Tracking what your body needs

26:20But how do we get to a place where we think more of health care as preventive, like a personal dashboard to monitor our health in a sort of more holistic way? Yeah, well, we have to change in financial incentives. That's number one. What happens is people really only go to the doctor when they're ill, and so therefore they only go every few years typically. There's no reason for any health plan to keep you healthy today and that's why we practice sick care because that's when people get paid. And the one exception to this is this life insurance company, John Hancock. They have a vitality program that basically gives points if you wear smart watches and do things that keep you healthy.

27:05Walk your 10 ,000 steps, for example. And so we need more things like that because in that case, the incentives are aligned. If people live longer, John Hancock makes more money. It's a life insurance company. So they wind up making more money if you live longer and you are healthier. So that's a good thing. And so, again, they've got the financial incentives aligned. We need that for our health providers as well. that they, and in the whole system, it's pretty clear if you stay healthier, you know, you'll push off having all these chronic conditions. And hopefully the idea is for us to live long, healthy lives and then just pass away sort of all at once, but not hanging on there for the last decade of life.

27:54There are studies now that show that people live the last 11 to 15 years of their life on average with chronic conditions, meaning they're living their last decade of life unhealthy. And that's not a good situation to be in. And so I think as these technologies get cheaper and cheaper, as they get more facile, like we talked about the heart attack case, if we automatically have people's information from their devices going to their doctor's office, that would actually be much more accurate because your resting heart rate first thing in the morning is way more accurate than what's in a doctor's office.

28:31And so that stuff should just be online, sitting there when you walk in. Right now, your nurse takes your blood pressure and all these things. That can just get pulled straight in and it'd be more accurate, better data. And no more of this, well, when did this seem to go off? You could actually look at someone's heart rate information and see, wow, it looks like it went off, you know, three weeks ago or whatever. You can see it because of a jump up. So I think we can pull in information a lot better. and then the physician can make better assessments and spend less time on the routine things and spend more time on more complex things.

29:06Now, of course, we're all going to have AI agents in the future, and the physician will be working with those to help actually better manage your health. Okay. My spidey sense, my worrying radar is going off beep, beep, beep right now. I want to push back on a few of these things. Okay, so first of all, digital privacy. Who's in charge of all of this data that's being collected? And if an insurance company is using it to incentivize me, couldn't they possibly also punish me or hold a pre-existing condition against me? Yeah, well, we would hope not. You're not allowed to be discriminated against for your genome information, for health insurance.

29:46You can for life insurance, though, and employment. You're not allowed to be discriminated for that based on genetic information. My own view is that we, obviously, if people are getting discriminated against, I do think we need laws to protect that. You know, I'm a believer that in any, you know, wealthy society, which I view the United States and most Western countries to be in, that you should have some minimal level of health care for your citizens. So I would hope that that would be the case for everyone. Obviously, it isn't, but we need to get there. But even if it were the case where, let's say, someone was using your smartwatch, I'd rather know that something is off and catch it with a watch than not know it exists and die of a heart attack, for example.

30:34So we need to, you know, the information is still valuable, but as it moves and becomes more facile, we do need, I think, I would argue, laws and protect people than in those circumstances. The other concern I would have is that right now this sounds like a rich person's health care system. I mean, you know, having someone to actually give your data to, a physician or a clinician, that means that you are seeing a doctor to begin with. How do we begin to make this more accessible? Right now, this is an expensive proposition. So you're right, the way we do deep data profiling, only rich people can afford it.

31:17And getting your genome sequence and some of these other things, only people who pay out of pocket can do it. And, you know, we have a company called QBio that does whole body MRI and a pretty deep medical testing. It's$3 ,500. So a number of people can pay for that, but, you know, probably the average working class family cannot, or they'd have to save up. I do think it would save money in the long term, but it only hits a subset of people. So there I would say, yes, some people won't have access to that, but the one area where they will have access is the wearables. That's a neutralizer. So I think when you join a health plan, they should give you that smartwatch as part of the enrollment in the plan because anyone can do it.

32:04You can do it remotely too, right? You You can live in the boonies and have this data transferred to your phone. Most people do have a phone, even when they live in remote parts of the world. 60 % of the world has a phone, believe it or not, of adults. And so even in these remote places that have a phone, all I have to do is link it to a smartwatch, and you've got a health tracking system that can track a fair number of things. Again, resting heart rate, heart rate variability. Heart rate variability is kind of a new metric that's popped up that turns out to be a really great gauge of people's health.

