From socks that monitor normal babies’ heart rates and oxygen level constantly in their sleep wearables that report and grade on sleep to movement to heart rate variability to who knows … the is an abundance of data now available to anyone with a few hundred bucks to spend. And it is not a hard sell to many.
And I am sure that it can be helpful to some.
But how often is this data noise that obscures more than signal or even information that misdirects more than helpful?
“A pipe gives a wise man time to think and a fool something to stick in his mouth.”
Very often. In the emergency department, this is sometimes seen in people who measure their blood pressure ten times a day. Every time they take it, it goes a little higher!! Solution for many: only check your blood pressure once a week.
I am skeptical of these “electrocardiograms” people can do on their phone to detect “atrial fibrillation”. You don’t need a device for that, and a one-lead rhythm strip is not remotely as useful as a proper 12 or 15 lead EKG. It can’t detect a heart attack (unless very lucky) or dozens of other cardiac problems. Which is not to say it is useless, but more that it is likely to cause overtesting, false reassurance and/or anxiety. (The role may be different in people who have already had serious issues.)
Technocrats (Silicon Valley innovators who “will make hospitals obsolete”) think doing daily testing and more scans is better medicine. Often, it just leads to more unnecessary tests or procedures. If a normal value for a test is the 95% of people within whatever distance from the average, doing twenty or a hundred such tests makes it likelier some are abnormal just by chance. “Incidentalomas” are found on CTs and MRIs all the time. Unnecessary biopsies and operations out of an abundance of caution can cause some cases of things like impotence or colostomies.
It reminds me of a recent story about a Silicon Valley billionaire who had hired a team of thirty doctors to keep him healthy and slow his aging. He claimed a world record for greatest difference between age and genotypical age, was vegan, took a thousand treatments. A newspaper article bemoaned how the rich could afford so much better care. Ta minute, as they say in Quebec. Hold on a minute. The doctors they hired were thirty years old, which makes their clinical experience limited. The fact they tell him pleasantries and do things (skin cream with tea tree oil!) is not equivalent to exceptional care. Ka-ching! Capiche?
It reminded me of a similar story when I was a resident in small-city Eastern Canada. One of my mentor’s (and so my) patients was a tremendously wealthy tycoon who had moved recently from Toronto, and had a team of dozens of specialist doctors who had MRIed every inch of his body, done tens of thousands of dollars of extraneous tests. Did everything, everything possible… except make his actual diagnosis of lupus. They were too busy testing him and taking his money and telling him fluff to actually look at all of his symptoms. My mentor chucked about this for years. “So many specialists! They did everything but examine the patient”. Private health care has limitations when the balance between profits and patients becomes too skewed, no matter how good the marketing.
That’s what I did with my blood pressure. I was so worried about having another stroke. Now I just check once a week.
Cardiac doc had a cardiac loop installed, even though I don’t have A Fib It’s just for precaution, as when I wore the external monitor for a month, it showed no A Fib. Better safe than sorry, I guess.
I wish it were that simple. Interventions done to be ‘safe’ have a certain risk for morbidity and mortality also, and oftentimes cause more problems than they prevent or detect early. NOT that I’m passing judgement on what you had done, it’s just a tricky topic in general.
There’s a whole science behind trying to figure out what does more good than harm, etc. The NNT is a nice site for professionals trying to figure out whether a test or intervention will actually benefit a given patient.
From their website:
We are a group of physicians that have developed a framework and rating system to evaluate therapies based on their patient-important benefits and harms as well as a system to evaluate diagnostics by patient sign, symptom, lab test or study.
@DSeid This is a great topic for discussion! Thanks!! Giving more data to the hypochondriac (or even the worried well whose concerns have been overhyped in the media) tends to lead to suboptimal outcomes and poor use of resources.
I see your point. My cardiologist felt it was safe to have it put in and momitored than being surprised later. Said A Fib can some along any time and why take chances? If nothing happens in 3 years, they can either take it out or just let it stay in forever as it won’t hurt anything.
You’ve linked to that site before but I had forgotten about it. Thanks for doing so again.
