I recently bought a new bathroom scale that boasts about being able to measure my body composition in addition to weight. The composition breaks down percentage of fat, lean mass, bone mass, etc. Even within fat it breaks down to different types or locations of fat. The scale itself just has a simple display to show the weight. Getting the other information requires a smart phone app. The app itself shows this information but also displays details about where the measurement fits within a scale between too low and too high. The app allows you to add an objective criteria and then shows trend plots for progress toward that goal.
I was curious about how it can determine all this information from just 4 electrodes at the soles of the feet. I looked it up and found papers dating back to the early 1990s describing the technology. It has been around for while, but only recently made affordable for consumers. In context of my paying attention to these things, recently means sometime in the last two decades.
I do not think I need this information. I know what total weight range I want to have, and I am a little above that ideal range. In terms of body fat, I measure that by how well my clothes fit especially for the sizes I want to wear. I also measure my health by my abilities. I have been paying much more attention to my blood pressure, and I found that it is more manageable if I keep my weight lower.
Knowing a precise number for my fat or knowing its trend seems to me to be superfluous. However, I am a data fanatic. Now that I have the data, I want to watch to watch it. Instead of watching the numbers for measuring progress toward more healthy numbers, I want to see how the numbers change based on my recent eating, exercise, and emotional activities. I imagine that tracking these numbers over time may be a record of my hidden life that maybe I myself may not be aware.
It does not escape my attention that to use this information, I need an account on some remote server, and also that that information is probably eventually ending up in certain foreign countries. Setting aside the privacy concerns, there is probably someone studying this data both longitudinally over time and latitudinally across different demographics. I hope that this data may be useful to refine our medical practices. On an individual basis, this kind of data is probably used for managing existing health conditions. I am thinking its greater value may be to observe precursor conditions of some future diagnosis. On the other hand, maybe it is just noise.
I do not dismiss the fact that the information from this scale is basically just to entertain the user. The numbers may be broadly relevant, but that may be so broad that it telling a person what they already know. I can look in a mirror to see how fat I am. Having a number that changes from day to day is not really telling me anything important, but it is entertaining.
Once I set that up, I then set up my blood pressure machine to also upload to its smart-phone app. It has bluetooth capability, but until now I have been recording the numbers on paper with the expectation that the doctor will actually glance at some paper. I don’t think he will want to scroll through my smart phone, but maybe eventually he will be able to download the data.
This is health-related data and it has advantages of being measured in a familiar environment of the home, and measured frequently. Using affordable technologies, I can measure my body composition, my blood pressure and pulse, my blood oxygen levels, and even my own electrocardiograms multiple times a day and recorded across many months. Inevitably, there will be an expectation that a doctor will review the breadth of this data during annual wellness checks. So far it seems the doctors are resisting this demand. During a wellness checkup, the doctor makes his own measurements using his own scale, blood pressure meter, pulse-oximeter, and stethoscope. Each one of those things I can measure myself.
I imagine that their patients are pushing them to look at the entire data that they have been collecting. Succumbing to that pressure would make the wellness check more labor intensive. In effect the wellness checkup would require as much work as the doctor puts into helping with a real health issue. The new task for the doctor would be to treat the healthy.
This reminds me of the current pandemic situation with its obsession over asymptomatic carriers and the need for social distancing that is essentially a quarantine for healthy people. The medical system is treating the healthy. This tendency toward treating healthy people probably started much earlier than the pandemic. Even with the decade-old affordable care act, there was an emphasis on regular wellness checks and various screenings. The effect was to make every healthy person an active consumer of the healthcare system. The earlier alternative was for people to be passive about their need for healthcare professionals, even to the extent of trying to avoid it as long as possible.
This change from treating only sick people to treating everyone is partly what is straining the healthcare system. I realize that catching problems early will make treatment more effective and thus require less specialized care. The problem is that there is a lot more medical attention spent on the healthy and even more when there are false positive tests.
This is a cultural change that happened across the span of my lifetime. It started with a desire and goal to minimize interaction with a doctor. There may be annual checkups, but these were with doctors who were familiar with the patients outside of his practice. The earlier annual checkups doubled as a social visit. Now a doctor approaches healthy checkup as a challenge to rule out any possible looming health threat. It is as if it is not normal for someone to need medical attention.