32:37Yeah. Tell me about that because I've been hearing it. I used to think that a steady heart rate was what you wanted, but that's actually not true. Yeah, that's correct. So you have what's called your sympathetic nervous system and parasympathetic nervous systems are voluntary and involuntary systems acting. And it turns out when they intersect, you wind up, if you're healthy, you get a variable heart rate, meaning they're not exactly the same beat per minute for every beat. There's just a little bit of a difference in milliseconds. And that's healthy. You actually should be having that. And when people's health goes down, either from a viral infection, heart conditions, and we saw this in the case I mentioned earlier about the person who had the heart failure, it's a general rule, your heart rate variability drops.

33:26And so it's a relatively new measure, but it turns out to be a very, very important one. When we come back, more with geneticist Michael Snyder and how his hearing aids monitor his social interactions. Would you want them? Today on the show, tracking what the body needs. I'm Manoush Zomorodi, and you're listening to the TED Radio Hour from NPR. We'll be right back.

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35:17The whole space felt darker and angrier. Join me as I investigate the unsolved killing of 16-year-old Antonio Mays Jr. Listen to We Keep Us Safe on the Embedded Podcast from NPR. It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. Today on the show, tracking what the body needs. Stanford genetics professor Michael Snyder is a big believer in wearable technology. He regularly wears about eight devices, including four smartwatches, a few bio-tracking rings, and hearing aids that track different health measures 24-7. Snyder believes that individual health metrics tracked through these devices could bring about a revolutionary shift in how medicine is practiced.

36:08But also, it could change how we interact with each other on a daily basis. Let's go back to Michael's hearing aids. These new hearing aids, they come from a company called Starkey, which is a hearing aid manufacturer. And they basically are collecting data. We're measuring how much they're interacting and the kinds of interactions. So how much they're in conversations, for example, with others and how much they participate in this. We also measure TV time, how much they're, I suppose, on the internet by the voices announced, how much background noise is in their environment. So it captures all kinds of different information.

36:52And the goal is to try and understand what environments and how they interact with that environment will better lead to cognition because we're doing cognition surveys as we go along. So we think this is very, very valuable information. We're not violating privacy. We're not collecting information about what they're saying, but more whether they're in these conversations or not. And so we know that's important. And I think what we're going to learn from this hearing aid study is exactly what kinds of interactions are important for keeping your cognition up. So we want to know what keeps you sharp.

37:29It's the number one thing people worry about most as they get older is their cognition. They're afraid of dementia and Alzheimer's, and I don't blame them. Can we talk more about how doctors currently use data? I guess most doctors anyway. They rely on averages, right? So for example, I just got blood work done, and as long as each thing that they tested for was in the green zone, it came back as normal. Do you take issue with that approach? Population measurements, they are important. Don't get me wrong. If you're out of an individual range and you're very high on certain things, it is worth looking into.

38:08But equally important is knowing your baseline because we all have very different baselines for heart rate, for skin temperature, for all these different things. And when you go off from your health, you'll get a jump up in that. But if you're by today's world, if you're still in a normal range, nobody says anything to you. And a good example is, say your heart rate is normally 60, and suddenly your resting heart rate goes to 75, something's off with you. Whereas 75 could be very normal for other people and probably wouldn't be flagged on a population average. And I think we need to get this into medicine.

38:49There's two things that count. One is your shift from your normal baseline, and the other is population average out of range. Both of those are important. And I would argue the first one's even more important, shift from your baseline. And we can pick this up with wearables. We can pick this up with any kind of measurement, the microsampling I mentioned earlier, even your regular clinical measures. It's very important to know your trajectories. Is there ever a point, though, where all this information is too much information, that people become hyper vigilant about every little thing that their body is doing.

39:29Keith Diaz, the researcher at Columbia with whom I partnered, he says, I can't wear a smartwatch because tracking my steps makes me crazy. I'll find myself, you know, looping around my backyard to make sure I get enough steps. Where's the line? Yeah, no. Well, obviously we want everyone to be a healthy life. You don't want your devices making you unhealthy. My own view is there's no such thing as too much information, that this stuff is very, very valuable. But it's true you don't want people freaking out. Like, you know, people get their genome sequence and they're anxious about this sort of thing.

40:06You don't want them waking up every morning, oh, am I going to get breast cancer? I'm going to get breast cancer. But I'm a believer the person owns their own data. if you are willing to share it, your physician can definitely see when things are going off and you can see it too. Imagine when you go into the doctor's office and you say you're not feeling well, first thing you ask is, so when did this start? And you can almost always tell from your watch when it started. There's a shift. And suddenly you could correlate that with maybe something that happened. And in my case, when I got Lyme disease, it was picked up with a smartwatch and a pulse ox.

40:44I saw these shifts, and I knew two weeks earlier I was in rural Massachusetts helping my brother put up fences where most ticks are Lyme-infested in rural Massachusetts. I was there one day, and it's pretty clear because I was there one day. And then two weeks later, I saw the shift up. It raised a strong possibility it was Lyme disease. I never had a bullseye. But it's just the whole timing, and that turned out to be correct. It was Lyme disease. So I do think, again, this can be very, very important and valuable information. I've been learning about this concept of interoception over the last year, this idea of the body sort of indicating to the brain what it needs.

