TOPIC GUIDE: Health monitoring
"The constant monitoring of our health does more harm than good"
PUBLISHED: 10 Jun 2016
AUTHOR: Adam Rawcliffe
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Over the last few years, fitness bands such as Fitbit have seen an explosion in popularity [Ref: Apple Insider]. These wearables, which monitor activity levels, heart rate and sleep patterns, account for three out of four of the sales of wearable technology in the United States and boast celebrity fans such as Andy Murray, George Osborne and Britney Spears [Ref: Wareable]. The popularity of fitness bands ties into a wider trend of using technology to monitor our individual health. Thousands of health apps for smart phones are now available which communicate wirelessly with your wearable and PC or tablet, providing 24-hour health monitoring, with some of these apps even endorsed by the NHS [Ref: Telegraph]. Many are so excited by the improvements that technology has made to healthcare that they deem it the next medical “revolution” [Ref: Telegraph]. A future where technology knows we are ill before we do and informs a doctor or provides medication, may sound like something from a Huxley novel, but it could be just around the corner [Ref: Guardian]. Technology and greater monitoring of our health could save the NHS money, transform how we care for the elderly, and usher in a new age of personalised care some argue [Ref: Guardian]. However, critics are less sure, suggesting that the use of fitness bands and health apps is “untested” and “unscientific”, while constant health monitoring could generate anxiety and a new generation of “worried well” [Ref: Independent]. Does the constant monitoring of our health do more harm than good?
DEBATE IN CONTEXT
This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.
Is perpetual monitoring good for us?
Proponents of a medical technological revolution cite how a greater use of technology could transform medicine. For example, people suffering from chronic conditions like asthma, diabetes and high blood pressure could be fitted with sensors or use smartphone apps which upload data directly to medical records, spotting problems immediately [Ref: Telegraph]. Domestic care robots can monitor elderly patients’ eating habits, heart rate and whether they have taken their medication, and notify local nurses if they detect problems; in future they may even be able to treat acute episodes such as heart attacks or strokes [Ref: Guardian]. And tablets and smart phones give patients more options over how they interact with healthcare professionals - booking appointments or seeing medical records online or even Skyping with GPs [Ref: Telegraph, Speigel]. It’s estimated that these technological advancements could save the NHS up to £5 billion over the next decade, and make it easier for nurses and doctors to treat hard to reach patients [Ref: Telegraph, Guardian]. Yet despite this, some are not convinced of the benefits. Glasgow GP Dr Des Spence describes the use of wearables and smartphones in health care as, “untested and unscientific”, and risks the “over-diagnosis” of health problems, with people unable to distinguish between harmless variation, faulty readings or genuine ill-health [Ref: BMJ, Telegraph]. Similarly, the recent controversy over the Swedish app Natural Cycles has highlighted the potential problems when we become blindly reliant on technology and ‘self-monitoring’ as opposed to clinicllay trialed and tested contraception [Ref: Guardian].Critically, there is no scientific evidence that wearables or apps improve health [Ref: Independent], and doctors are reporting huge rises in the “worried well” [Ref: Telegraph] - healthy patients who, fuelled by Google and WebMD searches, are diagnosing themselves with everything from food allergies to brain tumours [Ref: The Huffington Post]. This not only costs the NHS millions, but evidence suggests that extreme anxiety can actually be a cause for illness [Ref: Channel 4].
A healthcare revolution?
Dr Eric Topol, a Californian cardiologist, predicts a future where smartphones will easily analyse, explain and transmit all relevant physiological data to the doctor, without the patient having to visit the surgery itself [Ref: New York Times]. Furthermore, Apple’s launch of a ‘technology enabled’ healthcare system for its employees suggests a high level of trust in the data collected by its technology [Ref: Guardian]. In this vision of the future, hospitals may be unnecessary, with services “performed in the comfort of our own home. Seeing our own data on our devices. In charge” [Ref: New York Times]. Healthcare may change so rapidly some argue, that an individual may not need to see a human doctor throughout the whole treatment process: the patient will diagnose themselves with the help of monitoring data; undergo surgery by an automated robot; and receive aftercare from C3PO in scrubs [Ref: Telegraph]. However, the role of a doctor is multi-faceted, and critics argue that it is not just clinical knowledge or analysis of data which is important, “it’s communication, it’s diplomacy, it’s tact, it’s pattern recognition” [Ref: Telegraph]. A doctor must make complex ethical decisions within an established regulatory framework, and deliver a message in a way that suits the individual patient. In this sense, the diagnostic process is a profoundly human one – after all, would you rather receive the news that you or a loved one had cancer from a text message or a sentient, understanding human?
