Does wearable technology have a place within modern medicine?

Currently healthcare in the UK can be seen as being quite inefficient as shown by the frequent headlines of the NHS regarding understaffing, a lack of appropriate equipment and hospital beds. However, the situation of the NHS is made worse by the fact that the UK has a growing and ageing population and so the strain on the NHS may become even worse in the future. There will be greater demand for hospital beds, equipment and doctors. At the moment, these issues are being tackled in different ways. An example is the long term plan made by Theresa May in January 2019 focusing on prevention and early detection. This involves £20 billion being spent on schemes such as healthy living programs.(8)  Prevention is an important word as it could perhaps be a solution to not just the stress faced by the NHS but healthcare systems all over the world. This is because at present, healthcare systems are involved in “sick care” which involves doctors spending their time on treating diseases once they appear or have reached a point where they have become so bad that they have to be treated. However, this becomes an issue when the demographic of a country is like the UK’s as the susceptibility to disease will be greater and so the healthcare system will become slower and less efficient.  On the other hand, prevention would help to reduce waiting times and the need for equipment and may even help to increase the quality of healthcare. As wearable technology is becoming more sophisticated, prevention is becoming a more feasible option.

In “A review of wearable technology in medicine. Journal of the Royal Society of Medicine” by Iqbal, Mohammed & Aydın, Abdullatif & Brunckhorst, Oliver & Dasgupta, Prokar & Ahmed, Kamran, many potential applications regarding these devices within medicine were stated (4). For example, they can be used as sensors in order to monitor heart rate, respiratory rate and can even give ECG’s with a very high accuracy and sensitivity. The source can be seen as credible as the authors themselves are doctors who have or are studying at King’s College London and Queen Mary, University of London. Their review is also credible due to the fact that it remains neutral; its aim is to look at the current evidence available regarding wearable technology and coming to and informed decision about their utility. They look at the advantages of such devices as well as their limitations; mainly the lack of randomized control trials to measure the true benefit of the devices. The review received information from 29 different sources. As the authors have used a large number of references, it can further strengthen their credibility as their judgment would not be biased as they have taken into account many viewpoints and ideas.

The main applications that the authors focus on in their review are the uses of wearable technologies for providing medical training to medical students, as biosensors to continuously monitor vital signs such as heart rate and core body temperature and to support patients who are partaking in rehabilitation programs. The authors however do show that there is not much background research into the use of wearable technologies as they demonstrated the lack of literature behind it to support the benefits it can provide. Furthermore, they talk about how some forms of wearable technologies such as headsets have issues with being too visible and uncomfortable for patients in public.

Another research paper that looked into wearable technologies was one called “Wearables in Medicine. Advanced Materials. “(2018) by K. Yetisen, Ali & Martinez Hurtado, J L & Ünal, Baris & Khademhosseini, Ali & Butt, Haider.(3)  The authors in this paper did not just focus on monitoring or detecting diseases with wearable technologies but they also focused on treating the disease once its symptoms appeared to become worse. This involves using a close looped system that uses biosensors (which detect the physiological and/or pathological changes) and wearable technologies which uses the information given by the biosensor to provide an appropriate response in order to minimise or reverse the initial change. There are many diseases that can be tackled using this system. These include diabetes, Parkinson’s disease and epilepsy. The paper also looks into how the information that biosensors receive can be routed to a phone or tablet through a Wi-Fi, 4G or 5G network allowing the patient and health professionals to continuously monitor the issue at hand. However, drawbacks with the use of these technologies were stated. These included patient data safety, inefficient usage of energy, high costs and frequent replacement and calibration.

The paper itself seems to be very reliable. This is because the authors work or have worked in departments such as chemical engineering, material science and engineering and bioengineering in universities such as the University of California and Harvard University. Therefore, the authors would have sound knowledge regarding how the wearable technologies that they talk about work and their applications.  Furthermore, the purpose of this article is to look at the current situation regarding wearable technologies and its future implications in order to provide and informative read for the reader. It covers both the benefits and the drawbacks of the use of these technologies at the moment and the future showing that the authors have a neutral viewpoint throughout their article. They do not seek to promote any of the devices they have mentioned. The authors have also used a very large number of resources (258) in the making of the article.

What distinguishes wearable technologies from most other forms of technology is the fact that they are very versatile. They are able to diagnose diseases very accurately based on stimuli such as sweat and temperature as well as being able to treat these diseases to the correct extent through the release of the correct dosage of drugs. This can potentially change the way medicine operates in the future because at the moment, if a person feels as though they are suffering from a specific disease, they would need to go to the GP to be tested and diagnosed. However, this person could then be referred to the hospital to undergo further testing or scanning. All of this is very time consuming especially today where there is a huge demand for health services from the general public. On the other hand, with the advancements in technology, biosensors in wearable technologies are becoming and will become more accurate. As wearable technologies can send the information that they have received from a person’s vital signs or physiology to devices such as a smartphone, people will be able to get access to data regarding their health straight away. It is not just the person who could receive this data, it can also potentially be their GP or doctor who can have access to their medical history. This can be very useful to the patient as they will be able to instantly know if there are any problems and as the doctor can also access their data, the person can receive information and advice regarding their issue allowing them to have a plan about how to best manage their situation. Therefore, the patient may not experience worsening symptoms of the disease that they may be suffering as they can take action straight away. It would also mean they are more likely to completely eliminate the disease. Furthermore, wearable technologies can alleviate the strain placed on the healthcare services such as the NHS and increase their efficiency as the demand for doctors in order to diagnose and treat a disease will be reduced. In addition, the need for equipment in order to diagnose certain diseases would also decline meaning that the money spent by healthcare services to provide them will be reduced. This would mean that there would be more money that can be spent on other areas of healthcare which need more spending.

