June 21, 2012

BECAUSE EVERY DEVIATION FROM "THE NORM" MUST BE ILLNESS:

The Measured Man: Larry Smarr, an astrophysicist turned computer scientist, has a new project: charting his every bodily function in minute detail. What he's discovering may be the future of health care. (MARK BOWDEN, July/August 2012, The Atlantic)

When Socrates exhorted his followers, "Know thyself," he could not have imagined an acolyte so avid, or so literal, as Larry. You've heard of people who check their pulse every few minutes? Amateurs. When Larry works out, an armband records skin temperature, heat flux, galvanic skin response, and acceleration in three dimensions. When he sleeps, a headband monitors the patterns of his sleep every 30 seconds. He has his blood drawn as many as eight times a year, and regularly tracks 100 separate markers. He is on a first-name basis with his ultrasound and MRI technicians, who provide him with 3-D images of his body, head to toe. Regular colonoscopies record the texture and color of his innards. And then there are the stool samples--last year Larry sent specimens to a lab for analysis nine times.

Larry is a mild, gentle soul, someone generally more interested in talking about you than about himself. He does not go out of his way to get your attention, and nothing about him is remotely annoying or evangelical. But if you show an interest in his project and start asking questions--look out. Beneath the calm and the deference, Larry is an intellectual pitchman of the first order. His quest to know burns with the pure intellectual passion of a precocious 10-year-old. He visibly shudders with pleasure at a good, hard question; his shoulders subtly rise and square, and his forehead leans into the task. Because Larry is on a mission. He's out to change the world and, along the way, defeat at least one incurable disease: his own. (More on this in a moment.)

Larry is in the vanguard of what some call the "quantified life," which envisions replacing the guesswork and supposition presently guiding individual health decisions with specific guidance tailored to the particular details of each person's body. Because of his accomplishments and stature in his field, Larry cannot easily be dismissed as a kook. He believes in immersing himself in his work. Years ago, at the University of Illinois, when he was taking part in an experiment to unravel complex environmental systems with supercomputers, Larry installed a coral-reef aquarium in his home, complete with shrimp and 16 other phyla of small marine critters. It was maddeningly fragile. The coral kept peeling off the rocks and dying. He eventually discovered that just five drops of molybdenum, a metallic element, in a 250-gallon tank once a week solved the problem. That such a tiny factor played so decisive a role helped him better grasp the complexity of the situation. And as he fought to sustain the delicate ecosystem in his tank, he developed a personal feel for the larger problem his team was trying to solve.

Today, he is preoccupied with his own ecosystem. The way a computer scientist tends to see it, a genome is a given individual's basic program. Mapping one used to cost billions. Today it can be done for thousands, and soon the price will drop below $1,000. Once people know their genetic codes, and begin thoroughly monitoring their bodily systems, they will theoretically approach the point where computers can "know" a lot more about them than any doctor ever could. In such a world, people will spot disease long before they feel sick--as Larry did. They will regard the doctor as more consultant than oracle.

Not everyone sees this potential revolution as a good one. Do people really want or need to know this much about themselves? Is such a preoccupation with health even healthy? What if swimming in oceans of bio-data causes more harm than good?

"Frankly, I'd rather go river rafting," says Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, and the author of Overdiagnosed: Making People Sick in the Pursuit of Health. "Data is not information. Information is not knowledge. And knowledge is certainly not wisdom." Welch believes that individuals who monitor themselves as closely as Larry does are pretty much guaranteed to find something "wrong." Contradictory as it sounds, he says abnormality is normal.

"It brings to mind the fad a few years ago with getting full-body CT scans," Welch says. "Something like 80 percent of those who did it found something abnormal about themselves. The essence of life is variability. Constant monitoring is a recipe for all of us to be judged 'sick.' Judging ourselves sick, we seek intervention." And intervention, usually with drugs or surgery, he warns, is never risk-free. Humbler medical practitioners, aware of the sordid history of some medical practices (see: bloodletting, lobotomy, trepanning), weigh the consequences of intervention carefully. Doing no harm often demands doing nothing. The human body is, after all, remarkably sturdy and self-healing. As Welch sees it, "Arming ourselves with more data is guaranteed to unleash a lot of intervention" on people who are basically healthy.

Not to mention creating an epidemic of anxiety. In other words, the "quantified life" might itself belong to the catalog of affliction, filed under Looking too closely, hazards of.

In that sense, the story of Larry Smarr might be less a pioneering saga than a cautionary tale.

Posted by at June 21, 2012 5:22 AM
  

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