It is curious that almost the first question asked in a visit is whether there is depression. A positive response gives them an easy win for a diagnosis, with an easy treatment of a prescription. The healthy patient has a treatable health problem in the form of depression.
The entire medical system appears to be striving to turn everyone into a patient. A good way to make high insurance premiums more accepted is to have everyone being a patient of some condition. They are getting a tangible return for their insurance premium. That is different from the earlier cheaper insurance model where the person’s goal was to not need the care. Now, everyone needs healthcare. Being healthy is a treatable health condition.
In parallel with the transformation of the healthcare system to pathologize health, there is the emergence of the personal trainer or coach in exercise gyms. The coach would help the individual reach particular goals by advising on additional exercises that the person may prefer to avoid but the coach knows is essential for the eventual goal. The coach would also advise on diet and eating habits. Good coaches have a complete or whole body approach to their clients. Their goal is the make the healthy person more healthy, or more developed physically.
The personal training is doing things that personal doctors did in the past. They advising on how to build upon the healthy state of the patient. The presence of healthy person was an opportunity to develop that health to be better prepared for what will happen later in life. This is qualitatively different than looking at each healthy patient as having something wrong that has not yet been detected.
I have not employed a personal trainer and I do not use a gym. I am merely observing the way the gym industry has matured over my lifetime. The trend I noticed is the elevation of the personal trainer. The trainers still focus on physical development, but their clients have changed from being athletes or aspiring athletes to now being anyone and everyone.
With that change came a need for the trainer to take time to understand the individual better. He no longer is able to assume that the client is trying to win a gold metal or win a fight. The coach knows enough about the person to make recommendations for changes in life patterns outside of the gym, including things like diet and eating habits.
The personal trainer or coach is doing medicine.
At some point the two trends will collide. There are too professions trying to be the primary physician of the healthy. One profession is challenging the healthy to become more developed. The other is comforting the healthy as having some undetected malady.
This discussion is related to my earlier post about the individual versus a team. I described the soloist as a person who has developed a self-sufficiency to individually complete some project. If others are helping, they are there as helpers and not as peer team members. I observed that there seems to have been a trend to value teams over soloists.
I recall this happening in cases where it was obvious that there was only one person who was key to getting a task done and everyone else was just there to help. In those cases, the term team started to come up. I recall it sounding like a good development. We were not helpers of the lead. We were team members. That means that the lead was also a team member. At that time, I would be in the helper category. Being reclassified as a team member was a promotion.
In contrast, the leader was demoted to become a team member. Being a team player requires spending time to help the other team members with their tasks. The lead is required to help those who are there to help him. This is exemplified by the mandatory daily standup meetings in scrum meetings where each person is supposed to offer their current challenges or impediments with the expectation that the other team members will assist. The challenges are in terms of completing some task that was expected from that person. Once that task is completed, the challenge is removed.
This is very different from a lead with helpers. A helper that can not help needs to find a different job. The lead’s efforts towards his helpers is in context of developing upon their existing strengths, especially if they show promise for future leadership. The leader is helping his helpers in their personal development instead of in their person tasks. This is hugely significant.
I look at my recent scale purchase and it is clear to me that it was a product from a team instead of an individual lead. I am pleased with the product. I think the team did a good job. Also, I don’t think a product like this could be possible from a solo entrepreneur. I realize that the product itself is an assembly of pre-existing technologies and products. Something like it could have been developed by a soloist with helpers. It would have been a different product.
As I mentioned earlier, the bioelectrical impedance technology for body composition has been around for decades. There were products that were sold to medical practitioners. These products were more likely developed by a lead person with some helpers.
One of the tell-tale signs of a soloist with helpers is that the user interface is hard to use. While the earlier product appealed to the medical practitioner, it took someone willing to be trained in the user interface to be able to use it effectively. Soloists tend to focus on the primary benefit. In this case, it is the technology and mathematics to convert impedance measurements into body composition percentages. The interface for connecting the probes and for reading out the data were not as well thought out. A certified professional was needed to use the tool.
