The last few years has seen a huge growth in the health and fitness market for mobile devices. Activity trackers such as the Nike Fuelband, Fitbit Flex, and Jawbone Up will monitor your physical activity across the day, or even while you sleep. Diet logging apps like MyFitnessPal will help you control the amount of calories you eat, and some fitness apps can even turn your daily run into a frantic escape from a zombie hoard, which is pretty good motivation on a cold December morning. This is all very useful, but how far can it really go in terms of our well being? Can our mobile devices become more than just a way to monitor our lives? Could they end up saving them?
Dr Larry Smarr is a hugely respected American computer scientist, who helped popularise the use of high speed networks before the internet. For the past few years he has been involved in an experiment where he monitors nearly every aspect of his life - weight, calories, activity, sleep, urine, saliva, blood, and even his stools. This may sound excessive, and for most people it certainly would be, but by using technology to accurately record such a comprehensive range data about himself he was able to spot tiny changes in his body, which led to a remarkable discovery. Before any observable symptoms appeared, Dr Smarr was able to diagnose that he was suffering from the early stages of Crohn’s disease.
‘In a world in which you can see what you’re doing to yourself as you go along,’ Dr Smarr told the BBC’s Horizon program, ‘the hope is that people will take more personal responsibility for themselves, in keeping themselves healthy. So, it’s almost like we’re at day zero of a whole new world of medicine, and what will come out the other end is a far healthier society that’s focussed on wellness rather than trying to fix sickness when it’s way too late.’
Dr Smarr may well have all the advantages of a complete medical lab behind him, but the principle he asserts, one where devices can help us notice trends before they become serious, is a very real possibility today. With smartphones and tablets now a maturing technology some innovative manufacturers are starting to realise this potential that they hold in terms of healthcare. AliveCor is a San Francisco based company that has designed and built a mobile accessory that’s far more useful than Will.i.am’s gold plated iPhone case, and is also considerably cheaper too.
The Heart Rate Monitor case (£169) for iPhone and Android allows users to monitor their heart via a slim protective cover that adds little bulk to the handset.
‘We built the device to provide immediate access to ECG rhythm data for patients and healthcare providers’ explains Euan Thomson, AliveCor’s President and CEO. ‘The AliveCor Heart Monitor provides people with suspected or diagnosed heart conditions, and those at risk of heart conditions, the ability to track their heart health anytime, anywhere, at an affordable cost.’
At first glance the case looks similar to many on the market; in that it’s black, offers a moderate amount of protection, and has gaps for all the ports. The one main difference is found on the back, where two silver bumps house the device’s sensors.
‘By pressing the fingertips of both hands on the electrodes,’ reveals Euan, ‘an ECG is easily recorded in approximately 30 seconds.’
The readings are then displayed on the corresponding AliveECG app, giving users the ability to record the patterns over time to build up a detailed picture of their heart. This might sound like navel gazing to some, but when you consider the fact that heart disease is by far the biggest killer of men in the UK, being able to see any irregular behaviour ahead of time could be a literal life saver.
‘As healthcare continues to evolve, we believe mobile health will transition into the standard of care’ says Thomson. ‘Mobile health devices have the potential to enable data driven healthcare that will, in effect, be able to help predict and prevent known or unknown adverse health conditions. It will not only impact the practice of medicine, but the way medical research is done.’
This sentiment is also held by Azoi, an Indian company with its own iPhone case (and stand alone module for Android users) which can measure not only your heart rate but also blood pressure, blood oxygen, temperature, and (via an included peripheral) the capacity of your lungs. The Wello (£120) is an impressive piece of technology, which utilises built-in sensors in a similar fashion to the AliveCor case. It’s extended range of functions also mean that it could prove useful in building up a wider mosaic of your health related data, something that would have been next to impossible without access to advanced medical equipment only a few years ago.
‘Thanks to developments in technology,’ states Azoi CEO Hamish Patel, ‘health monitoring can now be incorporated within everyday products - this is key as it makes it much less intimidating. Indeed, mobile computing is driving a profound shift in healthcare - empowering people to better understand and better manage their own health by making better lifestyle decisions. Judging by the demand we've seen for the product since launch, it is clear to us that this shift is already underway.’
