back to article Health apps and wearables make you nervous, not fit, say boffins

The British Medical Journal has staged a debate on the topic “Can healthy people benefit from health apps?” The debate seems to your correspondent to be a draw. Iltifat Husain, editor, iMedicalApps.com, and assistant professor of emergency medicine at Wake Forest School of Medicine, North Carolina, USA, argued the “Yes” case …

  1. SecretSonOfHG

    Real title should be: Health apps and wearables make you nervous, but someone is getting money

    Similar to homeopathy, chem-free dishwasher detergents and other "marketing" inventions.

    1. James 51 Silver badge

      Re: Real title should be: Health apps and wearables make you nervous, but someone is getting money

      Chemical free detergents? If you want to get technical even water is a 'chemical'. Labelling food organic is another pet peeve. If it was inorganic it wouldn't be much use as food.

      1. This post has been deleted by its author

      2. Electron Shepherd

        Re: Real title should be: Health apps and wearables make you nervous, but someone is getting money

        Labelling food organic is another pet peeve. If it was inorganic it wouldn't be much use as food.

        This sounds like a little bit of pedantry. Everyone knows what it means, and it's one of those many cases in English where the literal meaning of the words is ignored, and the intent behind them is taken as the meaning.

        In much the same way that it usually isn't the food itself that's labelled, it's the packet containing the food, but we all knew what you meant.

    2. Anonymous Coward
      Anonymous Coward

      Re: Real title should be: Health apps and wearables make you nervous, but someone is getting money

      Fitness trackers might have some limited benefit if they can detect arrhythmia or gamify jogging. I doubt they will cause much stress unless the UI or user is badly designed.

      The true test of wearables will come years on. Will wearable 2025 be able to image your wrist to do a blood test without drawing blood? Detect the biosignatures of cancer, disease, metabolism, diabetes, measure BAC and blood pressure and more all in one device? Finally, will a wearable 2040 act as a hub to communicate with nanobots in the bloodstream?

      We are in the stone age of preventive medicine.

      1. Anonymous Coward
        Anonymous Coward

        Re: Real title should be: Health apps and wearables make you nervous, but someone is getting money

        I think fitness trackers could be very good for people with sedentary jobs, like many of us. Anything which makes you think about moving more, for example by setting a daily target of steps, is a good thing in my opinion. My wife frequently walks the dog a little further than she might otherwise do, just because she "needs" the steps.

  2. Anonymous Coward
    Anonymous Coward

    Will apps simply empower patients to overdiagnosis and anxiety

    Since the World Wide Web is already doing that, the answer must be yes, in spades.

    In some ways the days when the doctor would say, "No, I don't think it's anything serious, just don't book any holidays for more than six months ahead" had their advantages.

  3. Zog_but_not_the_first Silver badge
    Thumb Up

    Worn by the "worried well"

    An excellent bit of common sense. My grandmother had something called the "People's Medical Dictionary", or some such, and could convince herself that she had dengue fever one day, Norwegian scabies the next. She died peacefully in her bed in her mid nineties.

    Of course, the monitoring isn't for the benefit of the wearer but that's another tinfoil hat full of paranoia.

    1. nijam

      Re: Worn by the "worried well"

      As I recall, there was a section about this near the beginning of "Three Men In A Boat" so it's not exactly new. The new part is that we are now making such paranoia power-assisted.

  4. Anonymous Coward
    Thumb Up

    “Humanity is wasting its time on monitoring life rather than getting on and living it.”

    An excellent conclusion.

    Perhaps the default position to should be that monitoring is not necessary. Only if there is a pressing need and specific verifiable advice should anyone take up a monitoring option - and then only the minimum necessary.

    Funny, could be talking about the spooks there as well.

    1. Charles 9 Silver badge

      Re: “Humanity is wasting its time on monitoring life rather than getting on and living it.”

      But what happens when the moment symptoms appear is already past the point of no return? Isn't that why there's a concern for checking out every little variance? In case it's something extremely serious where time is of the essence?

