King Broccoli

It’s no question that public health organizations struggle to manage chronic diseases.

The costs of diseases are socialized through insurance and public healthcare. When one person gets sick, we all pay for it. All of us would have more money in our pockets if we paid to prevent disease, rather than paying to keep someone with a disease alive.

It’s too little, too late, and too hard on taxpayers.

But where is the alternative? There’s no vaccine against heart disease, diabetes, or fatty liver disease. These conditions aren’t communicable, but the costs are shared. Still, it would be wrong to force each other to eat less and run more. 

I think wearables are the way out of this problem. We need to put tools like continuous glucose monitors, nutrition trackers, step counters, and blood pressure readers in everyone’s hands.

Why is this going to work?

The chronic disease pandemic is a crisis of slow feedback loops. We can’t tell which of our behaviors are the most problematic, or even what problem they’re contributing to.

For example, donuts are considered “bad” for you. Why? Because of fat? Sugar? Because of calories? Seed oils? Why are these things bad? Are they really bad? According to who?

Fast feedback means you can connect cause to effect. If you’re teasing a dog, you know you’re increasing your risk of being bitten or scratched. For chronic disease, we need instrumentation to speed up feedback loops.

Wearable continuous glucose monitors (CGMs) do this. They show you how much your blood sugar (glucose) spikes after eating. Regular, high spikes in glucose can lead to insulin resistance and type-II diabetes. 

Because CGMs speed up feedback loops, they allow you to build an intuition about what foods do and do not contribute to your risk of diabetes. It means that you don’t have to commit to a single diet. Instead, you can make informed decisions on a case-by-case basis, just like you do when you cross the road.

If this is so great, why aren’t democratized health wearables a reality?

Three reasons:

1. We need open sensor standards for health wearables.

2. Open sensor standards probably require government involvement.

3. People don’t want government involvement in health monitoring technology.

If we want this technology to be cheap, accessible, and useful, we should seek to standardize sensors. Doing that would create predictable, transferable data. This would allow companies to compete to create better user experiences, interfaces, and applications. All of these things suck at the moment.

Establishing those standards is not necessarily something that private companies want. It might be more profitable to own the full stack – that is, to make the sensor and the software, and to make your sensor and software incompatible with all the others. Like Gillette razors. 

But if the government stepped in to fund the research and development of a high-quality standard for sensors and data, companies could just compete to make the best-looking, fastest, and most intuitive feedback loops. If you didn’t like how a company was treating you or your data, you could easily take it elsewhere.

Unfortunately, but understandably, people don’t want Big Brother on their wrists. I don’t know how to argue against that possibility. Sure, it might happen. Either way, there is still cultural resistance to widespread health wearables use. Especially when people think of public health authorities, which are hungry for population data.

The monetary and moral benefits of solving the chronic disease crisis are worth navigating this resistance. Closing people’s health feedback loops via wearables is a hard problem. It’s going to be harder than stopping smoking or making seatbelts mandatory, but the stakes are higher.

Fortunately, I think wearables – if sensors and data are standardized – are going to be enough to take some chronic diseases off the “Top 10” charts. Even without the involvement of public health authorities. This is because the problem is not about Big Data. 

Big data pointed us toward the problem. But aggregating more data won’t solve it – fundamentally, these chronic disease crises stem from personal choices. Governments strong-arming citizens into jogging and eating broccoli isn’t going to work.

The solution is to enable people to close their personal health feedback loops easily and cheaply. Enabling people to tinker with their lifestyles, in order to align behavior with improved long-term health outcomes. A local solution to a global crisis.