Photo by Jeff Braverman
So where does the editor of the technology magazine Wired get off telling people how to manage their health?
Simple. Thomas Goetz has married advances in mobile computing with the health-data deluge in his new book, The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine. For Goetz, interest in health is homegrown. His father is a doctor, his mother is a nurse, one sister is a surgeon and another was a public health volunteer (killed while working in Uganda). Goetz himself went back to school at 37 to study public health at the University of California-Berkeley.
He says, “A lot of the ways we think about technology in terms of medicine are very cost-intensive — MRIs, CT scans, stents, surgeries.” Yet he feels relatively low-cost gadgets such as iPhone apps that help track calories do the most to help individuals take control of their health.
Oh, and about health care’s escalating costs, Goetz says, you can blame it on the Beatles. The Beatles? You see, in 1961 British company EMI signed the then-unknown Fab Four to a music contract. As a result, the company made millions (and by now probably billions), which it invested in developing new electronic devices, including the CT scanner, invented by an EMI engineer in 1967. In the decades since, use of this miraculous device has burgeoned into overuse, becoming a major contributor to the out-of-control costs of today. Surely the band was EMI’s ticket to ride in health-care technology.
Stanford Medicine’s executive editor Paul Costello spoke with Goetz about how the non-geeks among us can merge technology and medicine to improve our health.
Costello: At the beginning of the book you talk about three projects you see as pivotal for the future of health care. Two are famous medical studies, the Framingham Heart Study and Great Britain’s Whitehall study. The third is about a group of technology early adopters in San Francisco. Can you connect the dots for me?
Goetz: The Framingham study has been going for 60 years, following the health of three generations. For me it’s an example of how we can gather data and learn from our daily experiences.
The Whitehall study recruited 18,000 men from all different classes within the British civil service, from the ministers at the very top to the janitors at the very bottom, and they studied them to see who was most at risk for heart disease. What they found was pretty much a direct correlation between your social rank and your risk of heart disease. So people at the bottom had a profoundly increased risk of heart disease. The core insight — that when we are given control of our health, we tend to have better health — was to me an essential part of laying the groundwork for this new conception of health care.
So that’s where this third group comes in, the Quantified Self group, which is a local meet-up. This is a group of technology geeks who want to start experimenting. In this case, what they’re experimenting with is not computer code, but their own code. They’re tracking their genomes. They’re tracking how much coffee they drink. They’re tracking how much exercise they get. They’re tracking how much sleep they’re getting. They wear all sorts of different sensors and body monitors and use their iPhones to track various things about themselves. The idea is that this sense of control, as we saw with the Whitehall study, starts to kick in and we start to see our way toward better health.
Costello: Data is really king, is what you’re saying?
Goetz: Right. There is great public health research that shows when you give people feedback, when you give them a sense of where they stand in their health, and a goal, and then get them to keep track of how they’re doing — think about weight loss — that kind of feedback loop really is effective at behavior change. The trick is it’s laborious. So what’s changing is that the tools are getting simpler, and it’s getting much easier for more people to start changing those behaviors.
Costello: You wrote that staying healthy is as much a decision-making problem as a health-care problem. What do you mean by that?
Goetz: We know the basic rules of good health: We’re supposed to be exercising more and eating a little less, and eating more healthy foods. The problem that we have as a society is putting those rules into action. That’s really the place of decision making.
That’s when we need to get information delivered to us, at the very point that we’re deciding between having a piece of carrot or the piece of carrot cake.
Costello: Tell me more about how technology can help.
Goetz: What is really cool about what’s happening here is that information technology, like iPhone apps, are a really good way of turning data, that very logical and rational and quantitative approach, into something that we can understand and integrate into our lives. And you don’t have to be a geek.
That’s where iPhone apps are so powerful. Like the Lose It! app for weight loss — there are 10 million people using this app every day. Or there are very good blood glucose monitors that are useful for diabetics or pre-diabetics. If you want to quit smoking, there are quit-smoking apps that help people track their cigarettes.
There’s one great little tool that I might mention. It’s called the Fitbit. It’s a little accelerometer that you clip on to your belt, and it tracks your calories. It tracks how many steps you’re taking. It tracks your cadence. It’s a really great way to make sure that you’re getting enough exercise every day just walking around as much as you can.In addition to giving you the numbers, it has this great little icon. It’s a flower that grows, so the more you exercise every day, the taller your flower gets. It’s a great example of how it’s not just data that helps people. Making that flower grow is something that pretty much anybody can understand. Once you get this device, you want to make your flower grow every day.
This interview was condensed and edited by Rosanne Spector.