De nada. I’m not actually helping any individual patients any more since retirement, so it’s nice to feel like I’m putting useful info out there.
Timely thread. I just got a message about Amazon Clinic.
US healthcare is broken and needs to be fixed, but I’m not sure this is the solution.
If data is understood as just being data, then it doesn’t harm or hurt. It’s neutral, but still needs to be researched to see if it’s actually true and has any meaning to the person looking at it. But pure data can be put forth as a norm by an individual or institution, or even politicized. If that happens, it will invariably be used as an agenda. Still, the data itself just is what it is.
Most of what we see in newspapers is just data. Newspapers need to fill up space on their pages, man bites dog sort of stuff.
Somewhat relevant to both this thread and the one it came from…
My fasting glucose tends to be just slightly high - usually around 110. My A1c used to be a little high as well - maybe 6.0. None of this was a cause for panic. Instead, I changed my diet a bit, did a better job balancing my meals, exercised a bit more - pretty standard lifestyle changes. Glucose is still elevated, but my A1c has been (barely) normal for years.
Back in the early days, I discussed glucose testing with my doctor. I wanted to understand how much of an impact various foods were having on me, so I knew more about what to be careful with. My doctor pushed back, saying that my numbers were still low enough that it was safe to just try stuff and measure the results at my 3 month blood work. (For instance, I wanted to know if delicious IPAs with their higher alcohol content would show up in my A1c, compared to less delicious but also lower alcohol light beer. Turns out my body doesn’t care, at least from a blood sugar perspective, so I allow myself a few IPAs if I’m not worried about getting drunk.)
While the risks associated with pricking my finger were (presumably) tiny, they were non-zero, and he felt that the minor risk outweighed the benefit of the data the way I wanted to get it.
In theory perhaps. In reality, not so much.
Data is only neutral when it’s both a) accurate and b) presented to people who can interpret it skillfully and dispassionately. Which are both in exceedingly short supply. We might wish otherwise, but only a fool believes otherwise.
In the absence of those caveats data is simply shouting “Fire” in a crowded theater full of blind people. With predictably baleful & chaotic consequences.
I am sure that this isn’t the solution. If Amazon does to health care what it has done to storefront mercantile, we can assume the result will be cheap and fast but frequently wrong, skewed toward favored providers, driven to maximum profitability while turning health care providers into contractors to be squeezed to minimize expenses, and will leave you with no other alternatives. The answer to the problems of a for-profit health care and pharmaceutical system isn’t more profit.
Stranger
In medicine, the assumption more data is better is often false. Maybe for many being able to print out a strip showing their heartbeat “and send it to their doctor” (who does not want to see it if it is normal or nearly so) gives them a sense of control. But abnormal ECGs are common and often insignificant. Identifying insignificant stuff leads to worry, more detailed and costly tests with attendant procedure risks, taking more strips, possible insurance issues…And the strip misses so many things that it may falsely reassure people with more severe problems (ischemia, heart attack, pericarditis, bundle blocks, hypertrophy, yada yada…).
One techno-utopian thing I read mentioned how soon “an implantable device would test you twice daily for dozens of indicators. These would be seamlessly transferred to your doctor. Diagnoses would be immediate, early actions taken when needed, health care will become more seamless and inexpensive…” despite so much more testing.
Data is not just data if abnormal, which is guaranteed merely by doing enough tests. Data is not just data, say, if you get an X-ray showing “something in your lung” which might be cancer or sarcoidosis or tuberculosis or a glitch in the film or a shadow of a normal blood vessel or a calcified lymph node (no big deal) or anything on a spectrum between nothing and very concerning. (These sort of reports happen very frequently. More frequently with more tests)
Merely identifying these things can cause worry. Do you now need to take a sample of this thing? There are risks and harms with plenty of procedures, so you would want the benefits to vastly outweigh these.
You don’t want to know about everything not completely average, just the stuff that matters. Even knowing something could be severe is cause for additional stress. Not many people, told they need more tests for a thing not likely to much matter (which happens all the time), think “it’s just data” when personally challenged.
