1 Février 2017

Health-helping apps, the new society of « worried well »

Health-helping apps, the new society of « worried well »

Most of people have a smartphone now. Thanks to it, features such as geolocation, data backup and sharing are accessible very easily, anywhere and at any time. Connected objects such as bracelets or docking stations are now growing up on the smart technologies market since 2007. Monitoring and sharing what we do is part of everyday life, and smartphone applications have been recently invading the domain of health, diets, sports follow-up, or even smoking cessation.

Almost 20% of smartphone users have one or more applications on their device that helps them track or manage their health. It is estimated that by next year, 500 million smartphone users worldwide will be using a health app. We call them “quantified-self users”. The quantified self or Personal Analytics is a movement that brings together the tools, principles and methods for each person to measure, analyze and share personal data.
There is no doubt that these apps are growing in popularity and becoming indispensable tools with ever more advanced technologies.

But are they actually beneficial to the society ?

There are impacts on different plans, like the health, the medicine, the economy, the human behaviour. I will try to draw a synthesis of these varied criteria by taking the sociological and medical approach.

Firstly, from a purely legal and defined point of view : according to the Food and Drug Administration of United States (FDA), mobile health apps are "medical devices that are mobile apps, meet the definition of a medical device and are an accessory to a regulated medical device or transform a mobile platform into a regulated medical device." So, there are apps that allow us to monitor almost every factor that impacts health, including weight, exercise, blood pressure, cholesterol levels, sugar levels, heart rate and sleep quality, and some can even detect cancer.
By giving people the possibility of tracking their health on their own, it has got a financial and professional impact on medicine.

Foremost, giving access to such applications, extremely detailed and avoiding for some to go to the doctor, quantified self questions the financial and ethical stakes of the medical system. Writing in the BMJ, Glasgow GP and health commentator Dr Des Spence warns that the products, which increasingly include wearable devices that link to computers and smartphones, providing 24-hour health monitoring, are “untested and unscientific” and could ignite “extreme anxiety” in a new generation of the “worried well”. The fact that people can now know each part of a basic medical analysis make them trust in their smartphone as the same level as they trust their doctor. Thanks to the good design and the many possibilities which are well organized and brought in as a “medical aid”, health apps are becoming substitutes for medical visits, and poorly transform the relationship between people and the medical profession. In a society where everything is digitized, distanced from man - while giving the illusion that he is close to it - he thinks himself capable of managing and controlling all these acts and habits independently of a professional posture.

However, the medical body is divided about the impact of these applications on their own work and does not all consider this concept in the same way. Practitioners estimate that these objects are useful for those who have chronic or long-term illnesses (70%), but not as well for the younger ones (37%), according to the Odoxa survey, carried out with 399 general practitioners and specialists. 93% believe that they contribute to the prevention of health risks such as obesity, diabetes or hypertension. Yet many of them measure the risks of misuse of quantified self process. Christine Bertin-Belot, a homeopathic doctor and Woman's Medical Association president said : "Measures always need to be interpreted, because they refer to average measures, which are not valid for everyone. For example, going beyond the average may mean exceeding it too much, depending on one's antecedents. This interpretation can only be done by the medical profession ".

To prevent misinterpretations of the measures taken by their patients via devices such as medical apps, doctors now guarantee to provide additional information and to share with their patient those results in order to educate and guide them. The fact that medical apps can improve the knowledge of data from patients is an interesting but nevertheless dangerous tool. The vulgarization of these scientific data makes us wonder the learning of medical bases to the population - apart from specialized studies in medicine - and requires the training of people using these applications because the data they receive are not necessarily well understood, since they normally belong to the medical profession. “Besides wasting your money, these apps may actually do harm,” Mr. Cortez (Nathan Cortez, an expert in medical technology law and regulation at Southern Methodist University’s law school in Dallas.) said in an interview. “If you’re diabetic and your app is misreading your blood glucose levels, you may give yourself more insulin than you need and go into diabetic shock.”

