Ditch the doctor? Technology to transform healthcare
By Gemma Milne
Technology gives us increasingly numerous ways to monitor our health, but are we, and health professionals, ready for more individual control?
Sometimes our bodies can feel like difficult beasts to control.
Randomly falling ill out of the blue, feeling tired despite having a great sleep, suffering from depression and looking for a ‘reason’; having more control over our health is of course desirable, but surely it is something no human can have.
Or is it?
“In five years we’ll look back and think it’s crazy to not track your health in the same way we track everything else in life”, says Tom Livesey, Co-Founder and Chief Technology Officer of Thriva.
They’re a London-based startup which sends you a kit in the post for giving a blood sample, and once returned, then creates an online profile for you and your blood.
The idea is that you test your blood every couple of months, and can therefore spot changes in your blood profile.
Livesey talks about being ‘health engaged’ – the very act of finding out more about your health suggests you’ll take better care and responsibility of how your body functions.
“It means that in the future if something does go wrong you can look back at the changes to help make sense of it, but it also means you can look out for red flags now and intervene.”
An example would be with some aspects of heart disease – you may not feel the effects until they are severe, but gathering blood data over time can show early flags of detrimental activity.
“Gone are the days where GPs are the sole gatekeepers of your health – if you want to know more about your health, you should absolutely be able to.”
One customer of Thriva, Mark Baker, attributes his personal blood test to helping him better manage his sleep.
"Upon taking the test it alerted me to my low Vitamin D levels," he said.
"I approached my doctor with my results and they asked me to take an NHS blood test, which backed up Thriva, and prescribed Vitamin D tablets.
"I took these whilst making sure I got 15 minutes of direct sunlight a day and within two weeks I started to feel different."
The idea that the very act of checking in on our health means we’re likely to be healthier in the long run is a compelling one.
And with health really being defined as much more than just what’s going on in our bodies, being more aware of ourselves can surely only be a good thing.
The WHO’s definition of the social determinants of health looks at the broader spectrum of what affects us – from family and social status to work environment and country-wide economy.
If we were to question our blood results, maybe we’d be inclined to look out for the broader reasons as to why they aren't what we expect, and make the change.
But of course this requires everyone undertaking the tests to have this understanding of the make-up of their health as a whole.
With technology accelerating at a pace beyond previous generations’ wildest dreams, maybe controlling our health is indeed something we’re moving closer to.
Companies such as 23andme and uBiome are part of a trend towards personal preventative health, where you send off your biological samples to be analysed on your own accord, to allow you to track, spot and – ultimately – try to prevent any untoward health issues.
From understanding your DNA and gut, to tracking your blood over time, you’d be forgiven for thinking we’re approaching a world of preventing illness instead of simply curing it.
The question, of course, is how reliable really are these personal health kits, and are they actually simply satisfying a detrimental obsession with control as opposed to a thoughtful and considered approach to keeping an eye on our bodies?
A big concern centres around the fact that we still have little information about exactly what bio-markers cause exactly which illness or complication; for instance, we don’t know for certain if particular blood measurements would definitely cause liver failure – it is most often a combination of various markers.
Secondly, most information we have about acceptable levels for bodily measurements compare what we have to the entire population – but knowing that iron should fit within a certain gap only makes sense when you average across huge numbers of people, and doesn’t really indicate much for an individual alone.
Alexander Finlayson, a GP and technology entrepreneur, argues that we have to be careful about how readily this information is available to the population.
If we give too much information about individuals' health without providing the context for it to be understood, there are concerns that people will feel more anxious about their health, assuming worst case scenarios.
"Certain tests can be easily parsed – for instance, if you find out you are diabetic you can immediately make changes in your life to manage this," Finlayson said.
"But other tests aren't hugely helpful to know, and actually can be harmful, possibly causing health anxiety, especially if the test and actions to act upon the results aren't well defined or understood."
Indeed, a 2016 paper in The BMJ assessing whether knowledge of your DNA make-up prompted positive behaviour change, and whether health anxiety is a true concern, found no evidence of either.
In other words – the jury is out, and we don’t actually know if doing these tests is actually useful at all.
The importance of explaining results and providing context cannot be underestimated, and indeed, companies such as 23andme offer genetic counselling to content with the ethics of early diagnosis.
Finding out you are likely to get an incurable condition later on in life, for instance Parkinson’s, could be catastrophic and without any real utility.
Sergey Musienko, CEO of Atlas Biomed, agrees that this ‘mediator’ role – explaining and giving context to the information – is crucial if we are to move towards patient-driven healthcare.
"As an individual, it can also be hard to know what to do with DNA or Microbiome data, which is why we are committed to giving people targeted, personalised recommendations as to how they can improve their health based on the data we get from their tests," he said.
Atlas Biomed, another London-based company focusing on health kits, offers both DNA and gut analysis to add to the suite of data that members of the public can gather about their health.
"In the extreme case you would have full control over everything, but currently that is logistically difficult—for example, even having unified digital access to your medical records so that you can access or share them at any time is challenging," Musienko said.
It seems that the ‘perfect’ answer to truly providing strong information about our health involves collecting data passively, for a long period of time, across many different touch-points, in order to find clear patterns.
We’d need everyone to be unaware of the tracking, so as to not bias the measurements, and all of the data to be linked up in one system which we could all easily interpret.
Of course, this is far beyond our current capabilities, and data privacy laws, but maybe companies like Thriva and Atlas Biomed are taking the early steps towards a more global approach to assessing our health.
Controlling our health looks to be getting more realistic as time moves on, but if we’re to truly understand ourselves better, and take useful measures to prevent negative health issues, we must also understand the limits of the control we desire.