Geeky and hypochondriac business travellers can only rejoice: connected health is going like hotcakes. In a recent study, the French National Authority for Health (Haute Autorité de Santé) counted nearly 50,000 applications in France alone, noting that "new apps are appearing every day". This new approach to health and well-being is based on everyday objects that communicate via Bluetooth or WiFi with smartphones, and have gone into high-tech mode. These include, first and foremost, smart scales that track excess weight for diet addicts and monitor body mass index, one of the key indicators of cardiovascular risk. In the same 'healthy' spirit, watches and bracelets, riding on the wave of 'wearable devices' spurred on by the Apple Watch, calculate the calories burned based on the number of steps taken and floors climbed during the day, not counting those taken in lifts. The most advanced devices even go so far as to analyse phases of rest, so that you can wake up gently as you emerge from a paradoxical sleep phase.
These objects, with their highly sophisticated design, have become veritable personal coaches, guaranteeing a healthier lifestyle in our busy daily lives. But alongside the wellbeing and prevention aspects of connected health, it's the purely medical aspects that are also set to be revolutionised. The analysis tools that patients used to find in their doctor's surgery - electrocardiograms, blood pressure monitors, blood sugar meters, pulse oximeters, etc. - are now mobile and connected, transferring their results instantly to smartphones. Business travellers suffering from chronic illnesses can easily slip these devices into their suitcases for self-analysis and continuous monitoring of their condition. "I'm a good example of someone who is predisposed to heart disease: I'm not very physically active and I clock up hundreds of thousands of miles every year on business trips. Connected objects will enable me to monitor my behaviour while encouraging me to take positive action", says Stephen D. Pierce, who is in charge of developing medical tools for the IBM Group.
"Éric Sebban, founder of Visiomed, a company which, with its BeWell Connect solution, offers a kind of 'virtual doctor' embedded in smartphones, comments: "Everything is contributing to the growth of connected health. On the one hand, medical devices are becoming smaller. On the other hand, people have a real desire to take control of their own health". In this respect, 56% of the people surveyed last year by PriceWaterhouseCoopers believed that connected health tools could increase their life expectancy by ten years.
Hopes, but also fears
Is high-tech health the miracle recipe for enabling everyone to live, work and travel with a clear mind and healthy bodies? In its white paper on e-health published in 2015, the Conseil national de l'Ordre des Médecins notes that "connected health applications and devices can help improve patient compliance with prevention and lifestyle advice, as well as care protocols". Accustomed to trusting their smartphones to remind them of their every appointment, users have no trouble following their advice when it shows them that they need to lose a few kilos or when it warns them by text message that it's time to take their medicine.
They trust them completely. Too much, perhaps. Because the e-health revolution is raising as many hopes as fears. Regulation has been slow to keep pace with the growth of this fast-emerging sector, even though some observers such as the French health authority (Haute autorité de santé) and the start-up Dmd Santé are now trying to sort the wheat from the chaff between apps that are useful to public health, those that are mere gadgets or, worse still, those that are downright dangerous.
It is indeed difficult for a non-professional to identify the merchants of the temple in this vast nebula. And yet there are some. Studies have shown, for example, that certain applications offering skin cancer screening via photos taken by smartphones could classify images of melanomas as nothing to worry about, thereby delaying rapid treatment, which is synonymous with a cure in almost all cases. For its part, a test carried out in 2014 by the 'Science & médecine' supplement in the daily Le Monde observed differences in measurements of 25 % between different connected bracelets, with all the risks of over-physical activity that this entails.
As well as the dubious reliability of some solutions, their ethics are also being called into question. In its white paper, the Ordre des Médecins warns against "the consequences of the economic model underlying connected health, which is based on the valuation of data." It describes how "in the United States, when the Federal Trade Commission studied twelve health and fitness apps in spring 2014, it found that they were distributing data to no fewer than 76 third-party companies!" Indeed, many players are extremely interested in all the information contained in health apps; whether advertising agencies and companies to place their products, governments to monitor health insurance fraudsters or insurers to better assess their risks.
This Big Data-Big Brother version of health could, who knows, go so far as to influence everyone's lifestyle and way of being. Could mutual and health insurance companies, inspired by car insurers who have developed "pay as you drive" contracts, one day move towards "pay as you walk" solutions, based on physical activity and a healthy lifestyle? This future is already happening in the United States. Oil company BP has offered to fit several thousand of its employees with FitBit wristbands to measure the number of steps they take each day. The somewhat paternalistic approach was not in fact intended solely to support the good health of its employees. Its main aim was to reduce insurance costs, with those who took more than a million steps a year being rewarded with discounts on their health insurance policies.