The big players in the industry would also agree. Qualcomm, usually known for providing the majority of chips inside mobile phones, is investing substantial amounts in the areas of mobile healthcare. In 2012 it launched the Tricorder X Prize, a global competition where independent teams are challenged to build a handheld device capable of diagnosing fifteen key diseases, plus various health indicators, through non-invasive means. As the name suggests, this is based on the magical medical device that Dr McCoy used to wield on Star Trek, with Qualcomm even having Brent Spiner, who played Commander Data in Star Trek: The Next Generation, help launch the competition. While the dream of this technology may have originated in the realm of science fiction, the $10million prize, not to mention the $25,000 cost of entry for teams, shows that the Tricorder, at least in some form, may be a very imminent creation.
The idea of medical devices, perhaps incorporated into our phones, is tangible and realistic in the next few years. With their emergence though comes the question of how people will actually use them? After all, if you don’t know what you’re looking for how will you ever spot an emerging illnesses? Then there’s the more worrying issue that many people already resist the need to visit their GP even when they feel ill, so what potential harm could a device of your own bring with it?
‘We simply don't know,’ states Dr Margaret McCartney, long time GP and regular contributor to the British Medical Journal. ‘The fear is that the wrong people do and don't get medical attention. Instead people's information is a false positive or get false reassurance. Time and again we assume that more information is better for us when the truth is more complex and counterintuitive.’
‘‘The big problem is the lack of direct evidence of benefit’ she continues. ‘It's fairly easy to generate large amounts of data from the human body - it's far harder to know what it means (what's normal/abnormal) and whether there are effective interventions based on that data which will do more good than harm. It would be absolutely possible to do Randomised controlled trials - but at present the growth of the self monitoring industry has not been matched by quality research.’
This growth can be seen in a report issued by the Parliamentary Office of Science and Technology which found over 40,000 health-related apps available on the iTunes store alone. These ranged from ‘simple provision of health information, such as the NHS symptom checker app, to tracking the locations and severity of asthma attacks through a Bluetooth peripheral attached to an inhaler’.
In response to this overwhelming choice the NHS has set up its own repository of apps at www.apps.nhs.uk, where those listed have been approved by the organisation.
‘Apps can only become part of the library,’ explained Inderjit Singh, head of enterprise architecture at NHS England, to E-Health Insider, ‘if they have gone through a review process that looks at the information governance, the clinical safety and the potential clinical risks.’
While apps and devices which diagnose symptoms and provide advice on treatment may still be a little out of reach, using them alongside existing medical services as complementary therapy is already beginning. Indeed it might also go a long way to helping the current workload on the NHS. One such app is Vitrucare, by Dynamic Health Systems, which helps people with long term illnesses manage their condition.
‘70% of the NHS cost is on people with long term conditions - that’s £80 billion per year’ explains Dr Richard Pope, Clinical Director at DHS. ‘About 60% of a GP’s time is spent managing the care of people with long term illness. So it’s a huge problem, and it’s growing like topsy because of the change in the structure of the population and the fact that nobody takes enough exercise.’
Vitrucare is a web-based service that monitors data recorded by patients with existing conditions, and helps them set and achieve goals that will improve their health.
‘It dovetails in with the clinical service and eases the burden on that service, and gives the patient a much more immediate response than they might otherwise be able to get. What we do, is if somebody puts in results that we think are outside an appropriate range of self care then they get a warning.’
Because the system has been designed by medical professionals, is focussed on specific areas of care, and has been set up via an in-depth consultation-style process, it enables the program to have more precision in its delivery.
‘People who are managing long term illness are, in many ways, acting like athletes, says Pope. ‘In other words they have to watch their diet, they have to take a series of steps - instead of training it might be medication - they have to monitor what they’re doing...it is like an athlete, it’s the same sort of thing. So if you wrap an electronic coach around the person you can actually help them really substantially to achieve the sort of things that are important to them.’
There can be no doubt that the collection of data about our bodies and behaviours can be a strong weapon against illness, as long as it is shared with medical professionals who know how to interpret it correctly. Visiting your GP with more information than ‘I feel a bit off’ could be the difference between a long, drawn out diagnosis and a quick solution to your mallady. As mobile devices gain in power and popularity we face a new phase of health that will look very different to what we have had up until now.
See also: activity tracker reviews