Casey Means: 'Good Energy' & Biosurveillance
Can Big Data & wearables improve our health?
Since the Covid Crisis, there has been a renewed interest in people taking control of their health. This on its own is fantastic news. This is something that’s very close to my heart since I’ve been embarking on my own health journey. As part of this, I was gifted Casey Means’ book Good Energy by my mother. I think there is a lot of very useful and important information in this book. Sadly, it also leaves out a wide variety of important information, especially when it comes to digital autonomy.
The book is about Casey Mean’s journey from being a surgeon within the medical system, to adopting new ideas and practices for helping people take charge of their own health. Recognizing that to a surgeon armed with a hammer (scalpel) everything starts to look like a nail, she started to consider how many different problems were caused by common lifestyle factors. The book outlines how taking on many simple habits can really build into massive health improvements over time. The author provides a large picture of how our modern environment impacts our health, and strategies for mitigating this. If you’re somebody like me, who could learn a lot more about health, I would highly recommend reading the book as a good step in taking responsibility for one’s health.
Just because I agree with many points made by the book, doesn’t mean I agree with every line. It is absolutely true that to take better charge of one’s own health getting more information is helpful. On the other hand as a ’techie’ I have significant concerns over data privacy. It would be different if all the means of acquiring your own personal health information were entirely analog. In that case, you could harmlessly get all the information required with few to no privacy concerns. Sadly this isn’t the state of things.
Good Energy explicitly recommends many smart watches and devices known as ‘wearables’. There are non-trivial privacy concerns people should consider before making an informed choice about using them. The book goes even further to recommend having a Continuous Glucose Monitor (GCM) to get real-time metabolic information. The author is an adviser to Levels, a company that is launching a new smart GCM. over time, I’ve become more and more skeptical of the further digitization of health. All kinds of companies are after everyone’s medical information, but what are they using it for?
Wearables: A cause for concern?
Health monitors as a whole are a gold mine of useful information about a person. This is something that can be used for an incredible amount of good, but sadly also just as much evil. The best way to protect sensitive information is not to record it, and these tools by design do a lot of recording. It’s one thing to have crucial information in your own hands, but once it’s in others’ control the game changes completely.
While digitizing medical data could revolutionize healthcare, systemic inefficiencies, weak security measures, and a lack of trust in Big Tech make it risky. These vulnerabilities expose patients to data theft, scams, fraud, and exploitation. If patients can’t trust healthcare companies like UnitedHealth Group to safeguard sensitive health data, why should they believe digitizing and uploading healthcare data to a Big Tech company like Google is a good idea?
Android Police: Digitizing and sending medical data to Google sounds like a bad idea
This is a non-trivial concern. As we ‘digitize’ healthcare, there are many serious questions to ask about who or what is being empowered with our sensitive health information. We have already seen much simpler IoT devices used to enable stalking and harassment, the dangers related to health monitors are only beginning to become apparent. There is a frustrating lack of health monitoring gadgets that don’t require a smartphone app. These apps all inherently rely on connecting to a corporate controlled service with very few real guarantees of privacy. Even when a particular provider may have strong guarantees, little prevents it (and all of people’s sensitive information) from being sold to a new company with less scruples. There are countless ways personal health information on a wide variety of people could be misused and abused.
In fact, we already saw in the Covid Crisis that vaccination status was used to fuel systematic discrimination in many areas of life in many countries. Given the serious decline in both medical ethics and privacy since that time, there are hardly any guarantees about all kinds of forms of medical discrimination in the future. To be clear, there’s a lot of good to come from people being given the tools to take charge of their own health, but unfortunately that’s not exactly what’s being offered here. With the vast majority of commercially available options, the risk of people’s sensitive biological information being in the wrong hands is almost guaranteed.
