Harvard - Majalla
24-hour health monitoring is high tech. But is it helpful?
The day has arrived when doctors can remotely monitor your health every moment, if you (and they) choose. Increasing numbers of wireless digital sensors — some implanted in or on the body, some ingested, and some worn like clothing — are making the leap from patents to patients. In 2017, the FDA cleared dozens of devices for continuous health monitoring. “The hope is that people heading toward serious problems — such as high blood sugar or heart rhythm abnormalities — can be headed off at the pass,” explains Dr. Anthony Komaroff, editor in chief of the Harvard Health Letter.
NOT NECESSARILY NEW
We’ve had portable gadgets that monitor health for decades. One early example is the kind of heart pacemaker that detects irregular heartbeats and shocks them back to a normal rhythm. Today we also have devices that sense and respond to many other health problems, such as Parkinson’s disease tremors or pauses in breathing during sleep.
But, at least until recently, these devices didn’t report information to the doctor at the moment they were called into action. That’s been changing.
THE NEW MONITORS
Many gadgets now can wirelessly transmit data to your doctor’s office, often by using your smartphone. Some devices (like a pacemaker) monitor and affect a particular body function. Others track basic health information, such as your activity level, blood sugar level, heart and respiratory rates, skin temperature, posture, and even falls.
These new-generation sensors may be
• implanted in the body, such as a tiny monitor the size of a pencil tip that detects abnormal heartbeats 24 hours per day
• applied to the skin as a patch — also called electronic skin or a smart tattoo — that looks like an adhesive bandage; embedded inside are flat, flexible electronics that measure vital signs such as temperature
• worn as clothing, such as socks with special heat sensors that can detect foot ulcers as soon as they begin to develop, or contact lenses that may one day monitor blood sugar in tears.
Also on the horizon: orthopedic sensors that can tell doctors how well a hip, knee, or spinal implant is fusing with bone or coping with pressure.
The latest monitoring development came in November 2017, when the FDA approved the first digital pill. Each pill is embedded with an ingestible sensor that records when the drug is taken and then sends the information to a wearable patch. The patch can forward the data to your smartphone, caregivers, and doctors.
The approved medication with this technology is Abilify MyCite, which contains aripiprazole, an antipsychotic drug used to treat schizophrenia or bipolar disorder, or sometimes adult depression. But the approval of a digital pill opens the door for many other types of medications that could have tracking applications.
Imagine getting a call from your doctor’s office alerting you about a missed dose of medication, an abnormal heart rhythm, or a dangerously high blood sugar level.
“If we’re able to diagnose and treat you earlier, prevent emergencies, or predict whether you need to go to the doctor, that can potentially improve health and save money,” says Dr. Ameet Sarpatwari, a Harvard Medical School instructor who researches pharmaceutical policy.
Indeed, there have been many reports that digital health monitors have helped identify problems that doctors had not previously diagnosed, such as atrial fibrillation.
But we don’t have enough evidence yet to show if these devices ultimately save lives or money; some of them cost tens of thousands of dollars (including the hospital costs for implanting them, when necessary). “As purely diagnostic tools, they do have some value, especially the implantable versions. But we really need more data to see if this information improves outcomes,” says Dr. Deepak L. Bhatt, a cardiologist and editor in chief of the Harvard Heart Letter.
We also don’t have enough evidence that digital pills improve medication adherence. “There are many reasons why people don’t take their medication. The digital pill addresses only one component of a complex problem,” says Dr. Sarpatwari.
HEALTH MONITORING CONCERNS
Despite the potential to help your health, many concerns remain about digital monitors and pills, such as the chance a device will fail to transmit data, or the extra burden of dealing with the information.
“Physicians can get inundated. You need enough staff to process it,” says Dr. Suzanne Salamon, a geriatrician and assistant professor at Harvard Medical School.
The technology also raises ethical questions, especially when it comes to digital pills. “Will your insurer pay for them if it sees that you’re not taking them exactly as prescribed? Will an insurer lower your copay if you agree to take the digital pill? Will the insurer refuse to give you medication unless it can be monitored?” asks Dr. Sarpatwari.
As for wireless devices, they create new kinds of information for your medical record.
The privacy issues that apply to data from wireless monitoring devices are the same as those for your other health information: Who will have access to this information? And will insurers or employers be able to pressure you to be monitored, if you have a health condition that might benefit from monitoring?
There are also risks that hackers could illegally access your information and steal your identity, or worse, render an implanted device inoperable.
A LOT TO GRAPPLE WITH
Are these monitors protecting our health or permitting intrusion?
“That’s a decision each of us must make. I’d probably consider it a protection,” says Dr. Komaroff. “And given the degree to which people have allowed their personal privacy to be eroded in the world of social networks, I’ll bet that’s the decision most people make. But whatever decision people make, the point is that it should be their right to decide.”