Beyond the risks associated with understanding and giving importance to all of this data, connected objects and health applications raise new health problems by wishing to avoid others. The increasingly long port of connected objects emitting electromagnetic waves can become a danger to men. For Dr. Yakymenko from the National Academy of Sciences of Ukraine, using a mobile phone for 20 minutes a day, for five years would increase up to three times the risk of brain tumor; Using it one hour a day for four years, would increase up to five times the risks. Dr. Yakymenko told the New York Daily News that "data has been obtained with adults using their mobile phone for over ten years." The situation would be even more dangerous for children using these devices since their body is more sensitive than an adult. Thus, quantified self is a practical tool but withal adjoining the role of a doctor and a succinct use. It could also pose a threat to the credibility of the profession.

This is from the point of view of the professional and down-to-earth problem. But there is also a social impact on the app user that is much more insidious, especially to deal with sport apps.

In fact, the quantified-self movement is nothing new, but now that Google and Samsung have expressed their intentions to move into the market with specifically designed gadgets, the idea that every man will be wearing a small monitoring device and become transhuman is a very real possibility. Thereby we enter, with this type of applications, into an area of “worrying-well” which is not so well. Through this recurrent following, our bodies data are transformed into performance. Apps give the desire to continue observing them to do better.

But is there a danger of us being so overly obsessed with every minor detail of our daily routine that we forget about enjoyment, fulfillment, relaxation and relationships? Will even our feelings soon be harvested and stored?

Through these checks are raised behavioral changes such as hypochondria, or eating disorders, paranoia. Being constantly connected is already part of our everyday life, and following our physical behavior make us into a total availability. Our body becomes a tool of adjustment, a notion that we have to manage, modify, make better. By taking the step towards this relation to our body, we enter into an outbidding of means to achieve a good result, which answers to the majority. Our body must now respond not to our feelings, but to standards set in place by society, which corresponds in some apps to pushing man to his limits, in everything he does.

As I give the example of Nike+ Running, I want to show that the use of such training applications is almost depravity, because they allow us to maintain a link with a community able to observe all our performances. We give ourselves a role to play by running, eating, sleeping, as if each of these actions, at first glance personal and done for our fulfillment, become criteria of achievement in the face of society. “People move away from each other and watch themselves live by imitating themselves” Some people feign a performance to feel themselves existing, which slims the barrier they have between the truth and the lie. If someone dreams of running 12 kilometers but has not yet begun to make two, he will feel worse than the one who proudly proves to have made 20 more, even if he achieve something important for himself, as 2 kilometers. This voyeurism of the physical health of the other causes a form of frustration which leads to the overbidding. The data shared by each one no longer constitute an observation and an overcoming of oneself but an overcoming of one another.

Rather than contenting himself with facilitating his everyday life, man seeks a constant and palpable trace of his daily life. Even to keep a phone next to him for hours to watch his sleep, while a good night of sleep is already felt naturally. This obsession to regulate everything he can seem to be more devoted to others than to himself. There is therefore no longer any moment of disconnection, of relation to self. Everything is constantly recorded and mastered. The simplest and innocuous of actions becomes a pretext to be shared, quantified, questioned. By learning from his body by what he is obliged to do, man forgets the principal foundations of why he subsists. Actual values are discarded. A session of sport, a restaurant with friends is more than a simple moment of life, but a whole ritual to feed the applications. Everything is a pretext for performance.

To return to more punctual data such as blood pressure or heart rates, giving unlimited access to people to be able to measure themselves from all angles creates potentially a nascent concern for their health, which they would not otherwise have had.
The ability of man to have reflexes, senses, an opinion on what he feels without external data, seems vain. Beyond feeling oneself through its performances, man loses what makes him a living being endowed with instinct and discernment. By giving apps to see what we are, through data, we remove the subjectivity that makes our body and our mind a unique system proper to each of us. Applications are not able to either be 100% secure or have a similar impact from one person to another, and we rely on their system as if they held the absolute truth. If we keep basing our lives on devices that do not need us to exist, which are only a reflection of the norms we impose on ourselves, we may soon lose our capacity of free will, reconsideration, of what seems good or bad for us. It is important to always set limits to what we are able to control and how much a connected application or object can take responsibility that we naturally take before, especially in case its overuse defects men.

I would end my article with a quote from usbek and rica magazine, which far from being positive, sums up the situation :
“ In a society where collective utopias have become extinct, the body has become a refuge and health an existential quest. Thanks to connected objects and big data, each can become a potential athlete, summoned to measure himself and optimize his performance at every moment. So much the worse for the ugly and the obese, big losers of this pasteurized society.”

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