      1. Anonymous Coward
        Anonymous Coward

        Re: “Humanity is wasting its time on monitoring life rather than getting on and living it.”

        I think you have a valid point if we're talking about specific conditions that can be monitored for with a high degree of diagnostic reliability (and especially if the user has a known genetic predisposition to a problem that can be monitored for). Otherwise, the chances of catching anything serious as soon as it becomes detectable are pretty remote with current technology (or so I believe).

        I'd hate to live a life where I'm regularly prompted to worry about conditions that may be present, especially when the chances of getting a medical professional to take such diagnoses seriously are pretty remote (in some parts of the UK at least).

  5. Shannon Jacobs
    Holmes

    But I love TOYS

    Actually, it's not just love of toys, but some concerns about my health that have had me "playing" with some of these devices over the last few years. My own feeling is that most of the data is not useful, but overall I think it reduces worry because it pretty consistently indicates there isn't much to worry about. Your mileage may vary, especially if you have more severe medical problems that I do. Mostly I've concluded that I'm suffering from "getting-old-itis", but the doctors hate to say so.

    Having said that, I'm in the market for a sleep meter, and the options are almost overwhelming... Does anyone know of a good database where the various models of such devices are compared on some systematic basis?

    1. AndyS

      Re: But I love TOYS

      I've got a sleep meter. In fact I've got two. One is 18 months old, the other 3 years.

      They meter my sleep very effectively. I'll lend you one or, ideally, both, for as long as you like.

  6. Six_Degrees

    But...

    While there's merit to these arguments against obsessive self-monitoring, there are cases where it is desirable. One that leaps to mind is continuous or near-continuous blood sugar monitoring for diabetics, who currently get by on a small handful of measurements per day and the skewed sampling that brings to the table. Automated monitoring, even on the order of once every half-hour, would be a game-changer.

    What's missing, at present, is a sensor capable of such a thing, although there are a coupld of implantable options available. Accuracy, at present, is not very good, though.

    1. James 51 Silver badge

      Re: But...

      There is definitely a segment of the population who would benefit but they are people who are already ill or at high risk of something and long term tracking info (if it's accurate and complete) might be of use to professionals in helping them. If you're reasonably well then any benefit is going to be minimal.

    2. Shannon Jacobs

      Continuous monitoring? How about BP?

      I think continuous BP monitoring might be the most useful capability for most people, but the devices are still experimental and not yet approved. The continuous monitors use sound and vibration, not pressure, to track the blood pressure. However, you'd think they could start marketing some less reliable BP meters that can at least spot the critical situations?

      By the way, I really want to know what the thumb down on my earlier comment was about. Mindless criticism from another mindless critic? Or was there something interesting or provocative in my comment? You'd think I'd have noticed it, eh?

    3. Paul 25

      Re: But...

      I think the key is to know why you are tracking what you track. It's like performance tuning, you need to know what to measure and what to ignore.

      If you are tracking it with a specific aim in mind then it can be very useful, but otherwise it just becomes background noise, and for the otherwise fit and healthy I definitely think it could be paranoia inducing.

      I am losing weight, slowly, through simple calorie control and exercise. For that I constantly track my calories in and exercise, and measure my weight and body fat daily*, plotting a rolling average.

      Each of the things I'm tracking is for a reason, either there's a target/limit to aim for (calories in/out) or it's a measure of progress (weight/fat %). I measure calories in because a lifetime in an overeating family screws with your sense of what a reasonable meal is, so you have to retrain your brain.

      I used to wear a FitBit and use MyFitness Pal, but I found the passive nature of the data collection less useful than actively having to work it all out and record it myself. Because it required so little effort it didn't register as much consciously. Somehow having to work out the calories in a meal by hand and enter it myself seems to register more in my brain and is much more likely to make me stop eating.

      Measurement is all well and good, but you have to know what you are measuring, what it means, and more importantly, what it doesn't. It's one of the reasons I plot a rolling average, it's the long term trend that matters, not the day to day weight.

      * I know the number from a domestic body fat scale is dubious, but it's the change that's important)

    4. Bassey

      Re: But...