41:30I mean, I hear people who are like, I don't even know if I sleep well anymore. I look at my device, and it tells me. And sometimes I'm like, really? That's all I slept? I thought I slept well. Do we start to lose touch with our embodied sense of self when we start outsourcing all of our functions to being collected and tabulated by wearables? I would argue wearables for certain kinds of things like infectious disease, AFib. Those are really, really valuable, right? It's hard to argue with that. We have some studies running now on transplant families. There's individuals with transplants who are trying to see if anyone in the family gets ill.

42:10And if that happens, they get a red alert and they can isolate and not ideally infect the person who had the transplant. And this has worked, actually. So it's alerted people who could die if they actually got one of these respiratory virals. So I think there are situations where it's good. Now, you picked the example of sleep, which I think is one of the more interesting ones. one of my colleagues here at Stanford has run a study that shows that depending what you tell people determines how they feel so regardless of what the value is on their sleep device if you tell them they had a good night's sleep from their score even if they didn't they actually wind up functioning very well that day they do well if you tell them they had a bad night's sleep they actually don't function so well so I think there people are very influenced psychologically by the score.

43:00So maybe that is a trickier one.

43:08Earlier in our conversation, you said that continuous glucose monitors are the most important device someone could wear to keep track of their health. In an ideal world, how do you want to see people using them? Yeah, well, for one thing, I would say everybody wears one at least once a year, more if they're heading in the wrong direction, meaning their glucose out of control, it's getting worse. And they do it before they're diabetic. So prevent diabetes, keep people healthy. So we need to get them on these folks earlier. And because it's so visual, you will change your behavior in a good way.

43:47I'll tell you, when you wear one of these things and you drink a McDonald's shake, your glucose just goes through the roof and you'll think twice about drinking that shake again. And what's the danger there, just for people who are not familiar? What it's doing is it's launching a lot of glucose into your blood. It winds up, your proteins get modified. And a key indicator of this is something called a hemoglobin A1c. It's a measure of your glucose levels, and that's associated with diabetes. And technically, diabetes doesn't kill you, but diabetes is associated with everything bad, cardiovascular disease, increased cancer.

44:26And so you really want to keep your glucose levels down. And these devices, again, because they're so visual and it's real-time feedback, and I think if we get them out there, we can have a big transformation in preventing diabetes, in my opinion. And what would that look like in terms of affecting society and not having so many people who are diabetic? I think probably as teenagers, we start maybe before we start putting these on and then people would come where earlier parents knew the stuff. If I knew 40 years ago what I knew now, I would have been eating very, very differently. And I think, you know, new parents knew this stuff.

45:04They'd be a little more careful. Sugar is everywhere. So I think, you know, I am very Pollyannish. I think we can have a, you know, healthy society if we just educate people properly. Now people tend to look at this stuff as they get old because their friends are getting unhealthy and this sort of thing. And we should really be doing it much, much earlier. You know, I know when you're young, you feel like you're invincible. You're going to live forever. But I think more of these pictures of showing two people are 75, one who's all stooped over and doesn't look very good at all, and another who looks like they're ready to run a marathon and looks incredibly fit.

45:42Those are very important visuals that I think will help people become healthy and strive for healthy lives. And I think the wearables and things we've been talking about are good ways to give feedback to keep people that way, keep them motivated to stay healthy. That was Michael Snyder. He's a professor of genetics at Stanford University. You can hear his full talk at TED.com.

46:15I have to say, I am fascinated by all the data that we can now collect from our bodies and the potential for truly personalized, preventive medical treatments. But I am equally cautious about relying too much on data to the point that we begin to ignore the sort of natural cues that our body is giving us when something is wrong. So we want to end our show with an idea about exactly that, with a speaker who is asking us to simply listen. Here's a very personal story from Lizzie Rakes-Rinker from the TED stage. When you hear the term healthy, what comes to mind? What do you think of as health? So when I was in college, I was a rower and it was my entire life.

47:05Everything that I did revolved around being healthy and being an athlete. I was arguably at my physical peak. I was obviously working out all the time, but I also was a really hardcore vegan. I had this elaborate regimen of vitamins and supplements that I took every day. I carried my emotional support water bottle with me wherever I went, and I was a cliche of a healthy person. However, the reason that I started really thinking about what it means to be well is that despite being super healthy on paper, being an athlete, I felt terrible, my friends. I was having panic attacks almost every week.

