The Worried Well

July 2015

Dr Lynch explores the possibilities and pitfalls of MedTech in the new era of data-driven medicine.

The field of MedTech isn't new, it is arguably as old as medicine itself, and encompasses a very wide spectrum of technologies, from diagnostic tools, to imaging and health data management. As the Internet boomed in the late 90's, so too did websites offering a variety of information on disease symptoms, diagnosis and treatment, and to a degree, prevention. Some of these websites were, and are, completely legitimate, backed by venerable institutions such as the Mayo Clinic or even our own NHS. Others, of course, peddle dubious information with the sole intent of selling the latest variety of snake oil to gullible readers.

The upside of websites that offer health advice, and I daresay the reason the NHS produces its own well-researched site, is that it keeps mere sufferers of the common cold out of doctors offices and emergency rooms. The downside, as any GP will surely tell you, is that patients can go from having a mild headache to self-diagnosing a brain tumour with three clicks of the mouse. As technology evolves, and more data is put into the hand of patients, the proliferation of this second phenomenon is likely to continue, with the unintended consequence of putting a strain on already overburdened health systems.

Recent digital health advances come in many forms. It is hard to argue, for example, that in less-developed countries where access to doctors is scarce, the ability to access medical information via an app on a phone can be life-saving. I hear that in America, where Obamacare is producing a revolution of its own, the liberalizing of doctors and patients from the choke-hold of health insurance companies is creating a vast array of new apps and systems allowing patients access to doctors and medication faster and cheaper than ever without stepping foot in a surgery. These apps are forcing arcane systems that didn't benefit the patient, to adapt to a new way of doing business.

In those cases, MedTech is helping people who had little or no access to even basic healthcare obtain proper medical support. Thanks to other emerging consumer devices, individuals today have more data about how their body is functioning than ever before. Followers of the so-called "quantified self" movement measure any number of metrics of body function: heart rate, number of steps taken, blood pressure, sleep quality, temperature. Fuelling the mania of the self-obsessed are a host of gadgets of varying complexity: pedometers, heart rate monitors, phones and now, Apple Watch and a plethora of apps with which to record all the physiological highlights of your day. And as is only to be expected in this age of social over-sharing, the quantified selfers love nothing more than to connect with others and share in their daily footstep count.

I find this alarming on a number of levels. Firstly, did we need to be any more self-obsessed than we already are? Second, data about your health and lifestyle is in the hands of faceless companies and who knows where it will end up: how can you trust that your health data is kept securely? Imagine your insurance company or mortgage broker getting access to it… And lastly, I fear that we are creating a generation of the worried well, which could lead to a number of unintended consequences.

Proponents of the quantified self movement claim that having an objective, data-driven and intimate understanding of one's bodily functions can be an early warning system that something isn't working well. Early detection is clearly of benefit, but many diseases don't show symptoms that the wearable devices are tracking. That might change, as the devices become more sophisticated, but there is a very great danger that an arms race for the supreme health tracking device leads to the monitoring of absurd minutae? Do we really need to know the micro-changes in our salivary amylase or peptidases? And when we do, will we know how to interpret the variations? Let's not forget that one of the central tenets of medicine today is to intervene when there is a known outcome, doctors don't just fiddle with the human body willy-nilly. Medical tests today are only useful if they produce actionable insights.

Can our already beleaguered health system cope with a new influx of worried well making their way to their GP with printouts of their rising blood pressure or falling enzyme levels?

The NHS has a questionable record with adoption of technologies such as electronic patient records and data management, and this new generation of well-informed and micro-obsessed patients might start to put a strain on a system that is designed to treat the sick and injured, not the concerned obsessives. Technology itself might be the answer, and the devices that measure might also, with a further twist of sophistication, provide insights into severity of a symptom and alert an individual if an irregular heart beat is concerning or not. But until then, spare a thought for your GP before you trot off for your next check up with a binder full of graphic illustrations of your wellness. The real danger is not that you get turned away with a soft admonishment not to worry. It is that GP surgeries become full of the worried well and people who are truly ill are not being treated as they need.

A version of this article appeared in Cambridge News.