THE INTERNET OF THINGS
The week of January 4, 2015
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Cyberchondria and the downside of connected healthcare

By Mike Wehner

It’s a totally normal day, then suddenly you feel a painful twitch on the side of your head. How odd. You can’t remember ever feeling that before. It was only there for a moment, but it consumes your thoughts until you finally decide to see if it’s ever happened to anyone else.

You grab your smartphone and start poking around in the vast catalog of medical knowledge on the WebMD app and come across something that sort of sounds kind of like what you just experienced, but it’s usually accompanied by lightheadedness and nausea.

You’re not lightheaded are you? No, but you did feel a little bit dizzy when you stood up earlier. On to the rest of the symptoms.

Poor sleep? Your Fitbit says you tossed and turned a lot last night. Rapid heartbeat? Your Microsoft Band says you’re approaching 90 beats per minute right now.

That seals it: You have a brain tumor.

Or do you?

Medical anxiety goes high-tech

Take off the Microsoft Band, unclip your Fitbit, and set your iPhone on the table. Suddenly that peculiar two-second head cramp is nothing more than a one-time anomaly. You weren’t sick, but technology—and your mind’s tendency to search for the worst possible outcome in order to prepare itself for disaster—made you think you were.

This is what doctors have long despised about the Internet, and it’s what they’re starting to regret about the Internet of Things as well. This technology-fueled medical anxiety is such a problem for doctors that they’ve given it a name of its own: cyberchondria.

Like hypochondria, cyberchondria is simply a more elegant way of saying “it’s all in your head”—only in this case the people self-diagnosing are using tenuous data gleaned from the Internet and our ever-connected gadgets to support their hypotheses.

In a 2008 study by Microsoft, nearly 25 percent of those surveyed said that information they had received via the Internet made them concerned enough to schedule a doctor’s appointment, even if the situation itself was not serious enough for them to have sought professional advice from the start. Of those individuals, nearly 75 percent said that a single appointment was all it took for them to realize their “worries were not justified.” That’s a whole lot of not-actually-sick people going to the doctor thanks to something they saw online.

And the more things we connect to the Internet, the worse it gets.

The more things we connect to the Internet, the worse it gets.

“Wearable devices overall are terrific for empowering people to take charge of their health, and the future is very promising,” Dr. Kelli Harding, assistant professor of clinical psychiatry, told the Kernel. “The flip side is that taken to an extreme, devices can escalate health anxiety. Some people find themselves trapped watching numbers constantly and feeling out of control checking their devices.”

Instead of simply having to worry about patients spending too much time on WebMD or MayoClinic.org, the Internet of Things has spawned a whole new kind of anxiety thanks to smart devices and wearables that provide active and potentially worrisome feedback in realtime.

“For people prone to health anxiety, sometimes less functionality is more,” Dr. Harding said. “For instance, a device that tracks exercise or sleep might be less anxiety-provoking than one that also continuously monitors heart rate or blood pressure. In healthy people, heart rate and blood pressure normally fluctuate throughout the day. If you are otherwise feeling well, it’s key not to over interpret the numbers.”

A shot in the dark

There’s also the matter of accuracy. Virtually everyone who has put the Microsoft Band through its paces has come away with the claim that its heart rate monitor is simply… bad. The readings swing wildly and tend to be way off from the numbers shown by chest-worn devices—the most accurate consumer-level option. One reviewer even found a whopping 74bpm deficit in the Band’s readings.

The Moto 360’s heart rate monitor doesn’t fare much better, and in only the most perfect, motionless conditions will it provide anything close to an accurate reading. These are horribly inaccurate health tools, yet they are used as bullet points for would-be buyers to cling to.

“Frequent monitoring of heart rate and blood pressure for people who feel otherwise well is often unhelpful, especially if the reading is wrong,” Dr. Harding said. “For instance, if your device says you have a heart rate of 20 beats per minute, and you are still walking and talking, odds are there is an error.”

Three of the four apps tested failed to detect melanoma in 30 percent or more of patients.

Motorola, Microsoft, and any other company that provides nonprofessional medical information are always quick to slap on a disclaimer to avoid any actual legal implications, and none of them would ever claim to be as accurate or reliable as a real medical professional.

Even WebMD—the service that has given so many cyberchondriacs the fuel to continue guessing—has a note on every single one of its countless pages that states the site “does not provide medical advice, diagnosis or treatment.” And yet, that’s the one and only thing most people use WebMD for.

Misdiagnosis

“Don’t buy. Apple should screen these apps more before allowing people to buy them,” says one user of the iOS and Android app SkinVision, which claims to be able to identify whether a mole on your body is potentially dangerous or not. “I took three photos of the same mole,” the review continues, “one came back as ‘low risk,’ the second ‘medium risk,’ and the third ‘high risk.’”

The app itself is visually appealing, and its App Store description says it’s partnered with “leading melanoma clinics in Germany, the Netherlands, and the U.S.” Unfortunately, the only thing it seems to be able to accomplish is spitting out false positives with alarming frequency.

“Taken to an extreme, devices can escalate health anxiety. Some people find themselves trapped watching numbers constantly and feeling out of control checking their devices.”

A 2012 study by a team of five doctors and two students at the University of Pittsburgh Medical Center put similar skin-cancer-screening apps to the test to see just how accurate they actually are, and the results weren’t pretty. They showed that three of the four apps tested failed to detect melanoma in 30 percent or more of patients.

Not surprisingly, the single app that performed respectably actually forwards its images to actual doctors for analysis, rather than relying on an algorithm to detect abnormalities.

At the end of the day, our ultra-connected gadgets do—at least in theory—more good than harm. The vast majority of those who use the Internet of Things to track their health won’t find themselves wringing their hands over what their Apple Watch, Fitbit, or smartphone says about their bodies. But for those who are a bit too trusting of what medical feats our everyday technology claims to be able to pull off, the worry will never cease.

As Dr. Harding put it, “The devices, after all, don’t yet measure the anxiety they can generate.”

GIF by J. Longo