      An instance that immediately sprang to mind of a healthy group that already benefit from this monitoring would be endurance athletes. It is all too easy when training for a Triathlon or Ultra-marathon to over-train. There has been good medical evidence recently that Heart Rate Variability is a good measure of the body's catabolic state and so can provide a pretty good indicator that you are over training and should take a day or two's rest BEFORE you actually start to feel the effects of that over-training with either illness or injury. That is, proper rest, rather than an endurance athlete's idea of "active rest" where they might just swim for an hour and have a more gentle bike ride than usual.

      HRV used to require quite expensive equipment but can now be carried out to a fair degree of accuracy with a £5 app on your phone and a £30 Heart Rate Monitor. The camera based monitors aren't accurate enough yet but I have no doubt they will be within a couple of years.

    5. Anonymous Coward
      Anonymous Coward

      Re: But...

      There are already plenty of continuous monitoring arrangements for blood sugar; my daughter uses a blood sugar sensor which sends a measurement to her insuline pump every 5 minutes. It's not as accurate and reliable as we'd like, but great tech nevertheless...

  7. Doctor Syntax Silver badge

    Des Spence

    Sounds like the sort I'd want as my GP.

    1. Anonymous Coward
      Anonymous Coward

      Re: Des Spence

      > Des Spence

      Wouldn't he be better as your pharmacist?

  8. Electron Shepherd

    Correlation is not causation

    cited studies showing that users of weight loss apps lose more weight than those who don't adopt software-assisted weight loss regimes

    In other words, those more committed to losing weight were seen to lose more weight. It seems to me that use of a wearable is an indication of an understanding of the weight-loss process (move more, eat less) and not something that directly enables it.

  9. jake Silver badge

    The mind boggles.

    Humans have been living quite healthily for several hundred thousand years. It's only been in the last ~20 years that humans have turned to computers to tell them what to do.

    Honestly, kids, ignore your computer and open your eyes to the real world.

    1. Cuddles Silver badge

      Re: The mind boggles.

      "Humans have been living quite healthily for several hundred thousand years."

      No they haven't. For the vast majority of that time, humans have been living extremely unhealthily, with high death rates mostly due to poor nutrition and easily preventable diseases. For all the fuss about obesity and so on, humanity is far healthier now than it has ever been at any time in its entire history. Wearable tat may not be the gateway to the next big improvement, but to dismiss modern innovation on the basis of a purely imaginary past is just stupid.

      On a different note, I wonder how much of the appeal of all this wearable nonsense is a cultural thing. Americans make a big fuss about constantly monitoring everything they can, with multiple full-body health checkups every year and regularly seeing psychologists and other medical professionals despite not actually having any problems being considered not only normal, but actually necessary. Obviously this is in large part due to money - doctors make money from people coming to see them, so they tell people they need to come and see them as much as possible. In countries with national healthcare, however, the attitude is more "Stay the hell away from us unless there's actually something wrong with you". So I wouldn't be at all surprised if there's a big difference in enthusiasm between America (and presumably other countries with similarly privatised healthcare) where as much monitoring as possible is considered desirable, and other countries where we've generally just not bothered about it.

      1. nijam

        Re: The mind boggles.

        @ Cuddles

        Completely agree. Some of the recent studies on diet - exemplified by those with result that suggested the 5-2 diet - suggest that our bodies have actually evolved to starve to death; i.e. if we aren't starving, it's evidence we're eating unheathily.

      2. Justthefacts
        FAIL

        No, they haven't

        Trivally correct:

        "For the vast majority of that time, humans have been living extremely unhealthily, with high death rates mostly due to poor nutrition and easily preventable diseases."

        Obviously incorrect:

        ".....humanity is far healthier now than it has ever been at any time in its entire history."

        People are certainly healthier than at any time up to the 20C.

        Plus they are living longer than at any time in history.

        But there are more UNHEALTHY people than in the last two generations.

        A) High proportion of elderly, with health issues

        B) High proportion of chronically ill, with multiple complex issues, being managed by doctors

        C) High proportion of people with mental health issues

        D) High proportion of "worried well"

        Health Wearables will increase D, actively dangerous for B, and irrelevant to A and C.