In addition to all this, there are also simple fundamental technical problems with the lifecycle of these products. Being so dependent on smartphones and online services means that these products are vulnerable to (if not designed with) planned obsolescence. Just as one begins to take charge of their health, a simple business decision could pressure them into giving up more data just in exchange for continuing to use the tool they’ve begun to rely on. With people beginning to connect the very idea of taking care of themselves with cloud-based tools, they can forget the most important tool of all: being in control of their health and data. Without the individual being in control of their technological experience, just like with health, they can fall prey to very nefarious and harmful schemes.
Biosecurity: Is more information always good?
To reiterate, individuals having control of their own information is an entirely different circumstance than powerful institutions having insight into the public’s information. As we saw with Big Tech social media, information that can be abused inevitably will be. The stakes can only become higher and higher as the information collected from people shifts from self-reported data to passively collected biological markers. Far from a mere hypothetical, these tools are able to be weaponized to build wearable prisons given enough opportunity.
In a much related manner, the ruling class also seems to be marrying the issue of mass incarceration with the wearables revolution.
“In a digital world with ankle bracelets and GPS devices, there is no reason to believe that physical imprisonment is the only option for those convicted of nonviolent offenses,” Darrell West wrote for the Brookings Institute in 2015. “Compared to incarceration, ankle bracelets and GPS devices seem far more tolerable. They keep offenders in society, are less punitive than prisons, and are much less expensive.”
When one is letting a cloud-enabled wearable govern their personal health decisions, are they truly free? How many of those subtle nudges from the platform able to change seemingly unrelated decisions? Is it not out of the question to imagine of the individual’s biological information for propaganda and control purposes? Just as these ‘innovations’ blur the line between those incarcerated and those who are ‘free’, they also blur the line between civilian and target. Military use of and investment in wearables is rising precipitously. There are serious questions to ask about how personal health information is able to be used against people in the future.
And he’s [Giorgio Agamben] really articulated what this is and where it’s going, and the fact that this is a new governance paradigm for the planet. For example, he did an interview in May of 2020—so, very early on—called Polemos Epidemios, where he said:
“An epidemic, as is suggested by its etymological roots in the Greek term demos (which designates the people as a political body), is first and foremost a political concept. In Homer, polemos epidemios is the civil war. What we see today is that the epidemic is becoming the new terrain of politics, the battleground of a global civil war — because a civil war is a war against an internal enemy, one which lives inside of ourselves.”
And it goes on to say:
“It is important to understand that biosecurity, both in its efficacy and in its pervasiveness, outdoes every form of governance that we have hitherto known. As we have been able to see in Italy — but not only here — as soon as a threat to health is declared, people unresistingly consent to limitations on their freedom that they would never have accepted in the past.”
Well, that’s a pretty good articulation of what’s happened over the past couple of years.
Not only we can be sure that these changes have disastrous consequences, but we can also be sure that this information is already leaking wherever possible. Both wearables and various online fitness services have had massive data breaches in the recent past. Even when these services aren’t being outright breached, generous data sharing and selling will ensure that your information is not ‘siloed’ within a single organization.
It’s incredibly troubling to see prominent voices having financial ties to ‘solutions’ that collect, and eventually give away sensitive health information. For a time, a huge amount of YouTube personalities were sponsored by BetterHealth, an online teletherapy service. It turned out that BetterHelp was lying about it’s promise to not share customer sensitive data with Big Tech giants. This is an important reminder that we can’t take these companies privacy guarantees at face value.
Are there good wearables?
It’s certainly a minefield. Despite Mozilla’s glowing report on Garmin wearables, I’m not convinced there are enough acceptable options in the space. The most convenient option for many will be either the Google or Apple variant based on their smartphone of choice. The apps built around these watches all inherently make you more reliant on their services, undermining your ability to keep your information private. If you’ve made the (laudible) effort of “de-googling” your phone, a smart watch will likely claw back some of the progress made. Even if you do find a decently secure and private choice, other health apps can be their own problem.
