Monitor Me – Because I Need the Information

Watching Horizon – Monitor Me on BBC2 last night made me think about healthcare technology and apps in a slightly different light. Living with chronic illness since well before the advent of the world wide web, never mind smartphones and apps, the idea of self-monitoring health information isn’t at all new to me. I’ve been testing my blood glucose at home for three decades, albeit with meters which have got progressively smaller, faster and better featured. But because I think about my health every day, and collect certain information to help me maintain it, in the context of a pre-existing pathophysiology, the idea of using equipment to monitor what I regard as normal physiology hasn’t really occurred to me.

And to be honest, my overarching reaction is that this could well be overkill for most people, and simply a way to fuel unnecessary health anxieties – an increase the burdens on our health service – without improving any important health outcomes, especially as the use of so much home technology does nothing to address the long standing inequalities in health across the population. Those most in need of improved health outcomes are exactly those who often don’t have access to these sorts of technologies, nor the means to interpret the data they give. The program also did not look at how sustainable the changes they showed occurring in the short term really were, and how these might relate to more traditional models of health education. Clearly there is much quantitative research still be conducted before doctors will be prescribing direct from the App Store.

The part of the program which, inevitably, interested me the most though, was that which covered some novel new methods of monitoring actual health problems, rather than monitoring the healthy state. I was already half way through an eye roll, however, when they begun to trundle out a continuous glucose monitoring system, as I got the impression that they were treating it like a brand new technology – when in fact I’ve now been doing this for over seven years. That was quickly replaced with excitement though when I saw the neat integration in a mobile phone and the name DexCom at the bottom of that screen. I’ve been using a DexCom product (as a standalone unit, and then integrated in to my current insulin pump) for the last three years, and it’s a product that simply works. The idea of it working with my mobile phone is a very attractive one, although I’ve not had the chance to find out if this is actually a possibility in the pipeline for commercialisation.

Something became apparent to me, however, whilst following the social media conversations around the program. People seem to think that continuous glucose monitoring is all sorts of things that it’s not. They think it’s been around for years longer than it has (I was an early adopter – first real-time, at home systems came to market in 2005) or that it doesn’t yet exist outside of research programmes at all. They also seem to think that it is cheaper than traditional monitoring because it does away with the need to use so many expensive test strips. Unfortunately the technology isn’t cheap – sensors that are licensed for seven days currently run at around £50 each. The transmitters that last a year or so a several hundred pounds and the receiver in to four figures. Add to that the fact that you still need to use traditional finger stick monitoring to calibrate and before making dose decisions, and you can see the costs mount up. Convincing the NHS that this is cost effective is a long, hard road.

But most of all, people think it’s a gimmick. A game. An exciting gadget. They don’t seem able to comprehend the ongoing impact of actually “needing” to use this technology and relying on these results to stay as healthy as possible. They don’t think about the fact that you can’t necessarily pick and chose when to wear and use these devices, just as you can’t pick and choose when to have diabetes

When you have a chronic illness, monitoring your health is not something you do for fun or interest. You don’t do it in case you can spot early signs of a health problem. You do it because you have to in order to stay healthy. It’s a necessity more than a choice. Or rather, if you choose not to, the consequences can be enormous. If you choose not to run a sleep cycle app one night, chances are you will sleep fine. If you’re health conscious enough to use a pedometer, chances are you’ll take plenty of steps even on the days you don’t wear it. If, as a type 1 diabetic, you choose not to monitor your blood sugars, you could be taking a one way ride straight to hospital.

I don’t really expect people who don’t live in this bubble of chronic illness to get this, or to understand what relying on technology for your health really means, but I suppose that is at least part of the reason why I’m writing this now. I like a gadget as much as the next person. I’d be lost these days without a smartphone and I’m appreciative of the problems it’s solved and simplifications it’s made in my life. But I’m anxious not to see non-existent problems being addressed simply because we have the technology, and especially not to the detriment of people with true health needs.

Animas Vibe Dexcom G4 graph


One Reply to “Monitor Me – Because I Need the Information”

  1. It sounds like the kind of thing that could give freakonomics style statistics if used for healthy monitoring – as you say, the people who will be interested in healthy monitoring are those who would be healthy anyway and not as an effect of the monitoring. The use of technology for chronic conditions sounds like a far more interesting use of ever developing tech skills, lets hope that’s where the money gets sent.

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