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In his article, “The Primacy of Self-Regulation in Health Promotion”, Albert Bandura starts by saying “We are witnessing a divergent trend in the field of health. On the one hand, we are pouring massive resources into medicalising the ravages of detri-mental health habits. On the other hand, the conception of health is shifting from a disease model to a health model. It emphasises health promotion rather than mainly disease management.” This perspective lays the stage for this paper, arguing that Mobile technology is significantly challenging and changing traditional healthcare models in the world. While in certain developing countries, like India, Ghana etc, these technologies signify greater, cheaper access to healthcare, for some developed countries like the U.S, these changes start to pose a challenge to the existing model. Today, as mobile based self-monitoring devices seek to make the leap from early-adopters to the mainstream, and given urban patients’ heavy reliance on web-based information, the reality of ‘anytime, anyplace’ healthcare with implications for cross-border access is even now in the making.
Mobiles had a modest enough beginning, starting off as a wireless communication device only the monied could enjoy. The decreasing price of semi-conductors and competitive mobile internet data rates in many parts of the world have made mobile phones the smallest, cheapest transformative device available today. From being merely a wireless telephone, its’various avatars today include information dissemination, knowledge sharing, location awareness, social networking, entertainment, emergency relief, and self-monitoring. Smartphones and Mobile web, it is SMS that has been a powerful and innovative change tool in places where mobile phone affordability is limited to the cheap, standard Nokia phones. SMS based health initiatives are often used to spread knowledge and awareness, for eg The Mobile Midwife project in northeast Ghana is part of the ‘Mobile Technology for Community Health’ (MoTeCH) project. It uses voice or text messages provide relevant health information during the pregnancy. After the birth of the child information on essential vaccinations and the management of critical childhood diseases is sent. In addition, community health workers can keep electronic records and retrieve patient information using their mobile phone. (source http://www.mhealthinfo.org/). CycleTel, a proof of concept being tested in India by the Institute of Reproductive Health at Georgetown University uses mobiles to inform women of their fertility statuts. This SMS-based delivery of the Standard Days Method (SDM), is an information based, low-cost and non-hormonal method of family planning.
A project by MIT students, Sana aims to address the lack of skilled physicians in rural areas of developing countries. “Using the Sana app, health workers can run a procedure and collect patient data. Sana then uploads the information to OpenMRS for a doctor to review. After reviewing the case, doctors can notify the health worker of the diagnosis by sending results to the Sana app.” (http://www.sanamobile.org/about.html). This project uses an Android Smartphone and allows for quick collaborations between a rural health care worker and a city doctor, resulting in on the spot diagnosis, expert feedback and reduced costs for rural patients who could not afford to travel to a city for check-ups.
Another MIT project, NETRA (Near-Eye Tool for Refractive Assessment) “is a simple and inexpensive way to use mobile phones to measure refractive errors of the eye, including nearsightedness, farsightedness, astigmatism, and age-related vision loss. Until now, these measurements have only been possible using specialized equipment operated by a trained professional.” (http://www.media.mit.edu/press/netra/). The World Health Organization estimates that as many as two billion people worldwide have refractive errors of the eye, and that these errors, left uncorrected, are the world’s second-highest cause of blindness.
Lack of quality and affordable access to healthcare coupled with the ubiquity of mobile devices, which then form an alluring incentive for telecom providers to be innovative in their pricing and offerings, have created vibrant mobile health opportunities in the developing world. This however is only part of the story; while the healthcare challenges, both in terms of access and regulation are different in the developed world, mobile technology is fostering an environment that is geared more towards self-regulation and health prevention, like Albert Bandura describes above. Smartphones like the iPhone and Android ushered in the app era, and this is where self-monitoring devices have come into their own.