What I would like to see in a smart watch
I don’t think it’s impossible for a company to build a privacy-friendly wearable. In fact, ZSWatch is a model project to consider. It’s a Free and Open Source hardware & software solution. Using a powerful app Gadgetbridge to put you in charge of your own information. There’s a great deal of opportunity in designing a health monitor that doesn’t sacrifice on privacy and autonomy. If you’re interested in building these kinds of products, here’s my wishlist:
Highly Repairable
Waterproof (I like to swim!)
Replacable straps
No Smartphone/app required
All the basic metrics:
Sleep
Steps
Heart rate
Workout tracking
Optional personal server (appication) that can be run for those who want real-time metrics available.
Optional User-friendly software for updating firmware and making changes
Direct data export & backup/import
Robust support for simple applications being built by users
Notifications/Interactions for phones
Compatible with KDE Connect
Works as a FIDO2 key / additional storage.
Thinking differently
There are definitely still some “app free” pedometers available. I would encourage you to focus on the healthy habits rather than particular technologies. The most powerful tool you’ll ever have for improving your health is your own mind. Taking your own notes, recording your progress in a workbook can help a great deal. My hope is that you walk away reading this not only cautious about many of these wearables, but more importantly confident you can make changes in your life without them. All the value of these tools only matters if they genuinely improve your life, which is something you have the power to do without them. Having more in-depth information helps, but there’s a great deal that can be done on your own.
The book Good Energy by Casey Means is still an excellent guide for taking control of your health, even if you pass on the wearables recommendation. Having already made many of the changes suggested in the book myself (even prior to reading it) I’ve noticed a radical change in my quality of life. You will still get a great deal out of taking charge of your lifestyle without making yourself dependent on these online services. I can certainly understand circumstances where it may feel like a decent trade-off regardless. In that instance, I would just remind you that you’re not forever dependent. Once you’ve built the habits, you’re always free to continue your journey without the wearables.
I would love to hear your thoughts! Book suggestions welcome!
Not sure if you're aware of it but Pine64 has a FOSS smartwatch (let's be honest, it's a development toy) platform people can develop against that includes a heart rate sensor https://pine64.com/product/pinetime-smartwatch-sealed/
That said, I think if we can teach people to take care of their health themselves (Sleep right, eat right, fast, how to exercise for where you're at, supplementation etc) Wearable would become irrelevant outside of athletics and medicine. Anecdotally, I started wearing smart watches wayyyyy back around the time of the Fit bit flex, graduated to several higher end models until Google purchased them and I bought my first Garmin. I thought having the device would help make me health, that it would align me to my goals but the sad truth is that if you don't know what you're doing, you just have a really zazzy smartwatch that no one cares about. Now I've had time to work with trainiers, dieticians, and have concrete goals and I will admit that have the Garmin Ecosystem to help me tract my progress has been an absolute game changer for 1. monitoring my health generally, and 2 for helping me maximize/push myself at the gym.
For me, I'm stopping at technology that estimates, which at the end of the day is all Garmin's devices really do. And even then, there's no way there's a one-size-fits-all algorithm to tell you how healthy you really are. it can just make good approximations with the information it collects and that's good enough for me. but once you get into the realm of things that read my blood, or stuff like that I am squarely out.
Edit; regarding product life cycle and smart phone dependencies, High-end garmin devices have Wifi on board so you don't need a phone. But then we get into the realm of there being a bluetooth wifi beacon on you at all time.
Please don't think me harsh. I understand everyone has a different journey and different obstacles. I just want to share my view.
If you eat only a small snack that has little to no carbs until lunch and make your lunch no bigger than one sandwich or an egg and bacon or whatever and then at night have a simple small meal of whatever - pasta, meat and three veg, Thai green curry etc. you will be eating more than any of our indigenous ancestors. It will have a broader diversity of nutrients and it will make you healthy in about 12 weeks.
Tech has no role in that.
None.
I wish you well on your health journey