Big Brother tech might be America’s last hope for health

The United States spends more on health care per capita than any other nation, yet we have millions of people with no health care and poorer overall health than other industrialized countries. The most pampered generation, the Baby Boomers, may not live as long as their parents, and those who do will live sicker. Poor people of all races in the United States are seeing their life expectancies decline. The more we spend on Medicare, the sicker our population has become. And the shiny, new medical tech, procedures, and drugs we see in the news are too costly for all but the elites.

We waste $210 billion in unneeded care, $190 billion a year in excessive administration, $130 billion in overpriced care, and $75 billion in fraud. More than half of health care spending goes to cultural illnesses caused by obesity and sedentary lifestyles — ailments that are entirely preventable. We spend too much and get too little, and we’ll spend even more as we get less healthy as a nation.

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The answer to these woes may be a benevolent electronic Big Brother, a combination of monitoring technology and Amazon.com-like technology-based marketing. Or so several speakers in effect proposed at this week’s Wireless Life Science Alliance conference, which brings together medical and technology providers and whose speakers shared those scary stats.

Frankly, I’m not sure which is worse: the disease or the cure. The idea of being constantly monitored deeply bothers me. (That’s the odious business propelling Google and Facebook.) The same goes for the idea of being manipulated constantly by electronic feedback systems trying to change my own behavior, albeit in a quiet and friendly manner. (That’s the Amazon approach to getting you to buy more and more often.)

But it’s also clear what we’re doing today isn’t working, as the above stats show. Maybe we need to be more European, more Chinese, more Singaporean and give government (or perhaps, in our anti-government culture, corporations) the power to monitor and manipulate us for our own good.

Retraining people’s attitudes on health

Robert McCray, CEO of the Wireless Life Science Alliance, says we need a change in culture away from health care to simply health — that is, being healthy. As long as the focus is on care, people will not act to stay healthy, expecting instead their doctors to fix their self-induced ailments. We just can’t afford it, he says.

We need a consumer movement, McCray says: “Healthy people have more fun.” He cites several successful movements that have increase quality of life, such as the demonization of drinking and driving in the 1980s, the de-cool-ification of smoking by the entertainment and media industries in the 1990s, the safety campaigns in the 1970s to train people to wear seatbelts and government and insurance efforts to make airbags affordable standard equipment in cars at all price levels, and the broad government and business effort to train people to think about energy as a “how to use less” perspective (the MPG mentality) instead of a “where do we get more” mentality (the “drill, baby, drill!” thinking that hasn’t entirely gone away). You could argue the various equality movements followed a similar trajectory since the 1960s, with the “liberal media” and various governments teaming up.

Cultural change is hard, but it can happen — and it can even be directed to happen through propaganda (including marketing and advertising), regulation, and incentives.

Today, technology can help. McCray cites Amazon.com as a model of a system that tracks used behavior and adjusts its advice accordingly to get the user to do something that Amazon desires. Why not do the same with lifestyle and health data?

Google Now and Facebook are similar examples, though so far they are less active in trying to persuade users to take action. But research from the University of British Columbia shows how marketing technology — sentiment analysis, Web tracking, and so on — and big data analysis can be used to secretly influence user behavior.

The sources of that data now exist, notes Joseph Kvedar, director of the Center for Connected Health at the Partners HealthCare hospital system in Massachusetts. Sensors are readily available for all sort of health tracking, such as for blood pressure, steps walked, glucose levels, and body weight. As wearable technologies like Google Glass, the purported Apple iWatch, and sensor-laden clothing become available, what we can monitor about ourselves may astound today’s generation.

Vendors at the Wireless Life Science Alliance event talked about monitors embedded everywhere: a bed that tracks when you’re in it (in case you can’t get out, sleep restlessly, or take increasing bathroom breaks) and even your weight, stoves with burners that report if they remain on for more than a predetermined period (in case a forgetful person risks burning down the house), and doors that track whether they are open and closed and when they are used.

