Health-monitoring devices: Helpful or hinderance?

Kenneth R. Foster, Professor in the Dept of Bioengineering at the University of Philadelphia, discusses the pros and cons of health-monitoring devices
Kenneth R. Foster, Professor in the Dept. of Bioengineering at the University of Philadelphia, will be a lecturer at this year’s Trottier Public Science Symposium.

Kenneth R. Foster, Professor in the Department of Bioengineering at the University of Philadelphia, is familiar with FitBits, Apple Watches, and other health-monitoring devices. The question is, does he find them effective? Helpful? Harmful? Find out for yourself at the two-day Trottier Public Science Symposium, Minding the Future: Living in a High-Tech World, on Tuesday, October 30, where Dr. Foster will speak on Hype and Hope About Wireless Devices for Health Monitoring. For more information on #Trottier2018, please visit the Trottier Symposium webpage. Register here.

Have health-monitoring devices helped or hindered human behaviour/activity?

Karen Moffatt and Rita Orji published a very nice overall review of the effectiveness of “pervasive technologies,” a general rubric that includes health monitoring devices. Their analysis showed that the evidence is overall positive but mixed. Most studies find positive effects but some do not. The devices simply monitor and record physical activity or other health related activity. They may help motivate people to increase their activity, but whether this works or not depends on a lot of factors.

The general problem with Fitbit and other activity monitors is that many or most people stop using them after the novelty wears off. Studies that use these devices to increase physical activity of patients after surgery, for example, generally show positive effects for people who stick with the programs but there are very high dropout rates. Many people, particularly the elderly, can’t learn to use the devices with their smartphones effectively and drop out of such programs.

What do you think about the new Apple watch being used to diagnose heart problems?

The latest Apple watch does not make a diagnosis, rather it is an app that Apple promises to release later this year.

I have not seen test data but I think it is likely that the watch will do a decent job of measuring a one-lead electrocardiogram (comparable to placing an electrode on each arm). Other devices and smartphones have been shown to be reliable at detecting one particular kind of arrhythmia, atrial fibrillation (AF) and I would expect that the watch would work well for this purpose as well.

In some medical situations doctors might advise patients to use such devices to detect infrequent bouts of atrial fibrillation, for example if they suspect that it occurs but cannot detect it in a patient during an office visit.

But the medical community is not convinced of the benefits for asymptomatic people screening themselves – there is a balance between the possibility of helping someone by finding a previously unsuspected problem, and harming that person by a false positive or detection of an existing condition that is not likely to be harmful to the individual, a phenomenon called “overdiagnosis.” That is particularly true with screening for AF in asymptomatic individuals, since diagnosis of AF can result in anticoagulant therapy with its risks of causing internal bleeding.

For people whom I imagine are going to be the principal buyers of the Apple Watch, that is young or middle aged adults, the chances of having atrial fibrillation are very low and the likelihood of a false positive or overdiagnosis is much higher than that of actually finding a life threatening condition. On the whole, you do not want apparently healthy people to constantly screen themselves for conditions that they are unlikely to have. It is a good way to turn healthy people into patients, which has its own risks (not to mention increases healthcare costs).

Some companies are developing apps for the Apple watch to detect other kinds of heart problems (as well as other health conditions) but we have no idea how well they will work. AF is an easy case. Such apps would have to be tested using well controlled clinical trials before making any judgment about their effectiveness.

Can electronic devices be used nefariously to disrupt health?

Yes and no, depends on what you have in mind. The taser is an electronic device that, while generally incapable of producing lasting injury, has some potential for harming an individual depending on how it is used. In principal, one could use an electronic device to interfere with someone’s implanted medical device possibly leading to injury.  I do not wear an implanted defibrillator, but if I did I would not want a hacker to try to reprogram it while I am stopped at a traffic light someplace.

The potential for direct injury from wearable health monitors is quite low but I can imagine some future wearables posing problems depending on what they are designed to do. A noninvasive monitor for blood glucose in diabetics could cause harm if it is not accurate. Wearable devices pose a range of potential security and privacy issues that can open the door to possible mischief. I would guess that the major threats would involve invasion of privacy but who knows…?

Do you think that exposure to electromagnetic fields as generated by electronic equipment or devices can have a negative effect on health?

If you are talking about ordinary consumer devices, the potential for harm from electromagnetic fields is tiny to nonexistent. Canada and other countries have safety standards that protect against all identified health hazards of electromagnetic fields, and any device on the market presumably will comply with those limits. That is particularly true of medical devices. The potential problems, to the extent that any exist, are more likely to be related to shock or burns to a user from excessive case temperature or other such problem, not from exposure to electromagnetic fields as such.

Don’t charge your smartphone using a charger using an extension cord connected to a wall outlet and take it into the bathtub with you!

Some high power industrial or broadcast equipment uses high power radiofrequency fields that can be demonstrably hazardous to a person who comes too close to their radiating elements. Some medical equipment using radiofrequency energy can cause injury if used improperly or in accident scenarios. For example, on rare occasion patients are burned by electrosurgery procedures or short wave diathermy procedures gone awry. But that is not ordinary consumer equipment.

Some people are convinced that electromagnetic fields emitted by electronic equipment such as Wi-Fi causes nonspecific health problems (called electromagnetic hypersensitivity). A number of blinded and well controlled studies have failed to demonstrate any direct link between actual exposure to fields and the problems that these people report – they report symptoms when they think that they are exposed to fields, not when they actually are exposed. That controversy will continue for many years, however.