which makes me really happen.Since a rapid pulse was a primary symptom of this gremlin, I found myself getting in the habit of tracking, and starting to obsess, about my pulse numbers. And that led to me (a) having to not check my pulse unless I felt there was a problem to break that habit, and (b) having conversations with various doctors about this.They all noted that they’re starting to see this dark side of this “always monitoring” capability we’re starting to build into our lives. It’s easy to get too tied to the numbers, to start obsessing about them, stressing out around them. Finding problems in them that otherwise you wouldn’t notice, or cause you to turn a minor thing into a major worry.Or as I put it to my doctor once, “No, I didn’t research those lab results on the internet, because I didn’t want to turn a common cold into Dengue Fever”. For the record, it got a nice chuckle.I see the same kind of challenge with the upcoming glucose product, if and when it happens. I was honestly a little disturbed when Tim Cook said he’d been checking his continuously, because while he was obviously acting as a testing subject, I don’t think he’s someone who ought to be doing that. I think some advanced or elite athletes might benefit from it as well, but most of us who struggle to fill the rings every day wouldn't.Most people don’t need 24x7 glucose monitoring and it would become easy for some who try it to find reasons to freak out or stress about it.Who does need need continuous monitoring? Anyone on an insulin pump, or with really fragile diabetes. Most diabetics don’t. When I’m well controlled I typically test 2-4 times a day, and when I’m really well controlled more likely 2. During this time when I’ve been dialing in the insulin dosages, it’s been more like 5-7 times a day (and boy, do I want a way to do that which doesn’t involve a lance and bleeding). In the last week I’ve finally gotten back to that 3-4 times and I’m much happier for it.The problem is that more data doesn’t necessarily mean better informed. You can overwhelm yourself with data. You can find an individual reading that is out of sorts, which in reality will correct itself and you don’t need to worry about — but once you see it, you will.And from talking to them, the doctors are already seeing this, and honestly, dreading some of it. Because they’re already seeing people freaking out over data they don’t understand that doesn’t really say anything. It’s going to be a bigger thing down the road, one that we should have a public conversation about as these devices continue to expand in the market and cover new data sets.Just because you can monitor your pulse or your glucose 24x7 doesn’t mean you should. My advice to everyone I talked to the last couple of days was simple: sit down and talk about this with your doctor and work with them on what a reasonable monitoring plan is. In my case, that’s testing twice a day because I know from that how the rest of the day will go, and getting lab tests every three months. Other people will need other testing regimens — and the person best qualified to help you figure that out is not me, not Apple, not some web site, but your doctor.But I know, and we see this throughout our society, people jumping to conclusions and self-diagnosing and self-medicating, and sometimes maybe they’re right and sometimes they maybe feel better and often that’s because of the placebo effect, but I know of a couple of people who also ended up in the emergency room and almost dying because they self-medicated with stuff that didn’t cooperate and tried to kill them. you probably do, too.So this move to pervasive and endemic monitoring has both blessings and curses. We haven’t talked much about those curses, and we should. The next place I think we’re going to see this pervasive monitoring become a thing is in sleep management, and for all those people that are going to be helped figuring out how well they’re sleeping, it’s going to cause people to stress out because they’re only sleeping 6.5 hours a night instead of seven.I, in all honestly, am avoiding any device enabled sleep monitoring, because I know if I’m sleeping well already, because if I’m not, my body tells me. We shouldn’t lose track of that. It’s different with something like Glucose, where it’s hidden from view without testing — but we can get ourselves in trouble by being too informed just as badly as by being not informed.And my advice to everyone is this: don’t think about these monitoring devices from the view of what you can do. Think about how you should be using them. And the person to help you make that decision is your doctor, and we all need to have these conversations with them about this stuff.Because there is a dark side to these devices, and it’s not something mentioned in the marketing blurbs for them. Figure out how to benefit from them, not just use them.