We horses walk every day
but we do not count our steps
We got some new friends here on the pasture. They are four mares and a stallion from Clover Leaf Ranch. They’re visiting us from a State in the East. They are staying over because the Clover Leaf crew are participating in the local rodeo. We horses are happy to have some new souls around.
We were excited already when the three black trucks and their horse trailers stopped next to the pasture. We couldn’t help but notice something strange, though: as soon as the horses got out of their trailers, we saw that all of the guest horses had enigmatic, black rings around one of their legs. Our cowboys seemed to be wondering the same. They soon got the answer: over on the Eastern Seaboard, horses now all have to wear them. The local “health authorities” contend that “permanent health monitoring is an early indicator for many diseases, such as hoof canker, and can thereby prevent immature equine loss of life.”
We couldn’t help but see the parallels to a recent announcement made by US Secretary of Health Robert F. Kennedy Jr., boosting budget for advertisement on the benefits of wearable technology. He subscribed to a vision in which “every American is wearing a wearable within four years.”
Are wearables really that beneficial to health? Even if yes, is it a good vision to roll them out to the entire population? A lot can be said to these questions. To begin, let’s start with the fact that the term “wearables” can refer to many different devices. Some make direct skin contact, whereas others may be tucked away in backpacks or other accessories. Also, some wearables are designed as a monitoring tool for one or more specific medical conditions, but the vast majority are not.
In what follows, we will focus on those devices that could potentially benefit broader segments of the public. Of those, positive impacts have been reported on several health outcomes. The most obvious positive effect of wearable technology is a very relatable one: having it on leads to increased physical activity. Many who have tried wearing a smartwatch will admit to sometimes having gone for a walk or for a workout because their daily steps goal or number of “zone minutes” had not yet been met (“zone minutes” are minutes at increased heart rate during exercise). They would most likely not have done the exercise had they not been nudged by the device. This effect has even been confirmed to be an effective medical treatment, as it was proven to lead to increased weight loss in obese patients in a randomized control trial. Some caution, though, that the use of wearables can lead to over-exercise. Also, wearables’ nudging to exercise more seems to be most effective in the adult population, especially the cohorts that have a medical need to improve their health, such as the obese. However, the opposite effect in has been reported in adolescents, which may be explained by their typical aversion to nudging by anything that resembles authority.
Wearables can have a positive impact on mental health, too. If the daily goals to be monitored by the wearable are realistic, then the wearable will provide positive feedback on a daily basis, which leads to increased self-confidence and a sense of accomplishment. Likewise, wearables have been shown to positively contribute to sleep hygiene. They are also promising for management of chronic disease, above all so cardiac conditions and type II diabetes. They could help diabetic patients monitor insulin levels more accurately. Moreover, they could potentially be used in the general population as an early warning system for diabetes. They can be used to monitor blood pressure and cholesterol and could thusly initiate changes in behaviour that would then supposedly lead to more healthy readings of those same indicators.
We have been gradually moving forward from benefits that are easy to grasp, and to some extent scientifically proven, into the realm of possibility: wearables “could” lead to improved health outcomes for a set of indicators and conditions. Do they, though? Two meta-analyses have addressed that question, and have arrived at very similar conclusions. They agree in unison that wearables can lead to increased physical activity. However, they report little to no significant effect on other health outcomes. One study states that “Effects for other physiological (blood pressure, cholesterol, and glycosylated haemoglobin) and psychosocial (quality of life and pain) outcomes were typically small and often non-significant.”
Another study concludes:
“There was little indication that wearable devices provide a benefit for health outcomes. […] No significant reduction was discovered in cholesterol or blood pressure. [….] Only one study examined hemoglobin A1c, and it showed a significant reduction in older patients with type 2 diabetes. The current literature evaluating wearable devices indicates little benefit of the devices on chronic disease health outcomes. Wearable devices play a role as a facilitator in motivating and accelerating physical activity, but current data do not suggest other consistent health benefits.”*
Here, we note that these studies only examine positive health outcomes. To get the full picture, some negative effects, such as skin irritation, or occasional over-exercising, should be accounted for.
Based on the above, there seems to be little reason to roll wearable technology out to the general public from a medical perspective alone. There are other reasons for concern, though. At first, questions has been raised to the accuracy of the results obtained from wearables. Some individuals report that their wearables sometimes give them “zone minutes” for elevated heart rate when they are merely walking, yet they do not get those minutes when they are exercising on a treadmill. Beyond individual case reports, there is a growing body on scientific literature that investigates the source of error in measurements from wearables, such as heart rate.
