Wednesday July 8, 2020

Fitness apps: friends or foes of modern medicine?

Personal fitness trackers have been hailed as the wonder of the medical age, identifying preventable diseases early and easing the burden on healthcare systems. But are they as useful as they seem? And should we be happy to hand over our data to corporations? Hannah O’Brien investigates

2nd June, 2019

In recent years, it is safe to say that even the biggest technophobes have become more technologically literate. The health conversation continues to shift towards technological advancements. Not only does the pharmaceutical industry prescribe a pill for every problem, but the ubiquitous nature of technology means we have Google and its wealth of knowledge at our fingertips. Where once doctors were the sole source of medical information, people have become more health literate embracing the ‘Dr Google’ model, and have even started self-diagnosing.

Yet, while the technological generation would like to believe there is an app for everything, they seem to ignore the major elephant in the room – that no number of pills, gizmos or gadgets will ever be worthy substitutes for exercise and medical consultation with a live doctor. Or will they?

We are living in the era of the Fitbit – an electronic device used for personal activity training. These wireless and wearable devices measure data such as the quality of sleep, number of heartbeats and number of steps walked. The Fitbit very quickly became the darling of the workout world, spawning a large number of copycat styles and models. But, like most technological advancements, the wearable fitness tracker is not without its question marks.

Earlier this year, wearable fitness trackers came under attack from Britain’s NHS, as medical professionals felt that Apple watches and Fitbits were creating a culture of hypochondriacs among the “worried well”. In other words, the moment a Fitbit indicated an increase/decrease by 0.01 per cent in heart activity (a normal deviation), healthy people would book unnecessary GP appointments. GPs in the NHS feel that the use of health apps will ultimately worsen the wait times to see a doctor.

However, in Ireland some health experts feel that Fitbits and the like could be the way forward for modern medicine in an increasingly tech-savvy world. Professor Niall Moyna, from DCU’s Centre of Preventative Medicine, feels that the “engaged” and informed patient will be the “blockbuster drug of the 21st century”.

Moyna believes that health tech is going to be as transformative as the printing press. “When the printing press appeared it became ubiquitous and within 100 years you had books and learning throughout the world,” he says. “This technology will do the same . . . it’s going to radically transform the world as we know it.”

Speaking at the launch of Irish Life’s new health app, Moyna says this technology would enable people to take ownership of their own health. “It’s empowering. Up until now, there was what we call information asymmetry. The doctor had the monopoly on all the information. Now with the help of technology, the patients of the future will bring the data to the doctor.”

The only problem with this statement, argues GP and director of Medisec Ireland Dr Ray Walley, is “the accuracy given by these devices”. Speaking from experience with his own patients, he says that standard tests will occur regardless of any data proffered.

“The information patients bring isn’t necessarily information that we ask for. It cannot replace the patient history or the examination and it doesn’t necessarily add anything,” Walley says.

He adds that there is “no comparison between health tech and meeting with your doctor”.

Dr Mark Murphy argues that any healthcare intervention such as the Fitbit that promotes a healthier lifestyle “can only be seen as a good thing”. However, he feels such devices should be approached with caution, as “they may not have been adequately tested, could actually increase the expenditure on healthcare, and could lead to over investigation and over-treatment of healthy persons, furthering our tendency to over medicalise healthy people”.

Irish Life’s Health App received ringing endorsements from fitness aficionados such as Operation Transformation’s Kathryn Thomas and Olympic runner Thomas Barr. It is designed to encourage people to make small lifestyle changes that will improve their health. It incentivises users to reach targets with points that can be traded in for rewards such as cinema tickets and discounted Fitbits.

Moyna says: “The app affords us to go from health management to health – those who think they have no time for exercise will sooner or later find the time for illness. Technology will run our lives, and we have to embrace it and take advantage of it.”

But what if it takes advantage of us in the process? In the wake of Edward Snowden’s revelations about the collection of private email data, perhaps we should be concerned about who else will have access to these statistics.

Dr. Seamus O'Mahony (Consultant Gastroenterologist at Cork University Hospital) believes the use of such devices could have implications for personal freedom and privacy. He believes the devices could be used by large companies to collect data on populations. Insurance companies may, for example, insist on people wearing them, in the same way that young drivers are being asked to use monitoring devices that track their behaviour on the road in order to get insurance.

“At the moment, all of this is voluntary, but a lot of this data may end up being in the hands of third parties,” says O’Mahony. “By embracing these things we are opening a Pandora’s box and giving way to a future where these wearables are essentially spying on us, and that constant monitoring of our health becomes normalised . . . it is a form of surveillance capitalism.”

Another argument is for the “democratisation of health tech”.

“The Fitbits are preaching to the converted, as the majority of their users are healthy, young and wealthy,” says Murphy. Conversely, depending on their social status, some people cannot afford smartphones or private health insurance.

“It’s important that healthcare intervention policies like Fitbits are directed where healthcare is needed, not to the ‘worried well’,” says Dr Murphy. “What we really need to consider is how we can target our limited resources in health to improve the symptomatic unwell persons who have poor access to healthcare services in Ireland . . . that’s really the future of the healthcare service, as opposed to healthcare technology.”

Ultimately, it seems the experts agree that, as flashy as the Fitbits are, nothing can influence a person’s health more than their own desire to change their behaviour and lifestyle.

As Niall Moyna says: “This is not a one-size-fits-all solution. It depends on human behaviour . . . if you change your behaviour, then you change your lifestyle and can truly reap the benefits of exercise, lifestyle and technology combined.”

How health tech is taking over

Health tech is popping up in every facet of life, from nodding off to brushing your teeth. Bloomlife is a wearable device, worn around the belly, that allows pregnant women to track the muscle contractions in the uterus, thereby revealing patterns and monitoring pregnancy progression. It uses the same technology as employed in electrocardiographs to show heart rhythm. Later this year, the company will launch a machine learning-driven digital biomarker to identify early labour onset.

Biodegradable contact lenses are being used to treat eye complaints. Scientists at Mexico’s National Autonomous University have developed a contact lens that releases medicine as it gradually dissolves in the eye, designed to combat ocular inflammatory diseases.

The Y-Brush is potentially the most terrifying toothbrush in the history of the world. Shaped like a catapult, it cleans your mouth in ten seconds, instead of the traditional three-minute method. As the brush vibrates, you make a chewing motion for five seconds, after which you remove it, flip the brush and repeat. Developed by a company named Fasteesh, the Y-Brush ships worldwide.

With Pokémon Sleep, the creators of Pokémon Go are leading the gamification of sleep trend. Tabled for a 2020 launch, Pokémon Sleep will use bluetooth technology to connect your phone to a wrist device, monitoring slumber activity and rewarding you for “good sleep habits”. Can tech really aid, rather than disrupt, natural sleep patterns? The jury is out . . . for now.

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