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Will the Quantified Self Movement Take Off in Health Care?

“If you cannot measure it, you cannot improve it.” Lord Kelvin

“Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the “Quantified Self” blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.

“They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.”

(http://www.economist.com/node/21548493/print)

According to Wolf four technologic advances made the quantified self movement possible:

“First, electronic sensors got smaller and better. Second, people started carrying powerful computing devices, typically disguised as mobile phones. Third, social media made it seem normal to share everything. And fourth, we began to get an inkling of the rise of a global superintelligence known as the cloud.”

An investment banker who had trouble falling asleep worried that his concentration level at work was suffering. Using a headband manufactured by Zeo, he monitored his sleep quantity and quality, and he also recorded data about his diet, supplements, exercise, and alcohol consumption. By adjusting his alcohol intake and taking magnesium supplements, he has increased his sleeping by an hour and a half from the start of the experiment.

A California teacher used CureTogether, an online health website, to study her insomnia and found that tryptophan improved both her sleep and concentration. As an experiment, she stopped the tryptophan and continued to sleep well, but her ability to concentrate suffered. The teacher discovered a way to increase her concentration while curing her insomnia. Her experience illustrates a phenomenon that Wolf has noticed: “For many self-trackers, the goal is unknown…they believe their numbers hold secrets that they can’t afford to ignore, including answers to questions they have not yet thought to ask.”

Employers are becoming interested in this approach in connection with their company sponsored wellness programs. Suggested experiments include using the Jawbone UP wristband to see if different amounts of sleep affect work performance such as sales or using the HeartMath emWave2 to monitor pulse rates for determining what parts of the workday are most stressful.

Stephen Wolfram recently wrote a blog illustrating just how extensive these personal analytics experiments in self-awareness could become when coupled with sophisticated technologies. Wolfram shares graphs of his “third of a million emails I’ve sent since 1989” and his more than 100 million keystrokes he has typed.

Anyone interested in understanding just how far reaching this approach may become in the future should examine the 23 pages of projects being conducted by the MIT Media Center. My favorites from this fascinating list include automatic stress recognition in real-life settings where call center employees were monitored for one week of their regular work; an emotional-social intelligence toolkit to help autism patients learn about nonverbal communication in a natural, social context by wearing affective technologies; and mobile health interventions for drug addiction and PTSD where wearable, wireless biosensors detect specific physiological states and then perform automatic interventions in the form of text/images plus sound files and social networking elements.

It is easy to get caught up in the excitement of all this new technology and to start crafting sentences about how the quantified self movement will “transform” and “revolutionize” health care and spawn wildly successful new technology companies.

Jackie Fenn’s “hype cycle” concept has identified the common pattern of enthusiasm for a new technology that leads to the Peak of Inflated Expectations, disappointment that results in the Trough of Disillusionment and gradual success over time that concludes in the Slope of Enlightenment and the Plateau of Productivity. Fenn’s book, Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time can help all of us realize that not all new technologies becomes killer applications.

Jay Parkinson, MD has also written a blog that made me pause before rushing out to invest in quantified self companies or predict the widespread adoption of this approach by all patients. Parkinson divides patients into three groups. The first group is the young, active person who defines health as “not having to think about it until they get sick or hurt themselves.” The second group is the newly diagnosed patient with a chronic illness that will affect the rest of their lives. After a six month period of time coming to terms with their illness, Parkinson believes this group moves closer and closer to group one who do not have to think about their disease. The third group are the chronically ill who have to think about their disability every day. Parkinson concludes that “it’s almost impossible to build a viable social media business that focuses on health. It’s the wrong tool for the problem at hand.”

The quantified self movement should be closely monitored by all interested in the future of the American health care delivery system. The potential to improve the life of patients with chronic diseases is clearly apparent; whether most people will use the increasingly sophisticated tools being developed is open to debate.

Kent Bottles, MD, is past-Vice President and Chief Medical Officer of Iowa Health System (a $2 billionhealth care organization with 23 hospitals). He was responsible for the day-to-day operations of a large education and research organization in Michigan prior to his work with in Iowa with IHS. Kent posts frequently at his blog, Kent Bottles Private Views.

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  42. These personal analytics experiments are clearly not randomized clinical trials that attempt to eliminate all bias, and so they are not as scientifically sound as clinical trials. It is always hard to differentiate between correlation and causation even when does a double-blind clinical trial. On the other hand, Gary Wolf in the New York Times Magazine article interviews Seth Roberts, an emeritus professor of psychology at Berkeley and an expert on self-experimentation. “‘There is a large difference between what Barbier did and the minimal story of somebody who takes a pill looking for a certain effect and finds it…First, she wrote the numbers down, so the results are not subject to memory distortion. Second, she changed the conditions several times. Every switch is a test of her original theory.'” Barbier is the California teacher I mentioned in the blog post.

    I do not think the critical factor is financial incentive. I think what Parkinson was trying to write about is how lazy many of us are when it comes to health. We would just as soon not think about it at all.

  43. Kent,

    Is the issue at hand presently that these quantified self studies are done as a one-off by the individual and therefore are not validated through clinical trial studies? Clearly the future of mobile devices looks to be bright. Do you feel that the impetus for widespread adoption by thepublic lies in a lack of a motivator such as a financial one?

    If insurance companies began providing premium reductions to patients or employers that did self-quantify on some level (likely standardized) do you feel this would more likely lead to widespread adoption?

    Chris

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