Many of these monitors already connect to smartphones and computers, where their data can be analyzed by individuals, not just their caregivers, to provide feedback on their health and identify deviations and progress to goals. Insurers such as Progressive and Allstate already use such monitoring in cars to identify and reward “good” drivers, and presumably identify and punish “bad” ones.

To improve Americans’ health, Kvedar essentially suggests combining self- and provider monitoring, better risk assessment via big data and genetic profiles, and a culture of self-improvement and healthiness.

Even with such tools, most of us won’t act

Such feedback works well, Kvedar notes — for a while. The truth is a small percentage of people proactively use such self-monitoring data — usually limited to data-driven, improvement-oriented personalities common among athletes.

The rest of us ignore that data (when was the last time you stepped on a scale?) or give up after a couple weeks of well-intentioned but short-lived effort (when was the last time you went to the gym or used that pedometer?). Most people wear a pedometer, for example, for just two weeks, notes Harry Greenspun, senior director of health technology at Deloitte’s Center for Health Solutions.

Our inability to stick to it is why both McCray and Kvedar see the need for an Amazon-like quiet manipulation to get us to act in our own best health interest. Successful behavior manipulation doesn’t push people too far or too fast, notes Deloitte’s Greenspun: “If you set a goal that is too high and give feedback on their low progress, people stop.” You actually kill any possible progress by pushing too hard, a lesson e-commerce and other successful online feedback systems have learned and applied to their own digital experiences.

If you make it a social effort, you’re 10 times more likely to meet your goal, Greenspun says — but when it comes to health care, that social motivation is often missing. People may share their weight-loss successes or pedometer readings, “but it is unrealistic to expect people to share their illnesses, like the rash they got in Vegas,” he says.

The revolution in health data now available

Partners HealthCare’s Kvedar notes that there’s much more data to be used than a person’s medical history — more accessible now as the industry converts to electronic health records — and monitored health conditions, including the new generation of portable and wearable connected sensors.

Genetic data is now cheap, costing about $1,000 for a full genetic workup on a person and much less to look for markers for specific predispositions. That genetic data could make a huge difference in the feedback and steering given to people, because it will better ground the analytics behind them to reflect the person’s body.

For example, there five types of genetic predispositions to obesity, all of which affect how a person needs to avoid weight gain, what level of extra weight is of concern, and how to lose excess weight. “Imagine if we knew that in utero,” says Partners HealthCare’s Kvedar.

Beware the technological silver bullet

Technologists tend to see the solutions to problems in technological terms, just as doctors have tended to see the health issues in America as a medical problem. Deloitte’s Greenspun warns against that tunnel vision.

For example, he cites a hospital that decided to text aged patients when it was time to take medication. “That’s not a technology most of them use routinely. A smart egg timer would have been a better option.” The hospital didn’t even bother to text patients to see who responded and learn who might actually engage with a messaging-based reminder system, yet surely some team members have parents who don’t notice text messages or voicemail messages, much less know how to read them. “Adoption of mobile tech is very unevenly distributed.”

Likewise, Greenspun warned people about depending on social media monitoring to track health issues. It can be useful in some cases, such as the identification of flu patterns; James Fowler, a professor at University of California at San Diego, found that monitoring tweets and Facebook conversations for references to flu symptoms could accurately predict flu outbreaks two weeks before they occurred. Such social sensing is all but certain to be useless in others, such as tracing outbreaks of socially transmitted diseases, drug use, or other activities that few people want to air in public. “Be careful about notion of big data health analysis from social networks,” Greenspun says.

Enlightened change — or an unholy alliance?

Mixing tech in equal parts with medicine and propaganda — er, behavioral change coupled with realistic, tested user expediences (the user involvement so often lacking in technology efforts) may reverse the horrifying decline in Americans’ health. But because people seem unwilling or unable to direct the change to healthy behavior themselves, we may see well-meaning medical providers and governments step in for our own sake.

We’ll see less-beneficent companies step in as well, redlining “irresponsible” people out of the system, as health insurers have done for decades and have been forced to stop doing with Obamacare. They’re using the behavioral-modification technologies to exploit the populace with overpriced, unnecessary products and potions. It could be an unholy alliance of Silicon Valley and Madison Avenue.