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I’m a fan of CBC Radio’s Spark Podcast, and over the weekend, I listened to ep 263 which included an interview with MIT Professor Natasha Dow Schüll. Her 2012 book Addiction by Design, centers around UX design of gambling machines and compulsive online gaming. In that interview she also talks about a forthcoming book on the quantified self movement – particularly digital health and fitness trackers.

So these products could either be public health saviors, or total snake oil – I imagine we’ll see a lot of each, but one thing for sure is that it will be very hard to identify which are which!

Having recently delved into the health & fitness tracker space both professionally, and personally, I felt compelled to compile some of our thoughts on the topic (which I also sent to Dr. Schüll in an email this morning).

General Thoughts on Health Trackers
I worked on the original Apple/Nike+ program (possibly the first modern mobile age fitness tracker), and am also personally fairly health-science conscious. So I’m both personally eager, and professsionally skeptical of this new rise of fitness trackers. On one hand, I believe the positive potential for society is significant, but on the other, there is risk (both moral and medical) to cause users to act on inaccurate or incorrect information.

Considering that the use of these trackers will likely follow the same adoption curve of smartphones (25% of the world population in 2014 [source]), and the fact that these products are the “herbal medicines of consumer electronics” – in that they are mostly unregulated, there is an unprecedented opportunity for and risk on the global society. I’m hypothesizing, but I suspect that in terms of global medical impact, these devices pose a larger opportunity and risk than any previous public health issue in history.

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Sleep Trackers and the ResMed S+
Shifting from the general to specific, I’ve been a casual study of sleep science for the past 5-ish years. I’ve actually come to believe that understanding/quantifying sleep matters more than any of these other parameters (specific medical needs excepted), because everything during one’s waking hours from cognition to memory to ability and motivation to exercise are directly impacted by sleep quality. In other words, sleep is a super-parameter to all these other parameters devices are tracking… and let’s be honest, from a product development perspective, accelerometers are cheap and easy, which is why you see so much density around that, pun-intended, pedestrian capability.

I just started using the ResMed S+, a night-stand located sleep quality monitor which came out this month. I haven’t disassembled it yet, and they seem to be intentionally vague about how it works, but it seems to be able to accurately monitor your breathing, motion, ambient noise level, ambient temperature, and light. Specifically around the breathing detection, it may well be the most sophisticated remote-sensing and signal processing consumer product yet. It generates pretty awesome detailed reports. If your sleep quality is poor, it gives you specific, actionable advice to improve. If that doesn’t work, it generates reports for you to take to a medical sleep professional.

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If it is as good as it might be, then the US government should probably give one to every citizen – according to the CDC, US businesses lose $63.2B in productivity each year due to poor sleep among their employees [source article].

The Product Performance v Confidence Paradox
OR… it could be total BS. This product (like many of the trackers) falls into a category of products that I think of as Performance v Confidence Paradox products (see chart). On one axis, products like this are difficult to discern whether they are really working (i.e. reporting accurately), and on the other axis, whether they are actually working or not, people may be equally likely to believe they are working or not believe they are working.

In regulated devices, the FDA approval process demands both verification of actual performance, and also places consideration on the severity/danger of consequences in acting on incorrect information (in some cases such action may have no impact or positive impact, while in others could cause risk of death).

So these products could either be public health saviors, or total snake oil – I imagine we’ll see a lot of each, but one thing for sure is that it will be very hard to identify which are which!

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