When it comes to your health, what’s better for you as an individual — obsessively monitoring your personal health or opting for a “less-is-more” approach? A debate is raging between the medical and biohacker communities. (Photo: Getty Images)
Wednesday afternoon, Mark Cuban posted some interesting Twitter commentary on how the everyman should be tracking his own health.
Here’s the tech mogul’s prescription for well-being and longevity:
Cuban’s remarks caused a whir of debate among health-care journalists and doctors, as it undermines the current public-health framework that is trying to detract from over-testing patients. Notably, Pulitzer Prize-winning health journalist Charles Ornstein stepped in to provide the opposition, and eventually produced a piece discussing the debate in more detail.
“Medicine is complex. Patients should be encouraged to be active participants in their health care. But there’s this belief, and it’s wrong, that screening tests can only help, not hurt,” Ornstein writes. “There are false positives and false negatives. There’s fear that results from an abnormal result (even if it later proves normal) and there’s treatment. And treatment comes with side effects.”
However, there’s a huge debate over how much information is too much information — and how much is too little.
Cuban’s remarks yesterday were probably in response to a New York Times article from earlier this week about MIT doctoral candidate Steven Keating, which Cuban tweeted out earlier in the day
Eight years ago, Keating had a brain scan that showed a slight abnormality. Although doctors said they’d keep an eye on it, they also told him there was nothing to worry about at that time.
However, he was proactive. Keating researched and dug, finding out this particular abnormality was near the brain’s olfactory center, which is used to determine smells. Last summer, he started catching the scent of vinegar for no particular reason — and suspected he was experiencing small seizures.
Keating knew his own health well. Doctors performed an MRI of the brain at his insistence, found a cancerous tumor the size of a tennis ball, and removed it three weeks later. The whole while, he was fighting for his medical information from healthcare providers, 70 gigabytes’ worth, and collecting his own stable of data. He, in essence, probably saved his own life.
But is Keating’s case the exception, or what should become a new rule in preventative healthcare?
Biohacking is a growing trend in the public health space. It encompasses a range of health practices, but the underlying ideology is the exact opposite of the “less healthcare” movement. Biohackers obsessively monitor, track and test their biology to understand their own normals and get ahead of the curve in controlling their health.
Silicon Valley tech entrepreneur and biohacker Dave Asprey, founder of Bulletproof, explains the phenomenon simply. “The definition of biohacking is changing the environment around and inside you, so you can get it to react the way you want it to,” he tells Yahoo Health. “Your nervous system responds to the environment in these subliminal, automated ways. You can train those automatic responses to factors like stress, so you don’t feel like you’re going to die everytime your email inbox is full.”
Around 15 years ago, Asprey weighed 300 pounds and was experiencing perpetual brain fog. His doctors told him he was cognitively healthy upon physical exam, but he knew something wasn’t quite right. “I dug into my biochemistry, and got lab work done,” he says. “I eventually discovered I had been exposed to a severe strain of mold, which was causing chronic systemic inflammation.”
Today, Asprey does not have brain fog. Uncovering the source of his issue helped him take active steps, like cleaning up the air quality around him, to help tackle the factors that were dragging down his health.
But are cases like Asprey’s and Keating’s exceptions, or what could become a new rule in preventative health? In other words, should everyone be tracking their own stats and bodily quirks quite this closely?
Should everyone be tracking their own stats and bodily quirks?
Maybe not, if we’re too keen to fret about “abnormal” results from scans and tests, according to Dr. H. Gilbert Welch, a Dartmouth professor of medicine and author of Less Medicine, More Health: 7 Assumptions that Drive Too Much Medical Care. “In general, I’d say too much testing is particularly common in those of us who feel well,” he tells Yahoo Health. “The problem is that we all harbor abnormalities, and that our tests are increasing able to detect them. But most of the abnormalities they find are never going to be relevant to your health.”
Digging deep into your medical history, possibly provoking treatment, can potentially do more harm than good. For instance, prostate screening by way of a simple blood test was introduced more than 20 years ago. Now, in 20 years’ time, we’ve learned that one million Americans were treated for cancer that would have never affected their lives, resulting in side effects like sexual dysfunction, bowel issues and bladder problems.