        It's potentially lethal to B, because the conditions are typically complex/interacting - and the software for wearables is written by software engineers with no understanding of real complex medicine, and likely to give incorrect advice.

        Its a very similar situation to homeopathy.

        A) Homeopathy doesn't do anything, so it doesn't harm people, so no need to be regulated by the FDA

        B) But if it DID have real effects, it ought to be regulated by FDA

        C) Plenty of examples of people taking homeopathic stuff for cancer - and dying.

        If the Health Wearables had any basis to claim health benefit, they should be regulated like any other treatment. And of course, the manufacturers would never consent to that for ACTUAL health conditions, because they know the "advice" given out is just as likely to harm as help.

  10. Paul Barnard

    I wear a heart rate monitor when cycling to be able to better plan my training and keep track of improvements. Sure I can do it without but that is far more subjective and less insightful. Wearable tech has a place. Not so sure that someone just living their life needs it tough.

  11. Spleen

    "doctors need to be proactive about telling the public which metrics matter and which apps they should buy"

    Nope. This is a common error. Your fitness is not your doctor's problem (in the sense of your GP). Most doctors will tell a fat person that they should do more exercise, and that is their limit. A doctor's job is healing the sick - resetting broken bones, stitching up holes and dispensing drugs - not helping the non-sick to become thinner and fitter.

    Your fitness is your problem. Finding out which medical apps work and give valuable information, if any, is also your problem - caveat emptor. And as others have said, the last thing GPs need is more of the worried well clogging up their surgery wanting to talk about their tricorder readouts and preventing people who actually have a horrible pain in their chest from getting help.

    I am inherently suspicious of health bling - which comes from being a member of a running club and having watched dozens of people dramatically improve their health simply by paying 50p a time to run with others. Someone above mentioned that wearables may encourage people to improve fitness by "gamifying" exercise. You know what's even better at "gamifying" exercise? Games! If you don't like running, then join a football club. If you don't like football, join a badminton club. If you don't like any physical pasttimes whatsoever, then that's no problem - just don't eat as if you do.

    There would be no point in me trying to improve my fitness by buying one of those expensive watches for swimming which is submersion-proof and can track laps automatically - because I don't like swimming. Likewise if you don't like running/jogging then the answer is to find a sport you do enjoy, not buy a load of expensive crap so you can overanalyse your boredom.

    1. DocJames
      Stop

      I agree it's a common error, but think it is the role of doctors to tell the unfit they should be fitter.

      It will probably* help you live longer and have a shorter period of disease at the end of your life.

      COI: a doctor who spent this afternoon telling all my clinic patients they should think about more exercise. In fact, I used exactly the same line as you: find a sport you enjoy.

      * you may be hit by a bus tomorrow, and in this situation if you are killed immediately fitness won't help. If you're hospitalised for a prolonged period, then it will.

      1. Charles 9 Silver badge

        " you may be hit by a bus tomorrow, and in this situation if you are killed immediately fitness won't help. If you're hospitalised for a prolonged period, then it will."

        Fitness may also alter the odds of actually surviving the impact. Different body types offer different resistance to the impact of the bus, resulting in different possibilities. A fat person has more impact-absorbing lard but may lack strength in the bones a fitter person is likely to have, and so on. Just saying.

        1. Spleen

          I'm surprised you didn't point out the obvious which is that a fitter person may be able to leap out of the way in time. Or if it's not a bus but a car a fitter person can tuck-jump (leap as high as possible while pulling knees into chest) and go over the bonnet instead of under the wheels. (I do not suggest this thing I read in a book called "How To Survive An Action Movie" is always going to work but it improves your chances.)

          In short, basically fitness is a good thing.

        2. DocJames
          Pint

          Implausible

          with a bit of medical knowledge

          A fat person has more impact-absorbing lard but may lack strength in the bones a fitter person is likely to have

          Acutally bone mass tends to be directly proportional to weight. If you do more weight bearing exercise (running/jumping events) you will increase bone mass (not cycling/swimming/walking; they will not help).