Great application
While it is still difficult to foresee the major changes that will be brought about by connected health, one thing is certain: Apple, Google, IBM and others will play a key role in its future. For one thing, through their application shops, Apple and Google distribute all e-health solutions. But the field is also an ideal Trojan horse for their connected objects. So, after a mixed start, the Apple brand is clearly positioning its second-generation Apple Watch as "the ultimate object for healthy living". At the same time, the latest version of iOS, the iPhone operating software, includes a 'super' application that brings together all the user's 'fitness' and 'health' information - their medical records, for example, but also data sent by third-party apps and connected objects - in four areas: activity, nutrition, sleep and, in a Zen spirit, mindfulness. This last feature is linked to the Breathing app on the Apple Watch, which invites its wearer to take deep breaths, although these relaxation sessions are paradoxically disconnected, since the watch deactivates the sound of certain notifications during this time.
However, the involvement of all these promoters of a new high-tech world goes far beyond well-being solutions. With their ability to analyse billions of pieces of data, these giants intend to play a major role in public health. While IBM is using the artificial intelligence of its Watson supercomputer to conduct research in partnership with some fifteen hospitals, Microsoft has teamed up with French medical imaging start-up Median to develop new methods for detecting and diagnosing cancers.
Another example is Apple's ResearchKit platform, which enables healthcare establishments to launch very large-scale studies using a simple app. At the end of the summer, the Mountain View company formed two joint ventures, one with Sanofi, the world's number two diabetes treatment company, and the other with GlaxoSmithKline, which is working on miniature devices capable of modifying nerve messages. The 'big pharmas' need not tremble in the face of the GAFAs' grand ambitions in the world of healthcare.
At least, not yet.
Stimulating activity physics
Many connected watches and bracelets are encouraging people to follow the WHO's recommendation of 10,000 steps a day for good health. These include Apple, of course, but also high-tech wellbeing pioneers such as FitBit, Jawbone and Withings, GPS technology leaders such as Garmin and Tom Tom, and Nike in a more sporty version. Their most advanced solutions offer more or less the same functions: pedometer, heart rate sensor, sleep monitoring. In the event of prolonged inactivity, they remind you of the day's objectives!
Having a doctor in your pocket
The free Citizendoc offers detailed questionnaires to help make an initial diagnosis and guide you towards the most appropriate treatments. Based on 17 medical devices for day-to-day disease monitoring, the BeWell Connect goes one step further. If the user subscribes to the Check-up functionality (4.90 e per month), they can access a virtual doctor who bases his analysis on questionnaires containing 250 emergency diagnoses and 670 general medical diagnoses. If necessary, a platform of real doctors can be contacted.
Relieving discomfort back
A number of solutions have been developed to tackle the pain of the century - the aching back caused by hours of flying or sitting in meetings. Among them, the Lumo Lift sensor tracks movements to help correct the user's posture. For its part, the Bluetens electrostimulation-based medical device offers around a hundred programmes created by physiotherapists. Drawing on its expertise in the rehabilitation of neurological disorders, Hocoma has developed Valedo, with around fifty fun exercises based on 17 corrective movements.
Monitor the diabetes
This is the condition that is currently the focus of most research. While we wait for the miracle solution that, at the same time, no longer requires a drop of blood to be collected to analyse blood glucose levels and injects the right dose of insulin into the patient, there are a number of connected glucose meters, such as iHealth Smartlinked to the iHealth Gluco Smart app, or MyGluco from Visiomed.
Finding the right interpreter ailments
How do you say Doliprane in Chinese or Hindi? Created by a French pharmacist, the Convert Drugs has a database with almost a million trade names of medicines and 8,000 generic molecules. It can be used to find the equivalent of a treatment in over 200 countries. The free version is limited, but there is also a Premium version (€7.99).
Check the voltage
Cardiovascular accidents account for a significant proportion of medical evacuations, according to International SOS. To monitor these risks, there are a multitude of connected blood pressure monitors on the market, linked to smartphone apps such as BeWell MyTensio from Visiomed, the v2 Tensiometer from Withings or iHealth Feel. Even more advanced, there are high-tech, ultra-lightweight electrocardiograms such as the BeWell my ECG and iHealth Rhythm.
Also in this dossier: Advice: Guillaume Marchand, co-founder of DMD Santé
