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December 1, 2015

I’ve long thought the answer to a Patient presenting you with data from a fitness tracker is obvious (“try and use the information the app presents to you to help you get more active as it’s the single best thing you can do for your health“) but this Forbes article by Michael Thomsen (which feels like a click bait title to me as Forbes Contributors get paid on the traffic their articles get) shows once again how completely disillusioned some young men find the concept of self monitoring health tech.

mHealth Insights

Doctors Don’t Know What To Do With Data From Fitness Trackers

It stuns me that there are people who can report on technology that aren’t aware that fitness trackers are designed to be so easy to use that you don’t need a Doctor to interpret the data they collect.

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> “Earlier this year a story commissioned by Qualcomm and published on Quartz promised fitness trackers would soon be able to transmit data directly to physicians. Predictably, Qualcomm has plans to be the centerpiece in this future with its 2net platform, a cloud service that helps fitness wearables communicate with outside networks

I detect here that the author has some axe to grind with Qualcomm as even a cursory look at the 2net platform makes it clear that the focus is on capturing data from FDA cleared medical devices (the homepage lists that ‘2net is part of the Qualcomm Life Ecosystem, a group of over 400 collaborators including medical device manufacturers”).

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It surprises me that fitness data is considered to be such an unimportant parameter. While it might not be traditional (it would’ve obviously been too costly and difficult to collect only a few years ago) surely  if we’re in the business of helping educate and coach Patients we can see the value it offers eg. at 3G Doctor we can’t imagine there being any problem discussing with Patients the information presented by their FitBit app.

Perhaps the author thinks that it’s a waste of time to be working with obese Patients to help them turn around their poor lifestyle habits?

> “The technology isn’t meant to encourage people to stay committed to their trackers, after a recent study found more than half the people who own fitness trackers in America have stopped using them

Maybe all these people just got tired of the additional complexity of the tracker and started using the native activity trackers on their mobiles (like millions of senior citizens in Japan have been doing with their Raku Raku mobiles for 5+ years)?

And why is ‘more than half‘ failing to stay committed such a bad outcome? There are some gyms that don’t see +80% of their subscribers from one year to the next!

> “Taking care of one’s health doesn’t depends on access to money and the structural comforts it affords far more than data. If you’re working two jobs with a three-bus commute, live in fear of debt collectors and haphazard rent increases, all while trying to raise a family of three and keep a spouse happy, then monitoring your heart rate, counting steps, or keeping a log of how much water you’re drinking probably won’t feel much like health or care

I wonder if the author realises there are hundreds of thousands of citizens with lives as difficult and complex as this who also have (diagnosed and undiagnosed) diabetes?

I wonder if he could ever imagine meeting the three children when the main bread earner in their family has suffered from a complication of diabetes eg. a heart attack or loss of vision?

I wonder what the alternative to preventative care he’d recommend? Perhaps we should just all remain hopeful that the moaning and arguing will work?

> “A number of doctors aren’t so sure about the benefits of wearables eithers. A recent MIT Technology Review story found doctors from a number of specialities unsure about what to do with the data many of their fitness-tracking patients are bringing them.”Clinicians can’t do a lot with the number of steps you’ve taken in a day,” Neil Sehgal, a senior research scientist at UCSF Center for Digital Health Innovation said

The ability to find someone from a glamorous sounding ‘Innovation‘ centre who is unsure of the benefits of something is not evidence that there are no benefits. It might just be another mHealth innovation that’s happening outside of their field of expertise eg. most Emergency Room Doctors think they know how to conduct a visual acuity test but the evidence shows Patients would be better off self administering it with an App!

> “Andrew Trister, an oncologist and researcher at Sage Bionetworks echoed this sentiment. “[Patients] come in with these very large Excel spreadsheets, with all this information,” he said. “I have no idea what to do with that

Perhaps Andrew needs to let Patients work with other members of his team and stop trying to treat everything with an office visit?

One of the short-term problems for trackers is that their not actually reliable enough to be medically useful. The sorts of measurements that devices cheap enough to be commercial products tend only to focus on vague metrics that could just as easily be inferred from a short interview or basic examination

The mobile phone industry has changed this old concept. It’s important to realise that mHealth tech is not available for a low cost because it is ‘cheap‘ but because of the economies of scale of high volume mass production/retail.

> “While certain health trackers have shown promise—such as the small implants that manage insulin for diabetics—they can also produce a hyper-vigilance and paranoia, leading to a degenerative process of over-managing issues that a person’s body is already handling

Clearly anything can be badly designed but it’s interesting that Michael Thomsen is impressed by insulin pumps for diabetics but doesn’t get why Qualcomm is keen to ALSO promote technology that is working to help Patients identify steps they can take to prevent the development of diabetes.

> “This spring the AARP asked 11 physicians what one thing they would do to reform the current healthcare system in America and the top answer wasn’t more data from patients, but instead a need for patients to have more information about their healthcare options

If Physicians are so worried about this why arent’ they documenting their care for their Patients, why are Patients launching campaigns to get 30 seconds before being interrupted and being told they’re Little Miss A-Type Personality when they ask for access to their medical records?

> “The fitness tracker industry pushes people in the opposite direction, encouraging them to collect a mass of non-specific data about themselves during times when they don’t have any particular health concern, then expects their physician to do the work of a soothsayer, reading an exact diagnosis from a thicket of numbers about a person’s weight or heart rate

This is delusional. Today the Fitness tracker industry makes money by selling accessories people wear on their arms that help nudge them to think about the decisions they make that impact on their health. There is no Fitness Tracker company that is making profit from providing customers with Microsoft Excel spreadsheet outputs that they recommend are taken to a Doctor, suggesting so is like suggesting that Google is pushing people away from healthcare because citizens are too dumb to be able to find any practical use for it.

> “The key to good health is having enough money to pay for it. Everything else is just data for someone else’s bottomline

It should be obvious why this is completely wrong: America has the most expensive healthcare system in the world but the extra money being spent isn’t all being spent making people healthier…


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