Is the data always useful?
Supporters of health monitoring note that the healthcare service is notoriously slow to adapt to new technology. And the testing process which a piece of technology must go through in order to be deemed safe for medical application, is deemed arduous and long-winded, so many private companies choose to skip it all together and sell their products directly to consumers [Ref: Modern Medicine]. But for opponents, such regulation is vital to ensure patient safety [Ref: Guardian]. That said, in the future, health monitoring could be utilised by using electronic prescribing systems, which have been shown to make prescription errors 50% less likely, and can be checked to conform to sensible drug quantities, interactions with other medication, and even clinical conditions [Ref: Guardian]. Monitoring technology can also help in the diagnostic process, as some evidence suggests that first diagnoses by a GP are frequently inaccurate [Ref: Guardian]. In these scenarios, the objective nature of monitoring technologies may allow us to mitigate the risk of human error in healthcare. However, others are cautious about such claims, and note that technology may sometimes end up doing more harm than good. For example, some doctors are querying the value of breast screening programmes, suggesting that women risk false positives and over treatment, including unnecessary breast removal and surgery on harmless cancers [Ref: Daily Mail]. Furthermore, companies such as 23andme will now screen any individual’s DNA for genes associated with inheritable conditions for a fee of £125 [Ref: Guardian]. In light of this, Dr Ewan Birney queries the usefulness of this sort of data gathering, with much of the information based on “very small shifts of risk, which are better served by simply living healthier and getting more exercise”. He goes on to conclude that there is “an understandable concern that this type of genetic testing could cause inappropriate harm, simply through people worrying excessively or becoming neurotic over these small increases in risk” [Ref: Guardian]. So how should we view health monitoring technology - do we really understand what all the data means? Are patients in danger of being deluged with data that they do not fully understand? [Ref: Spiegel] Is having constant information about our health a good thing, or does it just add one more thing for us to worry about?
It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.
BMJ 14 April 2015
Sarah Knapton The Telegraph 21 February 2017
Paul Lamkin Wareable 24 May 2016
Donna Marbury Modern Medicine 3 May 2016
Guardian 15 April 2015
Chris Cooper Independent 14 April 2015
Maxine Frith Telegraph 20 July 2014
Professor Maureen Baker Telegraph 26 January 2016
Sarah Knapton Telegraph 17 June 2015
SA Mathieson Guardian 8 June 2015
Dr Dan Poulter Telegraph 2 November 2014
Philip Bethge Die Spiegel 1 May 2012
Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.
Useful websites and materials that provide a good starting point for research.
Adrian Bridgwater Forbes 24 May 2016
Zach Guzman CNBC 3 May 2016
Bertha Coombs CNBC 25 April 2016
James Kirkup Telegraph 12 January 2016
Emmanuel Tsekleves Guardian 4 June 2015
Charlie Kurth Aeon 12 February 2015
Abigail Zuger New York Times 5 January 2015
Mark Piesing Guardian 10 October 2014
Mark Ryan Guardian 20 May 2014
Mike Orcutt MIT Technology Review 23 December 2013
Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.
IN THE NEWS
Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.
Dawn Foster The Guardian 24 July 2018
Business Insider UK 26 May 2016
Financial Review 26 May 2016
News Medical 23 May 2016
MedCity News 23 May 2016
Telegraph 11 May 2016
Apple Insider 4 May 2016
Forbes 20 April 2016
Daily Mail 3 March 2016
Telegraph 24 July 2015
Wareable 11 February 2015
Guardian 2 December 2014
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