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© 2001 Michael Hawley ([email protected])in: MIT Technology Review, March 2001
see: http://www.media.mit.edu/~mike/trThings That Matter
A Picture of Health
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Annual doctor checkups? How quaint. Networks of wearable or ingestible sensors, along withsmarter household appliances, can much more effectively track the condition of your body.___________________________________________________________________________________
Weight Watchers
As I stepped on the bathroom scale, my life flashed before my eyes. Instead of a wigglingneedle, I saw my weight as a graph, plotted over the last year like the Dow Jones average,with bumps during the Thanksgiving and Christmas eatathons. It was a sobering picture.Anyone looking at that graph would conclude that I had not been jogging enough. And theywould be right.
That scale, called NetWeight, was the invention of Brad Geilfuss, a member of our researchteam at the Media Lab. In the face of 1999's zillion dollar IPO's that pitched on-line medicalhandholding in various guises, Brad's scale argued a more fundamental thesis: that the way torevolutionize medical practice is by connecting one's body to the medical system moredirectly. The bathroom is a clear starting place. You're a captive audience for ten or fifteenminutes a day in front of the bathroom mirror, so with a bit of sufficiently advancedtechnology, Brad adapted these channels. He built a magic mirror to display one's vital bits.
Geilfuss' Net Weight: a scale that never forgets. (Webb Chappell photo)
The mirror contained a Silicon Graphics computer and a rearward video projector so that livegraphics were overlayed on your reflection. Cardiological animations were projected overyour heart. The graph of your weight could appear on your belly. The scale itself contained acamera that used a picture of your toes to identify you. What if it were a web-cam? Weightwatching could really mean something.
Before you run screaming from the littlest room in your house with visions of Big Brotherwatching your every excretion, let's think this through.
Matters of the Heart: Four Hours to Live
It is not just our flab. For example: there isn't a person on planet Earth who has seen a simple,cogent picture of the health of their heart over the last few years. This has graveconsequences.
Our country's medical system costs over a trillion dollars a year, almost too much money tocount. The thickest slice of that pie goes to heart attacks, over $130b/y, which somecardiologists feel is a conservative estimate. In any case, it's a big chunk of the overall cost,and it's growing in both dollars and percents in every westernized country in the world.Here's part of the problem. Of the 1.5m heart attacks per year(!), perhaps 20% of victimsreceive critical treatment early enough. When you have an attack, you need an injection of an
anticoagulant within an hour or two. If it takes more than a couple hours, the drug may domore harm than good. Of course, by then it's moot. The muscle has begun to die.
Why do most attack victims fail to get treatment in time? And where are the killer delays?Maybe the patient got stuck in traffic. Couldn't find a parking place at the hospital. Had to waitin line at the E.R., or spent an extra half hour mired in paperwork. Maybe the ambulence wentto the wrong address. But it turns out that hospital-side delays have been reduced from hoursto minutes with better technology. The biggest source of delay? It's us: the patients. Weignore symptoms, or just don't recognize them. (Remember, most of us can't even point toour own liver. Can you?).
People are basically disconnected, both from their bodies and from emergency services.They don't hear what their body is saying, and don't connect with a service soon enough.
How hard would it be to build a wristwatch with some cardiological smarts for high-riskpatients: detecting an attack, which is about as subtle as a 7.0 Richter quake, the watch wouldsend the right blip to the right place so that the patient gets the right treatment in time. Or atthe very least, the watch might flash an alarm: "Four Hours to Live! Call this number. We meanit."
Of course, heart problems are about much more than a few critical moments: there is a longperiod of unhealthy living that leads into the risk zone, and therapy after. Through all of thatliving, most people are flying blind.
The overall sense of the Robert Wood Johnson foundation is that most Americans get by onwhat seems like 1930's-era medical care. Our sick care system (and that is what it should becalled, since most folks only use it after blowing a gasket, after the damage has been done) isbuilt on the quaint notion, exercised by relatively few, that you'll visit the doctor once in ablue moon and provide a pinprick of data. This is as barbaric as yanking out a tooth byslamming a door with a piece of string tied to it. Once bodies are online, when just by gettingdressed in the morning, your jewelry, apparel and bathroom kit casually forms a "bodynetwork," collecting more vital data every day than your doctor sees in a year, the sporadicmedical checkup will go the way of the dodo.
Marathon Man
The last time vital sign monitoring was "invented" it transformed hospitals. Around 1863, KarlWunderlich proposed a standard medical chart hanging on the end of the hospital bed. Afterstudying 32 conditions in 25,000 patients, and how they affected body temperature, hewrote a classic treatise: On Temperature in Diseases. His chart showed temperature, pulse, andrespiration data so that, at a glance, a physician could monitor the patient's progress, evenwhile the patient slept. That basic tool probably had more overall impact on quality of hospitalcare than anything outside of drugs and antiseptics. But technology is changing much moreradically now.
The coming wave of personal vital sign monitors are wearable, networkable, evenfashionable and fun. The implications of these inventions go far beyond hospital critical carerooms. Some signs of the times:
• MIT researchers run 101st Boston Marathon with fanny-pack body monitors. Vital stats(pulse, footsteps, internal body temperature, GPS position) are transmitted to theinternet. Similar technology is tested by climbers on Mount Everest in 1998.
• Reebok introduces Traxtar shoe: the first shoe with a built-in computer, it measures
how high you jump and how fast you run.
• Olympic sprinter Michael Johnson wears ultra-small accelerometers to measure thekinematics and physiology of his 400m sprints.
• This year, companies like FitSense and Nike have introduced watches with radio linksto your shoes. The watch is a "dashboard" that precisely tracks how far you run. Ittransmits the signal onto the web.