47:45I had this really weird chronic pain that no one could quite figure out, and I wasn't getting my periods. I just felt off, but I was really healthy, right? I kept saying, something doesn't feel right, and I couldn't really articulate what it was. So this is a picture of me from the middle of college. And nine days before my dad took this picture, moving me into my apartment, our mom, Becky, died after a really long and hard-fought battle with cancer. And let me tell you, it kind of sucked. It is incredibly disorienting to watch somebody that you love be sick and die. It was incredibly disorienting to be going through that experience as I was a college athlete because one part of my life was completely revolved around optimizing my body and health and wellness.

48:43And I was seeing evidence every single day of that working. However, on the other side of my life, my mom did everything right. She was healthy. She was active. And she still got sick. and there was nothing that we could do about it. So because of my mom's illness and because of my experience as an athlete, I went on to make an entire career out of really exploring what it means to be healthy. So I'm gonna throw some definitions at you, okay? The first one is health. The World Health Organization defines health as not having disease in your body. So in that instance, I was healthy. Nary a toxin was getting near this.

49:22I was obsessed with being clean and, you know, doing all the right workouts, but I couldn't really articulate what was going on. And what I found in my work is that what I didn't have while I was healthy is I did not have any wellness. So holistic wellness is a trend that gets thrown around a lot. And it's rooted in this idea that we are a whole person, not just our bodies. So rather than putting all of the eggs into the physical basket, we start to look at our lives from the health of our environment. It looks at all of our circumstances, all of our lived experiences, and really takes those things into account to consider what we need.

50:01I've been working in wellness for 10 years, and I have coached hundreds of athletes, and I have seen a couple things to always, always be true. The first, from an athletic standpoint, is that if an athlete does not have a holistic, balanced life, their performance will fail. It's not a matter of if, it's a matter of when. It is incredibly hard to keep it together and to care about, I don't know, going a little faster on the rowing machine if you are waiting to find out if your mom has made it out of surgery. If you don't have a safe home life, it's really hard to perform. The other thing that I see is that we're all shitting on ourselves.

50:40I'm talking about all the things that we're like, ugh, I really should do more of X, Y, Z. And it might not even be a thing that you like. This happens to me a lot. I am really into running and people will find out this about me and come up to me and say, I should really get back into running. I used to be a big runner. I'm like, oh, what happened? Did you get injured? They're like, no, I hate running. I just really hate running. And I'm like, well, then why do you think you should be doing it? There are literally so many other ways that you can exercise, but this is what we do to ourselves. We tell ourselves we should be doing all of these things.

51:11We should be learning how to listen to our bodies. Like, what's the purpose of wellness? Is it just to lose weight? Is it just to look a certain way or to be able to go a little bit faster on the water? Or is the purpose of wellness and the balance of all of these different things to maybe, I don't know, make your life a little bit better instead of just your body? The last couple months of my mom's life, she was very frail. She'd lost a lot of weight and she couldn't drive. So I had to drive her to the grocery store. And this woman saw her from across the way and ran up to her and was like, Becky, I haven't seen you in years.

51:44You look amazing. You look so good. You're so healthy. My mom was like, I am literally dying. But this is what we do to ourselves and to each other. We assume if you look a certain way that you must be having a certain experience. And that is just not true. You cannot really tell anything about somebody's wellness or their lived experiences and their circumstances by the way that they look. And this is why we have to consider holistic wellness. And we have to start looking at our health as more than just our bodies, but everything that we experience. Those are the things that make a life. I'm going to leave you today with a quote from my favorite poem.

52:23And I said to my body softly, I want to be your friend. It took a long breath and replied, I have been waiting my whole life for this. That was Lizzie Breaks Rinker. You can see her full talk at TED.com. Thank you so much for listening to our show today. This episode was produced by Katie Monteleone, Avery Keatley, and TED Talks Daily's Lucy Little. It was edited by Sanaaz Meshkinpour and me. Our production staff at NPR also includes Matthew Cloutier, Rachel Faulkner-White, Fio Geeran, Harsha Nahada, and James De La Hosey. Our executive producer is Irene Noguchi. Our audio engineer was Jimmy Keighley.

53:03Our theme music was written by Ramteen Arablewe. Our partners at TED are Sal Khan, Logan McClure-Davda, Helen Walters, Roxanne Hylash, and Daniela Ballarezzo. I'm Manoush Zomorodi, and you have been listening to the TED Radio Hour from NPR. This message comes from NPR sponsor How to Be a Better Human, a podcast from TED. It's a show for the self-help skeptic. TED speakers explain how you can be the best you with science, thought-provoking insights, and hilarious stories. Listen to How to Be a Better Human wherever you get your podcasts. This message comes from Mint Mobile. If you're tired of spending hundreds on big wireless bills, bogus fees, and free perks, Mint Mobile is for you.

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