From a rather meta perspective, this topic reminds me of the DIKW Pyramid that I remember first hearing about in querying databases:
But to my earlier point, and somewhat bolstered by @Digital_is_the_new_Analog post above, some patients who are the right combination of rational, informed, wise, conscientious, compliant, and committed can probably improve their health outcomes with some kinds of data, if obtainable at low risk/cost, and for some kinds of conditions or diseases.
[Understanding the kinetics of the particular biomarkers being measured would be part of the equation.]
That’s the kind of patient who understands the difference between Data, Information, Knowledge, and Wisdom, and can make their way upward on that pyramid 
That’s interesting. I have paroxysmal AF. Controlled with medication for years until the dosage needed got too high so had an ablation in 2019. In a followup with my cardiologist in late 2020 when I said I was still getting AF he recommended getting the Alivcor Cardiomobile. I’ve collected several strips since then when I feel the AF happening. I’m overdue another followup where I’ll send him a sample of what I’ve collected.
Hence the last sentence. Since the AFFIRM trial, it has been known the risk of fibrillation is mostly from the high rate and not the abnormal rhythm. Nevertheless, plenty of people dislike irregular rhythms and get ablation or meds that attempt to restore sinus rhythm. You can likely tell when you are fibrillating without anything else. A device can confirm it, of course.
But you are a different population (confirmed and treated problem) than many who might overreact or underreact to other problems. Atrial fibrillation itself requires a search for other possible causes, including lung, thyroid, clotting, alcohol use, ischemia, infection and other heart issues and triggers, though many cases are idiopathic.
But you are not “the worried well”. High blood pressure is a real concern. If very high, or if elevated for weeks at a time it can cause problems. If briefly somewhat elevated because you are exercising, it is less serious. Measuring your blood pressure ten times a day might cause worry, which will elevate pressures, often without solving any real issue. Buying socks to check your babies heart continuously might help if your baby has been diagnosed with a heart condition. But much less so if the baby is healthy and the anxious mother has a few hundred dollars to spend.
The most important thing for commerce is to create, grow, amplify, then sustain that group of “worried well”. Or “worried consumer” in the general case.
Whether it’s scaring Moms about germs on their countertops, dust mites in their HVAC ducting, or eeeevil carcinogens in every non-organic apple, scared people buy more countermeasures than do non-scared people.
As we also see with the paranoia-mongers behind the gun industry; one gun is never enough, you need several to quiet the worst of your fears (that we’re busy feeding all the way to the bank!).
Of course people get used to anything, even scare-mongering. So sellers need an ever lengthening list of ever scarier (but actually increasingly implausible) things for your customers target to worry about.
And from a commercial POV that’s all the public is. A target to be herded into a killing zone then financially slaughtered for the seller’s convenience and profit. The very idea of a mutually beneficial customer / vendor relationship is simply absent.
Why does this remind me of Theranos’ promises?
One device to diagnose them all, one device to treat them,
One device to make it chronic and with the medication bind them
In the Land of Medicor where the profits lie.
As this kind of trends start in the USA and then come to Europe, I am worrried. I see a bleak future:
Buy two adult treatments and get one children’s treatment free!
People who got sinusitis also experienced constipation! Special offer combi treatment, only for a limited time!
Recomended for you: Anxietol Forte! Won’t cure your cancer but you will feel better nonetheless! Now in a bespoke female edition!
Do you want to add extra funeral cost insurance to this item? (Disclaimer: only applies to placebos)
Well, it costs little to measure your blood pressure once you have bought a device. There are caveats to making the reading accurate and interpreting the numbers, and they can be understood - or not - but they are not too difficult to understand. You may think it is unusual to have someone come in to the emergency room in a state of extreme anxiety after measuring their own blood pressure many, many times but actually be healthy and generally well. You might think, in short, this example contrived or unrealistic.
Except it isn’t. I have seen dozens of such cases. This does not mean there is no value to checking blood pressures occasionally, or that it is completely unimportant. It does mean too much data and testing is often counterproductive.
Diagnosing a heart attack is not difficult for most emergency doctors. But a famous study (discussed in Gladwell, methinks) claimed to improve accuracy by reducing the amount of data to only the most important points.