Biometric Monitoring Systems: A Role for Monitoring & Managing Cancer?

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bimetric scoring systems, ces 2013, digital health, health, michaeal singer, Quantified Self, vitality analyzer, wellness

By Gregg A. Masters, MPH

There is considerable (and growing) attention focused on the emerging role of ‘quantified self’ tools to improve our overall health status, enhance access, improve outcomes while also lowering the total cost of health care. At the recently concluded CES 2013 Conference and Exposition a Forbes article posed the following question:

CES 2013: The Year of The Quantified Self?

If you’ve not heard of the ‘Quantified Self‘ movement you will. Their website is chock full of information and health apps for the curious and motivated. The recent blog post: Future Normal: Quantified Self Tools at the Apple Store hints at the new normal now in sight. Or as overheard several times on the Silicon Valley circuit for at least the last three years and oft credited to William Gibson:

The future is already here. It’s just not evenly distributed yet

So in this entrepreneurial frenzy and resultant sea of digital health apps all chasing the holy grail to define and manifest a healthier America, much attention has rightfully focused on the capture, reporting and sharing of meaningful biometric data to maintain health, improve health literacy, better inform doctor/patient communications and ultimately support improved health outcomes.

Against this background, now ponder the following xPrize-esque(?) question:

Imagine if you could have a conversation with your body on a cellular level. What if you asked your cells, how am I really doing? Am I healthy? Is my treatment working? Is there anything I could be doing better?

And consider the following reply:

‘The Vitality Analyzer, an FDA approved Class II over-the-counter medical device that electrically measures your health, is a simple tool that helps you answer those questions. Based on well established technology, the Vitality Analyzer measures your health collecting information about your body’s cells and then translates it to a numeric score; your Vitality Index a global health indicator.’

Sound interesting, if not a bit of an over the top claim to make? it did to me. So on the Wednesday, January 30th 2013 broadcast of ‘This Week in Oncology‘ we’ll chat with the inventor Michaeal Singer and dive deeper into the peer reviewed science supporting the ‘well established technology’ cited above.

To state the obvious, at least from the point of view of cancer patients wondering what is happening at the cellular level minimally in between those routine or non-routine follow-up visits to the oncologist, if this metric can reliability report on the underlying state of health or to the contrary tumor pathogenesis, this is the kind of ‘biomarker’ information most cancer patients would want to have.

One More Monitor

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digital health, doctors, George Sledge MD, medicine, Oncology Times, Per Chance to Dream, Quantified Self, science of sleep

By Richard Just, MD

At about 3:30 PM, I sat down in my family room, raised my feet onto an ottoman, and conked out until 5:00 PM with a copy of a medical journal in my lap.  My wife nudged me on her way out to meet a friend for dinner. When I’m sleepy, my first reflex is to check my continuous glucose monitor (CGM) for a high blood sugar level.  Nope.  95 and steady.  As they say on the beer commercial:  “It don’t get any better than this.”  I also wear (as in attached to my body, not my clothing) an insulin pump and a heart monitor. Neither of those could offer help in this situation. So I turned to my newest monitoring system: LARK (Editors Note: see Wired’s ‘How Lark Went From Idea to Apple Store in One Year‘).  According to the accompanying app on my iPhone, my “time asleep needs work”, meaning I should be averaging 8 hours of sleep per night, but I’m only getting 6.  LARK suggested I go to sleep earlier and at the same time each night.

My wife and I often drive up to L.A. for the day, a 300 mile round trip.  Lately, especially on our return trips to Escondido, I’ve been almost nodding off at the wheel.  A lot more serious than falling asleep in my family room!!  On these occasions, my wife is not so gentle in rousing me.  In June, she’d had enough and marched me down to the local Apple store to purchase a specialty device called LARK.  Because she is hearing impaired and doesn’t pick up many audible wake-up alarms, Dee Dee bought LARK primarily for the wristband which pulsates at a scheduled time.  While I also use this new silent alarm system, I am more interested in the objective data the accompanying app provides about my sleep patterns. Using this data, I’m alerted to possible corrective actions I can take to improve performance throughout the day.  I can also share this data wirelessly via Facebook or Twitter.

Coincidentally, in June, when I bought the device, Dr. George Sledge authored an article on sleep (“Perchance to Dream”, Oncology Times, June 25, 2012, pg 28), and a second article entitled “Decoding the Science of Sleep” appeared in the Wall Street Journal, August 4-5, 2012, pp 1-2.  Both document how common sleep disorders are. To illustrate, the annual number of prescriptions written for sleeping meds last year was about 60 million.  And studies have demonstrated that these pills don’t work.  Unfortunately, they can impair short-term memory so that people believe they slept better than they actually did.  So poor sleep habits “can also be a data problem” in that the medicated individual can’t really remember how well or poorly they slept.  Devices like LARK can collect this information for us, and supply analysis for possible solutions.

Before you can designate something as abnormal, it has to deviate from what is considered normal. A. Roger Ekirch, a Virginia Tech history professor, spent 20 years researching sleep and provides the seminal work defining “normal sleep”.  He found that, until about 200 years ago, our normal sleep pattern was divided into 2 phases:  the “first sleep” started just after sunset and lasted until just after midnight, when the person would wake up for about an hour, then fall back into the “second sleep” ending with the rising sun.  The time between the two episodes of sleep was spent reading, praying, contemplating dreams or having sex.  This normal sleep pattern was totally altered by Thomas Edison and the electric light.  The result is that about 20% of our general population has some type of sleep disorder.  We’ve become a “wired and tired” society.

Dr. Sledge estimates that 45% of cancer patients have insomnia.  Some are afraid to fall asleep as they might not wake up (“somniphobia”).  Sleep disorders tend to be intertwined with other problems, especially fatigue, depression, and pain, “making it hard to tease out cause and effect.”  For example, I saw a patient today with multiple myeloma who said his main complaint was fatigue.  On further questioning, he was taking longer naps during the day because he didn’t sleep well at night, sometimes taking an Ambien.  When this didn’t help, his primary care physician tried Lunesta, which didn’t work at all.  Turns out he wasn’t sleeping because his Velcade-induced neuropathy only bothered him at night.  Fortunately, this patient has a good memory and an attentive wife, who happens to be a nurse.  So we were able to figure out the problem without a device like LARK. But most situations are not this straight-forward, and data-driven solutions can be quite beneficial.