The 'Year of the Wearable' and the motivating value of metrics

Many people are calling 2022 the “Year of the Wearable,” where we’ll see a wave of new devices and associated types of health data points flood the market. A recent article in the WSJ described an influx of devices ranging from measuring your hydration status to the extent of your oral hygiene to your blood sugar levels so you can better understand your metabolism. This is immensely exciting to me, particularly for the self-proclaimed “data geek” half of me. Seeing the detailed accumulation and analysis of my own health data and making tweaks in my behaviour that optimizes this makes me tick. Read: Fitbit app can detect undiagnosed atrial fibrillation: study My lived experience has been that quantifying my fitness, steps and exertion through apps has fueled me to make routine physical activity a successful habit for over half a decade now. Beyond supporting positive habitual changes, the idea of “hacking your health” through prevention and optimization isn’t anything new. As we inch closer to unlocking these realities, my other half—the pragmatically weary family physician eager to adopt technology but suspicious about is macro-level societal impacts—tries to balance the enthusiasm with a reminder to design and use safely. We’re all too familiar with unsolicited “gifts” that technology at times has given us when left unchecked—take social media and its impact on our collective mental health. With the current state of affairs in healthcare, bracing for impact for a tsunami of information (and likely associated anxiety in many cases) is crucial. The “nocebo” effect (opposite of the placebo, whereby a harmless intervention actually worsens the psychological or physical condition of an individual) and “infotoxication” (increased difficulty in understanding an issue and making a decision due to the presence of excessive information) may indeed become diagnostic codes in the next iteration of ICD. These are problems we can anticipate and solve for, and they should not hinder the upside of benefits we can unlock through the quantification of health. Here are some of my musings on how three major stakeholders in the equation (the technology vendor, the individual and the clinician) can help minimize these unsavoury side effects. I hope to continue to add to these overtime and I hope that it sparks conversation for how we can steer wearables towards success. Technology vendors should design for healthy behaviours, not just “sticky” ones. By anticipating that constant self-tracking and “stickiness” in user experience may have deleterious and unintentional impacts, it is possible to design around healthy usage of these tools. Perhaps like cars can now sense fatigue and tell driver’s to pull over, these applications should sense unhealthy addictions and limit usage. Furthermore, a responsible and honest commitment towards engaging in clinical research and validation of safety needs to be built-in from the moment ideation begins. What are the true positive outcomes that we can deliver with a given health tracking device and how are we incorporating this measurement into design? Are we ensuring that we are reaching people from all walks of life, particularly those that may benefit most from the measurement of healthh? I believe this will be a marker for corporate success and responsibility, and consumers will respond to businesses that show a genuine commitment to better health, not simply profit from it. As individuals, we all need to pause and “check ourselves”. This aphorism holds true with how we interact with any app or personal technology, but rings particularly loud in the case of wearable and health-related devices. If the initial intent was to improve some facet of our heath (let’s say sleep or our cardiovascular fitness in specific activities), is the use of the device moving the marker in the right direction? Are there negative behavioural changes accompanying the use of the device? I’ll draw an example from my own experience—I used a sleep tracking app a number of years back, and found that this particular application interfered with my ability to fall asleep, as I was concerned the device may move out of ideal position and it would draw inaccurate conclusions about my sleep quality. Needless to say—not a great outcome. The public may play an even more important role in decentralizing the validation and safety process. Crowdsourced efforts to share information, analyze anonymously and draw attention to macro-level effects of data gathering through a range of devices is likely to outpace the capabilities of traditional players (i.e. research and academic organizations), and may spawn collaborations and business models. The clinical community will need to take a proactive leap here. There is a reason I’m addressing clinicians last here. The revolution of the quantified-self will take place whether or not your family doctor wants it to happen. I say this facetiously as a family physician myself, however the reality is that the combination of: a) public appetite; b) a burgeoning availability of health devices; c) business models that help individuals navigate their newfound data as a service, and d) the scaling of online communities and networks for knowledge sharing, will make it such that for the most part, many clinicians may not even know that their patients are tracking highly detailed information about their health (I’m guilty as charged here as well). That is, until the device itself prompts the person to see a clinician. A meaningful step forward would be for clinicians to simply prompt and ask whether a patient is using any devices to help track their health and what their goals are. It’s also a call to educational institutions and professional associations alike to step up in advancing technology and data training and awareness for healthcare providers across the spectrum. Specialties like cardiology have been able to respond with frameworks to help develop an approach to understand various devices and their utility to their patients. The promise of the quantified-self being able to transform the way in which we bring awareness to our health and unlock the ability to both prevent illness and optimize wellness is palpable. While I’m personally and professionally at the front of the line with embracing this, now is the time for us to also have dialogue about unintended effects. The ideas outlined above are far from infallible or exhaustive. I look forward to a conversation. Dr. Puneet Seth is a practicing physician and digital health executive dedicated to the advancement of healthcare through the ethical use of technology. He is also managing principal at TELUS Health.

The 'Year of the Wearable' and the motivating value of metrics

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