Fanny packs containing vital stat monitors for marathon runners. (photos by Chappell, Hawley)
Some technologies are exotic. For example, marathon runners swallowed a horsepill thatmeasured internal tummy temperature and transmitted the results via radio to a beltbucklereceiver halfway between an oral thermometer and the other kind. The idea of ediblesensors was a mindblower for some people. Of course, any electrical engineer knows that it's
hard to build a circuit that isn't accidentally a thermometer, too; and most drug designersrealize that, since the circuit is cast in a plastic shell so that it doesn't react chemically with thebody (you swallow it, then poop it out), FDA approval is relatively straightforward. That pilllent itself to a classic demo: place a graduate student near a computer, feed it a pill, andobserve the temperature graph on the screen. Then pour some piping hot coffee into thestudent and watch the graph go up. Then some ice cold beer. Then some piping hot coffee.
This cycling is much like what one observes when watching an on-line marathoner. Bodytemperature goes up for the first few miles as you warm up. And at mile 18 or thereabouts,the temperature starts to fall off a cliff: you've burned up all the fuel in your furnace and thebody begins to get cold. But on closer inspection (which may mean glancing at the tele-dataon the web), the temperature graph climbs up and down, with periodic dips every few miles.Each dip turns out to be a cold swig of Gatorade. Of course, in other situations you mightprefer to drink champagne...
Heart Throb: Better Living by Accessorizing
MIT student Maria Redin gave the technology a romantic twist. Working with Ron Winston,president of the Harry Winston jewelry company on Fifth Avenue in Manhattan, she createdthe Heart Throb Brooch, a lavish diamond and ruby pin. The rubies glow with every heartbeat.A transmitter in a clutch purse or an Armani glasses case completes the ensemble, and sendsthe signal to the net.
Maria Redin with the Harry Winston Heart Throb brooch. (Webb Chappell photos)
Flashy jewelry suggests both a natural channel and a killer app (er— no pun intended!).Jewelry touches (even pierces) the skin in places like earlobes, necks, navels, wrists andfingers. Often it is worn near the heart. So it is well poised to monitor a suite of vital signs.Jewelry also can be expensive, which may be seen as a feature, not a bug: with all thoseWinston diamonds, you'll hardly notice the cost of the technology. And jewelry is a ticket toaccessorize. It invites a networked ensemble, a set of sensible jewels that form a littleinternet around the body. Finally, jewelry exists to communicate. It signals your status andtastes to partners or potential mates. Redin conceived of the Heart Throb in a his & hersconfiguration: one spouse might wear a sensor, the other would wear the jeweled display,and when the two drew close at a party, one would glow like a Christmas tree.
And it won't stop there. HDTV may finally find their place as retinal implants (wouldn't youlike eyes with 200:1 zoom, or better night vision? or turning a knob to adjust your iris color?).Maybe the movie The President's Analyst wasn't too far off with its injectable phone. Clearly,coming decades will see startling advances in human body networking: more than a moodrings, we will live through revolutions in wearable, edible, implantable, sense-able,fashionable, tasty ensembles of things. Probably within ten years we will take the notion ofbodies on line for granted, like e-mail and web links and cell phones now.
But do we really want this? Well, like it or not, we desperately need many of thesetechnologies to tackle specific problems, like deafness, blindness, diabetes, or heart disease.It's a matter of time before tools that address these niche problems become networkable. Infact, the balkanization of body sensing technologies is too expensive to sustain. They mustnetwork. Moreover, many inventions will arise for other purposes, like sports orentertainment, or home health support for the aging, and those inventions will help formnew capillary network links, adding to the synergy. Some will be fun. Some will be vital. Allwill connect to form a bigger picture. It will happen.
That is why, to our grandchildren, the notion of Doctor Jellyfinger collecting a pinprick of datawill seem as quaint as treating cholera with leeches, and an absurd basis for a health caresystem. Their world will be one in which, just by getting dressed in the morning, putting onpants one leg at a time, vital signs will be sampled casually and continually. They will wonderwhat a regular checkup was, or how their grandparents lived in a world in which they knewmore about the state of their cars than about their own bodies. This isn't just an ounce ofprevention, but gigabytes of it, for a healthcare system that provides most Americans with1930's era treatment, and is hemorrhaging trillions of dollars.
It's time for a new bathroom scale. Got the picture?
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References and Acknowledgements
Online Links:
Tanita, www.tanita.com— Tanita makes a wide range of body composition analyzers (ie., fancy scales). Thesedevices are computer peripherals that record weight and bodyfat. Products range fromsimple consumer models to professional (hospital) gear.
Traxtar, www.traxtar.com— Reebok’s smart shoe for kids. The Traxtar is the world’s first running shoe with a built-in computer. It measured speed and jumping height and was a novelty shoe for kids.
FitSense, www.fitsense.com — FitSense makes wireless web-linked spedometers andheart monitors for runners and walkers.
Nike, www.nike.com — Nike’s recent techlab is creating innovative sport/technologyproducts (spedometers, heart monitors, etc).
Polar, www.polar.com — Leading maker of heart monitor wristwatches.
Books:
Love & Survival: 8 Pathways to Intimacy and HealthDean Ornish, M.D.Harper Collins, 1999.— Dr. Ornish proved that symptoms of heart disease can be reversed through an aggressiveprogram of diet and exercise. His numerous best-selling books explore many facets ofheart-centered health ranging from cookbooks to lifestyles to intimate relationships.
Acknowledgements:
Don Lindberg, [email protected], Director, National Library of Medicine.Steven Phillips, [email protected], Cardiologist/Surgeon in residence at NLM.Sam Joffe, [email protected], President and co-founder of FitSenseRonald Winston, [email protected], President, Harry Winston
Comments, Errata:
Please send me any questions, comments, or corrections.— Michael Hawley, [email protected]
