NEW YORK – An interesting phenomenon is happening to health care in the United States, quite apart from all the noise about changes to the country’s system of health insurance: individuals are starting to take charge of their own health and trying to avoid needing care in the first place. Just as people long ago moved from institutional, mainframe computers to personal computers, they are starting to make the same move from institutional to individual tools with their health – not for treating serious diseases such as cancer, to be sure, but for everyday monitoring and prevention.
A variety of trends are coming together to make this happen. First, it is becoming apparent that many health problems are self-induced: too much unhealthy food and drink, too much smoking, too little sleep or exercise. There is nothing new about that insight, but now it is easier to keep track of personal behavior. Just as we can use financial software to manage our money, we can now use a variety of software tools to monitor our own behavior and bodily statistics.
Many of these tools are things people first designed for themselves. For example, J.J. Allaire founded the weight-loss Lose It! iPhone app for himself and has gone from 195 to 170 pounds (88 to 77 kilos) and gained some 4.5 million users in the process. Like the founders of the Homebrew Computer Club, a seminal group of Berkeley computer geeks who got together in the 1980’s, many started by rigging up gadgets and later realized that they had come across a commercial opportunity. Many of these new “homebrew health” people meet at so-called Quantified Self Meetups, where some people demonstrate their software and others come to learn or compare data with others.
The tools they use include everything from pedometers/accelerometers that monitor footsteps and motion (from Nike, FitBit and others) to sleep monitors (MyZeo), pulse and heart monitors, and glucose monitors (mostly for diabetics). People also count and calculate their food consumption. Just as you can use your computer to manage your finances according to a budget, so can you use it to manage your body.
The hope is that the data may help you to modify your behavior in the right direction. In my own case, I behave pretty well already: I swim for 50 minutes a day, I floss regularly, I eat sensibly, and so forth. But now that I use the MyZeo sleep monitor (I sleep fine!), I have noticed a marginal change in my own behavior when I am out at night. Sometimes, I am more motivated to leave early, anticipating extra sleep points in the morning! It is a small thing, but the kind of change that adds up over time.
Potentially even more effective are social tools, using so-called “game dynamics.” That is, just as you can earn points by collaborating with others in video games like World of Warcraft, so can you earn points by competing or collaborating with your friends in healthy behavior. These are services that make health into a serious game where others can reinforce your willpower.
Imagine a health club that does not threaten you, but rather sends a message: “Juan and Alice will be waiting for you to join them lifting weights today at 4 p.m.” Or “Your team is only four points behind the Blue team. Please come and help us win.” An existing service in which I plan to invest, www.GetUpandMove.me, allows you to challenge a friend: “I will swim for 50 minutes if Alice runs around the block four times.” The challenge is posted on Facebook or Twitter, ideally soliciting encouragement from your friends.
Right now, this market is incoherent, much like the early days of the personal computer. The different applications do not talk to one another; it is difficult to match your exercise against your sleeping patterns, or to share data with other people.
But that is the excitement: there are many companies at early stages, all looking for money and partners. Not all of them will survive; with luck, some of them may merge. Those with great technology and lousy marketing will find others with lousy technology and great marketing. The companies with back-end standards will create interfaces to a couple of the leading applications; then other applications will tie themselves into those back-ends.
How will all this be paid for? In the beginning, early adopters will pay for most of these tools and services directly; others will be sponsored by advertisers. It would be good to believe that they will be effective, but so far we have little proof. A vendor’s testimonial that nine out of 10, or 99 out of 100, customers are satisfied with the results will hardly be convincing, because those who fail to improve will have less interest in participating.
More convincing will be data shared by individuals and collected (with permission) by third parties. At some point, employers, who are interested in healthy, motivated employees and lower health costs (but demand a lower level of proof than insurance companies and governments), are likely to come in, based on these informal data-collection efforts and their own pilot programs. That will lead to more data being collected, and eventually there may be enough to convince insurance companies and governments to pay as well.
One part of me resists that: good health should be something that people do for themselves. But the realist in me knows otherwise about what can help good behavior spread. As a taxpayer, I would rather pay to foster other people’s good behavior than pay more for the consequences of their bad behavior.