If you’re someone like Jared Sieling, you’ll track everything you eat for weeks and then pore over the data to uncover your nutritional shortcomings. Other self-trackers monitor their heart rate during workouts, log how many steps they take each day or chart how far and how fast they perform on their daily run.
Are these “elite livers”, as some of them call themselves, a standout example of highly engaged health consumers or are they just, well, obsessed? And where does the average person fit into this?
The rising popularity of self-tracking was explored recently by the Star Tribune of Minneapolis, where a Twin Cities Quantified Self meetup took place this month. Sieling told the newspaper that self-tracking has helped him zero in on where his health habits could improve – more protein in his diet, for instance.
Most Americans track their personal health in some way or another. We weigh ourselves on the bathroom scale, check our blood pressure with a home monitor or wear a pedometer to count how many steps we take each day. As athlete Erin Klegstad told the Star Tribune, “I just like to see the numbers and [it's] fun to watch it all. It’s taught me what my body can do and makes me push harder.”
But with the growth of hundreds of new apps, monitors and gadgets, self-tracking has reached a whole new level of data collection and analysis. Many people are starting to wonder: Are health apps really as beneficial as they’re cracked up to be?
Heart attack survivor and Heart Sisters blogger Carolyn Thomas attended a conference last fall in Silicon Valley, where she encountered a whole passel of mobile health app designers. All of them were convinced that technology is the answer to healthier living, but Thomas couldn’t help wondering if any of them knew what it’s like to be a real patient.
It struck me that the imaginary patient using this technology wasn’t anything like me, or my readers, or most of the heart patients I meet or hear from or talk to on any given day. Instead, the patient that the hypemeisters talked about seemed to be some kind of fairy tale fantasy patient: tech-savvy, highly motivated, compliant, eager to track every possible health indicator 24/7, and most of all – oh, did I mention? – NOT SICK.
In other words, an apparent case of “healthy privilege,” or the tendency of the healthy to assume everyone else is like them, Thomas wrote.
Jessie Gruman, president and founder of the Center for Advancing Health in Washington, D.C., is recovering from stomach cancer and needs to eat something every hour, a task that takes time, planning and mental energy every single day. But when she downloaded a popular app to help keep a food diary, she found it was more time-consuming to use the app than to actually eat the food.
“I used the app for three days before I resorted to pen and paper,” she wrote a few months ago in an “Open Letter to Mobile Health App Developers and Their Funders.”
Gruman offers this real-life advice to the app people: 1. We will not use mobile apps that add to the time we spend caring for ourselves. 2. We do not respond well to nagging. 3. We favor apps that are linked to (or associated with) our clinicians.
There’s a big difference between those who use technology to track every aspect of their daily health and those who are living with chronic conditions and may not have the energy or commitment to use the technology in a meaningful way, Thomas writes.
“I do consider myself an engaged patient, but I do not own a smartphone, a 7-inch tablet, or an iPad – nor, as a person with a chronic illness living on a modest disability pension, could I afford them,” she writes.
Even the medical community is struggling to figure out the role that self-tracking can, or should, play in personal health.
Dr. Michael Joyner, a physiologist and professor of anesthesiology at the Mayo Clinic, told the Star Tribune of Minneapolis that the proliferation of health apps offers some hope for improving the management of chronic diseases. But at the same time, it’s possible to go overboard with detailed self-tracking, he acknowledges. “Are they living life or are they tracking life?”
Dr. Leslie Kernisan, who provides care for geriatric patients, recently pondered whether she should be prescribing apps – and if so, which ones?
Apps can be useful if they help patients meet their medical goals or provide information that’s clinically useful in some way, she wrote. “But I worry that we’ll end up making the same mistakes with apps as we’ve often made with the prescription of medications: recommendations based on marketing rather than thoughtful assessment of expected value, and prescription of apps for every little medical condition rather than choosing a few high-yield apps based on a whole-person approach to managing healthcare.”
Here’s some final food for thought: A 2011 consumer survey of smartphone users found that one in four health-related apps were used only once, and nearly three out of four were abandoned by the 10th use.
Are health apps mostly a niche technology for the worried well and the data junkies? Or do they hold some promise for real, live, actual patients in need of tools to help them manage their health in ways that are constructive rather than burdensome? At the moment, the answer isn’t at all clear.