And notably in Keating’s case, keep in mind that he had a big edge over most men and women wondering where to find turn for sage wellness wisdom. As a Ph.D in MIT’s Media Lab, he was plugged into the health and tech space, and very aware of the information he needed to mine to track his own symptoms and the development of any disease.
Advising everyone to demand this sort of information may not at all be helpful, says Welch, who says money, media hype, legal climate — and what doctors perceive to be the expectations of patients — all lead to overdiagnosis. “Testing may also be a quick substitute for genuine physician-patient communication — a way to make patients feel ‘heard,’” he explains. “With the advent of the EMR, diagnostic tests are an easy, one-click response to a patient’s concerns.
“There is pressure on doctors to react to abnormal tests,” Welch continues. “And the disturbing truth is that it is hard for us to make a well person feel better — but not that hard to make them feel worse.”
That said, you might know of a few close encounters, or even personal encounters, with medical error — administering the same treatment multiples times, giving the wrong medications, or missing test results that might have helped prevent an illness. “I have stories from informed patients, who have known they’re not getting the right treatments,” says health-technology expert Ben Shneiderman, a professor in the Department of Computer Science at the University of Maryland. “There’s a long history of doctors distrusting patient records, but there’s reason for patient distrust, too.
And with all the mobile apps and trackers available right now, people can get involved in hands-on health more than ever. “When people keep records, they have a better understanding of their own health,” Shneiderman tells Yahoo Health. “The growing number of mobile apps to track sleep patterns, weight, and the number of steps per day, the remarkable thing is that they go on to better understand their medications, diagnoses, and treatments.”
However proceed with caution. In response to Cuban’s tweets about quarterly blood-testing, Shneiderman says, “that seems extreme, and patients will demand more and more tests” that ultimately will not be helpful.
Are there pros to close monitoring?
“There may be some,” says Welch, “but, in general, we have exaggerated the benefits of this type of monitoring. And there are definitely negatives —unnecessary worry, which can’t be good for your health; subsequent investigations, some of which can hurt you; and unnecessary treatment. Remember, all of our interventions can produce harm.”
When it comes to tracking, your best bet is likely to focus on becoming well and balanced, not obsessive. “Really, we’re talking about wellness — not healthcare — and what people should know,” Shneiderman says. “It could be that people track their personal wellness, come to be better informed, and don’t need that blood test.”
Biohacking and similar monitoring doesn’t need to be a high-tech endeavor costing thousands of dollars. “One of the first things you can do is to simply write down, ‘How am I doing right now?’ Pick a number everyday, one to 10,” he continues. “You can literally figure out if you were unusually upset, angry, or so on, and then think, ‘What could it have been?’ You did something to give yourself a food craving, or become angry.” Asprey says so much of our well-being is food-related, so tracking your personal trends can help you identify triggers.
Shneiderman also tracks certain facets of personal health. For instance, he says he had a minor heart blip while running a while back, which he captured on his fitness tracker and presented to his doctor. He monitors his blood pressure at home with frequent readings, which he then brings to his primary-care physician, so she has a fuller understanding of day-to-day trends — and not just one set of numbers every few months. “Informed patients make better patients,” he says.
All the experts agree, though, that we live in a world where there’s a flood of knowledge out there — blips and beeps, apps and gadgets to alert and inform you about your up-to-the-moment health. But more is not better. “Only track what you’re going to hack,” says Asprey. “Diet matters most, sleep matters next, and then comes exercise.”
Ultimately, over-informed patients may not know the noise they need to listen to and act upon. “People should be proactive about their health – but not by looking hard for things to be wrong,” Welch explains. “They should instead focus on the positive – the activities that promote health and make you feel better now. Good food, more movement, finding meaning and helping others.
“I think it is important that people recognize that a strategy of looking for things to be wrong is not the best strategy to promote your health,” Welch says.
“Ironically, part of being healthy is not paying too much attention to it.”
So, yes: it’s a brave new world of biohacking, wellness technology, and personalized healthcare. But there may be a very fine line between staying smart and becoming obsessive. At what point is that line crossed? “It varies from person to person,” says Shneiderman.
Only you can be mindful and decide.