Wearable technologies can not only be helpful to patients but also doctors themselves due to the fact that certain forms of wearable technology such as headsets can be used alongside virtual reality in order to provide a controlled environment for medical students or doctors to practice in. This can prove to be very important in improving the quality of healthcare in the future because at the moment, medical students or junior doctors are only able to carry out certain procedures due to their lack of clinical experience. However, although it is understandable that this is done to ensure that the patient gets the best treatment possible; this may mean that the healthcare system is not as efficient as it could be. There is also the issue of how doctors in senior positions cannot fully devote the time to run through what a  junior doctor should exactly do to treat a patient as they may be busy treating a different patient who is in a more severe condition. Another common problem is the fact that junior doctors are likely to not get the full exposure of all the possible scenarios that could occur within their medical career and so this could potentially cause problems when these doctors are faced with new scenarios as they are likely to not be adequately equipped to deal with them. Simulation based training can tackle all of these problems as the person being trained can have access to many different simulations which can be repeated by the user if more practice is required(5). In addition, an “immediate automated feedback” (4) is given at the end to the user regarding their performance. This feedback is often based from experienced doctors and so it can prove to be invaluable to trainees.  From an ethical point of view, virtual reality can therefore be seen as a benefit to medicine as there will be less medical errors carried out on patients which could be life threatening. This would also have the economic benefit of reducing cost to healthcare services as patients would spend less time in hospitals due to medical error.

However, a key issue with using wearable technology is the fact that a huge amount of data is generated (3) as they are continuously monitoring the body’s physiology and/or releasing drugs. This is a problem especially if a lot of people in the world are using wearable technologies even if it for non-medicinal purposes as all of this data would need to be stored. The issue is that companies that store data through storage servers need to make revenue otherwise there is no point in running the business in the first place. However, in order to make that revenue, they will need to sell the data that they have to other companies which can then use this data to send users of wearable technologies advertisements aimed specifically for them. If the data being sent to companies that send advertisements involves medical information of various patients, then the confidentiality of these patients will be at risk. Patient confidentiality is one of the key principles underlying medicine and so by companies releasing sensitive information to other companies, this may mean that patients would lose trust and faith in wearable technologies and may stop using them completely.

In conclusion, wearable technologies do have a place within medicine.  This is because their wide range of applications within medicine such as diagnosing and treating various diseases ranging from dementia to diabetes as well as being used in training enables them to have widespread implications within the field of medicine. These changes are beneficial overall as they enable patients and doctors to be able to react to complications as soon as they arise rather than later helping to prevent diseases from developing. This can be helpful for the NHS as problems that arise from old age such as osteoporosis can be detected and treated earlier allowing the health of the elderly population to improve or at least show a slower decline. This would not just apply to the NHS but other healthcare services as well.  Prevention of disease and complications are also likely to arise from the fact that doctors can be trained more effectively by using head mounted displays. The areas that doctors can be trained in are immense ranging from surgery to diagnosis. This can help to reduce the number of medical errors made during clinical procedures causing the number of deaths caused by this factor to be reduced. This can be seen as being very significant especially in countries where medical error accounts for a huge number of deaths. For example, in USA, medical error is the third leading cause of death.(7)  Furthermore, even though there are issues with data safety, there are potential solutions which can be used to solve them. For example, manufacturers can be” given fines of up to £500,000” and can face “brand damage” “if breaches in data protection legislations” are made (6). This can act as an incentive for service providers to ensure that their customers’ personal data is protected. As wearable technologies become even more widespread, there is likely to be more legislation in the future regarding personal data from these devices in many different countries around the world and so this may also help to ensure that the patients’ data is even more secure.

References

(1)https://www.researchgate.net/publication/305442998_A_review_of_wearable_technology_in_medicine

(2)https://www.researchgate.net/publication/271966629_Virtual_Reality_for_Medical_Training_The_State_of_the_Art

(3) https://www.researchgate.net/publication/325714213_Wearables_in_Medicine

(4)https://www.researchgate.net/publication/326661913_Wearable_Technology_in_Medicine_and_Health_Care

(5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195067/

(6) http://www.wearabletechnology-news.com/news/2015/sep/10/where-law-stands-wearable-devices/

(7) https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html

(8) https://www.bbc.co.uk/news/health-46777387

Photo Credits due to: https://www.cctnews.com/wearable-technologies-relationship-medical-services/

Lavan Suthaskaran