I think the need for a certified user is a hallmark of a design by a soloist with helpers. The soloist typically creates something impressive enough to be sellable despite the training and labor burden it placed on the customer. The difficulty of use, or at least the right level of difficulty, gives the product an elite status. A customer buys the product for the opportunity to offer an elite service. There probably was a time when some doctor could charge a good fee to apply this technology once to a person and then prepare a manual report listing the different body composition numbers.
I think it takes a team to create a product that a consumer can use. The consumer only needs to step on a plate so that his feet covers four electrodes. To read the results, the customer only needs to glance at his smartphone where the results are combined in formatted in a large number of ways where each one is elegant and intuitive.
I wrote much earlier about the need for consumer health care appliances. At the time I was writing that I was unaware of how many appliances are currently available. Most of what was available exclusively to doctors offices or hospital outpatient rooms are now available for consumers. These devices are easy to use, and they present data that is easy to understand. There are even affordable technologies to provide health intervention, such having ventilators with oxygen enriched air.
More invasive medical technologies still require a professional setting, I think. We are doing some invasive procedures ourselves, such as the finger-prick for getting blood sugar measurements and self injections for some medications. I imagine people can set up their own intravenous lines, and I heard that this happens with soldier self-treatment in military settings. If I weren’t so lazy, I would research this more and probably find that there are contraptions that can automate even this so that all the consumer has to do is put his arm in some sleeve.
I concede that teams are important in producing consumer products. These products must require the least amount of training for the consumer to get the full value of the technology. This takes a lot of attention to each aspect of the product and a lot of attention to the breadth of capabilities and sensibilities of the broader population. Teams make this possible.
The concept of building teams have been around for a long time, but I think it has taken a couple generations for a culture of teams to mature. We now live in a world that is more comfortable with teams rather than individual leads with helpers. We are benefiting with an explosion of consumer products of technologies that once were reserved exclusively for professional use only.
In the broader sense this is a positive development. My attention tends to focus on the narrower sense of the individual. There are individual humans in a team. These individuals are living through their life trajectory. If they are anything like myself, they are interested in their personal unique development. In a team setting, they have to collaborate in the team effort. They may have an opportunity to show excellence or to hone skills on a particular sub-task, but they may get assigned a completely different sub-task later that requires completely different skills. Eventually, they may develop multiple skills but it will be in the sense of being a jack of all trades but a master of none.
There is within a man’s spirit a desire to be a recognized master of something. The opportunity for developing this mastery is very limited in team settings. There is little opportunity to focus on something specific, especially something that would be rare with high value. More significantly, there is little opportunity to work subservient to a master while learning the master’s craftiness as well as his skills.
I probably could have wrote a similar complaint a half century ago, and I think I might have. The complaint is the loss of the old model of training within some guild or profession. The training started with an apprenticeship that eventually lead to master status with the ability to run an entire shop, often at the time when the original master retires. While the apprentices are important for the success of the shop, they are not considered part of a team that includes the master as peer. The hierarchy is clear. The apprentices worked in the master’s shop. They helped make his masterworks.
For the most part, those masterworks were not intended for mass market.
The current culture shift toward team behavior has occurred over multiple generations. It may be that the younger generation is so steeped in this new attitude that they have no nagging desire to recognized for their ability to create something of their own. I know there are still examples of young people who strive and succeed as mastering some valuable trade. They tend not to be in corporate environments. The people in teams seem to have people who are content with their place in the team. More significantly, they seem to be content in staying in their place indefinitely.
Within teams, the measures and concepts of personal growth and development are very different. Within the team, the individuals are treated like a modern patient going to a doctor’s office. The goal is to comfort the team member and to hopefully prevent anything from ever ailing him. In the team environment, there is no personal trainer whose goal is to build a stronger person.
I acknowledge that the type of scale I have is probably useless for measuring actual body composition or even trending it over time. It may have no value in terms of medicine or training, but it is a technology that previously was only used by professionals and now is available to consumers. That conversion to consumer use is the main point of this post. The tangential topic of consumer health devices is something I will explore more in the future. The good devices still have to be consumer-friendly as well as affordable. The complete product will come from a team rather than a solitary master with helpers.