The first time I encountered health monitoring, there was blood everywhere. It was five years ago and I was spending Easter with some friends of mine in Wales. I came down to breakfast one morning to find our host’s thirty-something brother fiddling with a small white device beside the kitchen sink. What he was doing? “Just checking something,” he said, “Shall we check you out too?”
Unable, at that unearthly hour (9.30am on a Saturday), to spot that telltale, medical orderly usage of “we”, or to resist his manipulation of my arm, I found my fingers being splayed and my thumb pushed on to a plastic rectangle. There was a click and a metal bodkin pricked my thumb so that it bled. Before I could protest, the guy whipped out a small white gizmo and plonked my traumatised thumb on it. “Just a few seconds…” he said, then read out: “Four point two. That’s about average. I think you’ll live.” (It could have been six point eight, or fourteen point nought. I instantly forgot.)
“My thumb is bleeding,” I said coldly. “I have not yet had my Crunchy Nut Corn Flakes and you’ve punctured my flesh. What the hell?” “Well really, John,” he said, “first, you shouldn’t be eating commercial cereals stuffed with sugar, and, second, aren’t you happy to know your cholesterol level?”
I remember that smug little smile of his still today. He probably also monitored his liver activity every morning, and his stool consistency and his sperm count. He was the kind of guy who congratulated his body on behaving well and looked disappointed if he had a sore throat or a spinal twinge, as if throat and spine had let him (and, of course, themselves) down.
In those days it was called home diagnostics. Now it’s health monitoring and instead of the little white machines we have health apps. You haven’t bought one yet? Get with the programme, loser.
There are thousands of them, connected to your smartphone or attached to your wrist, offering 24-hour health checking. There’s Fitbit and Jawbone and MyFitnessPal, which can monitor your heart rate, blood pressure, blood oxygen levels, even your sleeping patterns; there’s Fitnet and Sworkit and Fitmo, which act like personal trainers, give you workout videos and “fitness schedules” and ask, sarcastically, why you chose to stop in the middle of a particularly gruelling hill-climb. There’s a really annoying one called PumpUp, a kind of Instabrag, “the perfect place to post progress photos and motivate other like-minded people to meet their fitness goals”. Can you imagine the kind of person who’d sign up to that?
There are many, many more – and some have been given the thumbs-up by the NHS.
They’re very popular in Hollywood circles, and even in the less glamorous environs of the Palace of Westminster. As The Independent reported, George Osborne was spotted wearing a Jawbone wristband in a committee hearing two years ago, presumably checking to see how his blood pressure fountained as he fielded enquiries about VAT. But now voices have been raised, asking if these devices are actually good for you.
The British Medical Journal published a debate on the things this week, in which a Glasgow GP, Dr Des Spence, eloquently warned that health apps could be bad for you. He thundered about “middle-class neurotics continuously monitoring their vital signs while they sleep”. He fulminated against “corporate medicine and the drug industry who conspire to make us neurotic”. He asked: “Will apps simply empower patients to over-diagnosis and anxiety?” And ringingly concluded: “Humanity is wasting its time on monitoring life rather than getting on and living it.”
I wholeheartedly agree with the good doctor, while noting that there’s nothing terribly new about excessive self-diagnosis. People have fretted for centuries about random twinges or irregularities and, on looking them up in, say, Black’s Medical Dictionary, concluded that they have impetigo, thrush or bubonic plague. In Three Men in a Boat by Jerome K Jerome, the narrator reads a medical journal in the British Museum and becomes convinced that he has typhoid fever, cholera, diphtheria and St Vitus’ Dance – the book was published in 1889. What’s different now is that healthy people can be alarmed, not by twinges, but by a faulty reading on their app – an electronic error – and pitched into a hypochondriachal gloom that makes their work suffer.
But Dr Spence makes an additional point that’s alarmingly zeitgeisty. He says that health monitoring will lead people to subscribe to “the unspoken yet widely held view of illness – that there are the deserving sick…and the undeserving sick. Death and disease is a lottery outside our control. So when the ‘undeserving’ sick get sick, they feel cheated”.
You see where this takes us? To the idea that those who don’t closely monitor their health “had it coming” if they fall ill, just as surely as if they smoked Capstan Full Strength all day; and to the counter-idea that those constantly on the medical qui vive somehow deserve to live for ever.
In other words, it’s a correlation of health with morality and decency, not just with the taking of exercise – a pernicious kind of body fascism that goes back to one of Juvenal’s famous Satires, which suggested that only a healthy body could produce a healthy (as in virtuous) mind.
I’m sure the users of health apps would deny any such thoughts as they pound through their fitness schedules or check their blood pressure before and after making love to their fit and glowing partners. The rest of us, though, know that look – the look on my thumb-pricking Welsh friend’s face – that says: “Oh dear, oh dear. Your cholesterol count may be low. But because you don’t care whether it is or not, you’ll never join the master race, will you?”
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