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There are further reasons for caution concerning a broad rollout of wearable devices. At first, those devices collect a lot of data on personal habits. While the wearers may think to own those data, in practice they often have no control over how those data are used. Often the small print the users have no other option but to click ‘Agree’ to if they want to use the wearable, will allow the company to use the data as it pleases, which in some cases can include selling the data to third parties. The latter becomes more questionable when the third party is a health insurance company. As such, the wearers’ behaviours can have an impact on their insurance premiums. In fact, there are already quite a few health insurers who will give premium discounts or bonuses to customers who consent to share their wearables’ data and exercise regularly. As long as this is set up as an incentive to reward individuals who are willing to share their data, there should not be an issue. Howbeit, it does not take a long leap to picture a world in which insurance companies make collection of data from wearables a prerequisite for insurance, or significantly raise premiums for customers who are reluctant to share their data. In fact, that seems the direction in which the present US Health Secretary moving. Beyond the intrusion in privacy, doing so poses clear risks: it can make certain individuals with poor health or less active habits uninsurable, as was already heeded in a 2019 JAMA Viewpoint article. Another, more insidious consequence of possible coercion to use wearable technology by insurance companies, is that it may result in the fact that most individuals will be wearing them all the time.
One drawback of individuals constantly in need of wearable technology resides in power consumption. Back in 2019, the combined power use of all computers, laptops, smartphones and other devices already equaled all energy consumed for air travel. A blanket rollout of wearable tech to the general population would be yet another addition to power load and will not help abating fossil fuel consumption if that is thought to be desirable. But power consumption is the least of possible evils that constant, quasi mandatory, use of wearables may entail.
We are entering speculative territory, but the following Gedankenexperiment is worth your while. Let’s assume everyone is using wearables. Thinking of a cashless society, wouldn’t it be convenient for authorities to have everyone’s digital identification, linked to their digital wallet of central bank digital currency, accessible from the wearable? That way, they would be able to track each individual all the time, including their spending patterns and would be able to link those to their habits. Moreover, further sensors could be built into future wearable tech. For instance, it is not hard to imagine wearables that can monitor the wearer’s alcohol or drug consumption. They may then disable access to digital currency for further alcohol consumption if the “healthy limit” of two beers per week has been exceeded. Note that Canadian health authorities have postulated such a ridiculously low limit based on work of equally low scientific quality, using cherry-picked studies and arbitrary limits on the health outcome. Yet whatever they say the “healthy limit” is, may be enforced through wearable technology. Even worse, wearables might be listening to conversations, report wrongthink and deduce a fine from the “e-wallet” in real time.
Fortunately, those nightmare outcomes are all highly speculative and we can make sure that they never happen. One step in the right direction would be to end online blanket user agreements that cover thousands of lines, but allow the user to opt out of individual clauses, as was possible in the days of printed contracts. Another step would be to enhance digital privacy protections, such that information from smartwatches and the like can not be forwarded to third parties unbeknownst to the bearer, be they government or private sector. Finally, any jurisdiction should codify that cash shall always be accepted as legal tender, regardless of the amount. Even better would be that precious metals be accepted as well as a legal form of payment. Right now, some jurisdictions are moving in the right direction, but others are not. For instance, the present Canadian liberal government plans to outlaw cash payments over C$10000, a move that only serves purposes of surveillance and none of the purported benefits of border security.
A lot of water will still flow through the Hudson and St. Lawrence rivers before we end up with either dream or nightmare scenario. Meanwhile, it is up to the customer to decide wearables’ speed of adoption. Some people like the idea of meeting daily exercise goals, which is fine. If they opt to get a rebate from their health insurance by sharing their own data, they are welcome to do so. However, we should not overstate the benefits of wearable technology, since the scientific literature does not support that either. Because the positive effect on health outcomes is rather limited, we should definitely not try to blanket roll out these devices in the general population, much less so to try and coerce them.
The mares from Four Clovers were great company while they were here. I still don’t get why they were wearing those devices on their legs, though. We had a good time together and we hiked the entire pasture up and down several times a day. We walked exactly as far as they did, though. The only difference is, that we don’t exactly know how many steps we took. But let me ask you something: does that really matter? Even in Rancher Bob’s case, if he walks seven thousand steps one day and thirteen thousand steps the next, or exactly ten thousand steps for two days straight, does that make a difference? You know the answer. So do we horses, because we have pony common sense.
FOOTNOTE
*Emphasis by Wild Horse Wisdom
One major drawback of wearables is that, like all technology, they are addictive. People become obsessed, which increases their screen time. I remember when I used to wear one, I would constantly check it during a workout to see what my heart rate was, and worry when it was clearly not measuring it right. I would get frustrated when I wore it on a hike, and it wouldn't count my steps right if I was using hiking poles. We don't need wearables to know whether we're exercising enough, or too much, or how many steps we've taken in a day. We have a much better sensor between our ears. There is a danger in thinking that if it works for some, it will work for all. I heard a story from a neighbour about how it saved someone's life because it alerted to a heart rate anomaly. I also know someone who went to an emergency room thinking they had a heart rate anomaly because of an Apple Watch alert, and it wasn't true. So while it works for some, it cannot be extrapolated to the whole population. I expected JFK to understand that. So when a government official who should know better suddenly starts saying "everyone should have one", I get suspicious about his motives.