          I'm surprised you didn't point out the obvious which is that a fitter person may be able to leap out of the way in time

          But they may be more likely to be out for a run, rather than sitting on said bus, etc etc. We can only deal with the observational evidence we have, and I am unaware of any evidence linking fitness to risk of being involved in a pedestrian v vehicle.

          Exercise damages joints , in my staffroom

          Generally only "twisting" sports - ball games/racket sports. If you've had a joint injury eg from these sports, you're more prone to develop them when running; runners who have not had such injuries are (surprisingly) not more prone than the general population to develop joint problems. And can I suggest that you've got a biased and too small sample: how many of your staffroom are in the last 5 years of their lives? I'd guess a very small percentage (sadly, it is unlikely to be zero). You are therefore (given your small sample) unlikely to be able to see the benefits of exercise on longevity or general health.

          That's enough medicine; I'm off for the icon. Cos nobody lives forever.

    2. Diogenes

      Fitness - Not only no but heck no.

      Exercise damages joints , in my staffroom (& that does NOT include the PE staff) last year we lost more time to hip, shoulder, elbow, knee surgery, breaks and sprains than all other illnesses & 3 months maternity leave combined

      1. Spleen

        Complete rubbish. Your staff are taking the mick. Unless every single one is into extreme motocross or MMA. Most sports injuries only rule you out of sport, not your day job.

        I always smile when I hear the old excuse about exercise damaging your knees / joints. Waddling around carrying 6 more stone than your knees were designed to bear will do far more damage to your joints than exercise.

  12. macjules Silver badge
    Facepalm

    Oh damn ..

    I think the anxiety bit comes from "is my £10,000 AppleWatch about to run out of juice - I only charged it up 3 hours ago"

  13. HxBro
    Thumb Up

    Works for me, I didn't know how many steps I took before getting my smartband and lifelog on my phone.

    I now deliberately extend my routes when walking the dog including longer and longer distances, I then like to see if I've increased my steps for that particular walk. My average step count (and distance) is slowly increasing so I'm doing more general day to day exercise than I was.

  14. Mark 85 Silver badge

    Meh...time to wax philosophical.

    We live. We die. No one gets out of this life alive. <clichés but true ones> We know that sooner or later we will die. I, for one, don't want the stress of constant monitoring. I'll enjoy every day and hopefully will be enjoying the last one also. It just seems that that there's too much worry over "am I well?", "something could kill me"... etc. including disease, terrorism, accidents, cancer,.. you name it. Enjoy today. Tomorrow is anyone's guess.

    Yes, I'm being simplistic but I've earned it. Spent my time in combat and facing death or serious injury gives you a whole new perspective on life and priorities.

    1. DocJames
      Thumb Up

      Re: Meh...time to wax philosophical.

      Mark: nice. I haven't had the personal experience you have but I see others facing death - their own or their relatives. Enjoy it and try to make sure you can keep enjoying those days (ie keep healthy without obsessing!)

  15. Martin Budden
    Joke

    Is there an app to measure hypochondria?

    Cos I'm really worried I might have it.

  16. John Tserkezis

    "I agree it's a common error, but think it is the role of doctors to tell the unfit they should be fitter"

    Too bad that's not how real life works at all.

    If a GP were to actually do that, with many clients, they'll just leave and never come back. Turns out, people just don't want to be told they're unfit.

    1. DocJames

      If a GP were to actually do that, with many clients, they'll just leave and never come back. Turns out, people just don't want to be told they're unfit.

      Fine, if they don't want to be told. I tell people but they still come back: I can modulate my language and tone to be different irl compared to internet fora. I also think you're making the classic error of assuming that all patients are like you. Most are elderly, frail and have multiple problems. I hope this isn't you.

      And clients? Really?! I have patients. Nobody chooses to be ill; free markets don't work for illness. (Healthcare maybe, but I doubt it - costs, unpredictability, asymmetrical information, anxiety all prevent patients from being able to "choose" health care providers appropriately)

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