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This is part of the background information by Sylvia Engdahl for her science fiction novel Stewards of the Flame. If you don't see a menu on the left, please click here and then on "Remote health monitoring."

Remote Health Monitoring Is Already Here

While I was writing Stewards of the Flame I had no idea of the extent to which remote health monitoring is already being developed, or that monitors now merely wearable will be implantable very soon. Probably the least credible premise in the novel is that in a time when we have starships, these won't be used just as much on Earth as in a colony that carries medical control to excess.

There are many legitimate uses for such monitoring. It will be invaluable for people who live in remote locations, or are too ill to visit medical offices easily, or lack transportation -- in fact, it may eventually be less costly than office visits even for people physically able to make them. And enabling the elderly to stay in their own homes instead of nursing homes is an indisputably desirable goal.

So the coming widespread availability of this technology raises troubling questions. People with chronic illnesses will want it. Ironically, I have recently developed a heart rhythm problem that makes me feel I would benefit from remote monitoring myself, especially since it's indeed difficult for me to make office visits. Most certainly I don't want to end up in a nursing home in the future. Yet it's likely that once remote monitoring becomes common, people who are healthy will want to be monitored just in case some illness should develop later -- one of the articles cited below says they do even now! And that would be a large step toward the kind of society portrayed in the story; it's all too easy to imagine the voters deciding that everyone ought to be monitored "for their own good," just as they've passed laws forcing everyone to wear seatbelts.

Furthermore, once a person chooses to be monitored for a specific medical problem, where does it end? I don't want well-meaning healthcare professionals checking up on how my body functions and how I live my life; I want treatment only for conditions I have personally decided that I can't put up with. Most of the discussion about privacy in connection with medical technology centers on whether the data can be made secure against unauthorized dissemination. But I want privacy from doctors, too, except with respect to problems for which I've intentionally sought help.

This issue is particularly serious in the case of very old, or very ill, people who prefer to die naturally rather than on life support in a hospital. In the novel Jesse remarks that such people often refrain from doing anything about terminal illness: "That's how my great-granddad went, and nobody questioned it, and what he didn't tell the doctors was left unsaid." But if such people are monitored earlier when they do want treatment, will there be any way to stop? Or will the ambulance automatically come for them, just as in the story? We are a lot closer to that situation right now than even I used to think.

Here are some links to information about remote health monitoring.

Clever Toilet Checks on Your Health, CNN.com, June 28, 2005. "The 'Intelligence Toilet' System, created by Japan's largest toilet company, Toto, can measure sugar levels in urine, blood pressure, body fat and weight." It is now on the market.

Japanese Masters Get Closer to the Toilet Nirvana, New York Times, October 8, 2002. '''You may think a toilet is just a toilet, but we would like to make a toilet a home health measuring center....We are going to install in a toilet devices to measure weight, fat, blood pressure, heart beat, urine sugar, albumin and blood in urine.' The results would be sent from the toilet to a doctor by an Internet-capable cellular phone built into the toilet."

Bathroom Innovation, Trends in Japan, July 26, 2005. "The aim of putting all this technology into the Intelligent Toilet is to improve quality of life by keeping a continuous check on symptoms indicative of 'lifestyle' diseases, such as diabetes."

A Futurist's View, Yale Medicine, Winter 2003. "At DARPA we came up with something that got called the millennium toilet. The only place that we could monitor somebody and give a physical examination every single day would be in the bathroom."

Soft Surveillance: Mandatory Voluntarism and the Collection of Personal Data, Dissent, Fall 2005. "A diagnostic test routinely used in some Japanese employment contexts requires that each employee who enters a stall be identified through an access card. This permits a comprehensive record of flushed offerings over time. It is said to be of great benefit in the early diagnosis of health problems, and it can also determine drug use, recent sexual activity, and pregnancy."

Smart Parts, Physician's Weekly, January 14, 2002. "Whether wearable, implantable, or computer operated, these surveillance devices allow information to be conveyed remotely to doctors. At one time this equipment was dedicated to patients with certain diseases. Now a lot of healthy people want their status monitored too."

Micro Heart Monitor Will Send for Help. Telegraph (UK), July 13, 2002. "I can sleep better at night knowing the device is working and there's a person at the other end of the phone. If anything does happen they're straight in touch and they can get you to hospital straight away."

Technology as a Solution -- and a Policy Problem?, Nursing Homes, May 2004. "One policy problem with these technologies is that they potentially violate the privacy of elderly individuals. It is clear that users must be willing to trade some degree of privacy for an added sense of security."

Personal Medical Monitoring Devices, iHealth, University of Maryland, Spring 2004. "While personal devices today are largely if not completely external, the next generation may be implanted under the skin. Such devices ... could include artificial retinas, glucose monitors, organ monitors, cancer detectors, and general health monitors."

Internet Takes Heart as Pacemakers Move Online, EE Times, May 4, 2001. "Ultimately, engineers say they can foresee a day when an implanted heart monitor will detect a problem and call an ambulance, all while the patient lies sleeping.... 'We'd like to believe that someday a pacemaker could send a signal directly to a satellite.... When it comes to this kind of patient management, we'd like to believe the sky's the limit.'"

Video: A Remotely Monitored Health Status Bracelet

Implantable Heart Monitor Automatically Alerts Via Satellite. MTB Europe, August 31, 2005. "Loyola University Health System in Illinois has become the first hospital in the USA to implant the device into a patient."

Privacy and Wireless Sensor Networks. (Academic paper.) "Deployment of wireless sensor networks imply the collection of enormous quantities of mostly low-level data which if retained and analysed would provide information which could seriously compromise individual privacy.... It is clear that there is a need for a balance between the interests of the public and those bodies who wish to have access to data generated for whatever reason. This balance is very difficult to assess and needs informed debate to reach a consensus."

Remote Health-Care Monitoring Using Personal Care Connect, IBM Systems Journal, Vol. 46, No. 1 (2007), published online December 19, 2006. "We must consider new mechanisms for managing chronic conditions.... Remote patient monitoring collects disease-specific metrics from biomedical devices used by patients in their homes or other settings outside of a clinical facility. Remote monitoring systems typically collect patient readings and then transmit them to a remote server for storage and later examination by health-care professionals. Once available on the server, the readings can be used in numerous ways by home health agencies, by clinicians, by physicians, and by informal care providers."

Studies Of Technology For Healthy Aging Get Boost, Medical News Today, January 30, 2007. "Homes will be outfitted with a suite of sensors for detecting aspects of daily living such as moving through the home, patterns of disrupted sleep, and regularity of medication-taking.... If subjects are computer users, they may be asked to allow a computer monitoring system to collect data on their typing speed, the time they spend in applications, mouse movement activity and performance on research versions of computer games.... 'Our recent preliminary studies have demonstrated the potential of these approaches to tracking cognitive performance ... We foresee that further refinements of these methods will allow us to intervene and help elders maintain their cognitive abilities.'"

Links last updated in 2007