In his paper, ‘The Future of Mobile Health’, Jody Ranck says that Mobile health – the use of wireless devices to manage health conditions, collect health data, monitor vital signs, provide clinical decision support and access health information — is in its relatively early stages. Meanwhile, aging populations and health systems straining under rapid growth rates during a period of economic decline have helped boost interest in mobile health as a way to cut costs and improve continuity of care. He goes on to emphasise that Mobile health is not just about sickness, but about wellness. While a large number of apps exist for monitoring conditions like Diabetes (eg, Glucose Buddy, BGluMon) and Blood Pressure ( iBP Blood Pressure app, Heartwise Blood Pressure tracker), some of most popular apps for the iPhone and Android are wellness apps that are aimed at fitness & weight loss. Apps like Nike+, Runkeeper, allow one to measure activity and view and compare detailed graphs of them and other members of the system. Calorie counters like Daily Plate and LoseIt! are enormously popular, not just because they allow for food tracking, but because of the social aspect of forums that act as a support network.
Add to this the emergence of movements like the Quantified Self meetups. QS’s tagline is ‘Self knowledge through numbers’. QS users use different technologies like sensors, commercial devices like the FitBit and mobile phones to track everything from emotions to heart rate, breathing to Galvanic Skin Response, water consumption to stress. Although this movement is still at the early-adopter stage, the proliferation of self-monitoring commercial devices, and the proclivity of technology users to share personal information via social networks is creating a shift in this regard.
While all of these advances are already leading to discernible shifts in health related habits and behaviour, challenges to prevailing health systems will be pronounced with widespread adoption of mobile money transfer systems. Mobile money transfer services like M-Pesa, already radically affecting areas such as agriculture and micro-insurance in Kenya also extends to micro-health insurance, for eg, Changamka in Kenya is an m-pesa based prepaid health scheme. High cost of care like in the U.S and long waiting times for surgeries as is the case with U.K’s NHS, encouraged the growth of medical tourism. Web based services like WebMd and the strength of online recommendation systems have allowed people to decrease their dependency on physicians and take control of their information and choices. The use of telemedicine in countries like India has shown it to be an inexpensive and effective medium for diagnosis and immediate feedback, saving costs and lives. Cross-border healthcare based on mobile diagnosis, advice and transfer of patient information could increase global access to timely information and quality care, but also requires a credible reimbursement system and a conducive regulatory environment. Recent moves by the FDA to control health apps act as a significant impediment to the companies innovating in the area with a few choosing to move to Europe to develop medical technology.
Jody Ranck, in his paper ‘The future of Mobile health’ states that “over 50 percent of the U.S. population suffers from at least one chronic condition, and chronic care accounts for over two-thirds of health care costs
Telemedicine and mobile health hold the promise of providing more affordable ways to manage treatment of chronic conditions, facilitate business models for the medical home and offer substantial cost savings from improving drug adherence and monitoring vital signs. This can reduce rehospitalizations — a major source of expenditures in the health system.” As was seen with the example of Sana, mobile phones facilitate disintermediation and the use of less skilled workers where physicians are unavailable. This affects both cost and efficiency in the system. It also challenges inefficient, wasteful systems and forces them to innovate due to increased competition.
(Quinn posting for Suvi)
The author makes a very credible argument comparing LASIK to steroids in their ability to enhance and thus provide an edge in sport. I was surprised by how the entire discrimination between what constitutes cheating and what doesn’t hinges on a technicality, even if the technicality is being abused. But where would one draw the line here? If someone had bad eyesight, should they be prevented from improving it on the basis that that’s their natural state? Would that then translate into weight training as well? Obviously not. At the same time, the idea of someone winning on the strength of steroids is a lot more distasteful than knowing that someone got laser surgery and improved his performance. Is that just our natural bias?
(Quinn posting for Suvi)
This was a fascinating article given that I was one of those people Tim Maly was talking about when he described how most people viewed Cyborgs. But Robin Sloan’s article did extend Maly’s definition to an area that I could definitely identify with. To see Kanye West the performer as Cyborg made me look at my own former role as an actor differently. Was I a cyborg too? Were the hidden microphones, the concealed boom mike, the lights, cameras and channels also part of my own cyborg-ism? I was definitely a different person, embodying a different role, but the idea was that I was reaching millions of viewers each night, not as myself but as a character they could laugh and cry with. The person they came up to on the streets was not me; they were not the least bit interested in me. THey wanted to touch and talk to the fiction that inundated their life for half an hour each night, whose pain had been theirs for a moment. I have always been partial to theatre over film, preferring the magic & urgency of live performance over the retake-driven recorded one. But seeing this from Sloan’s lens, the wired-ness of T.V that hooks each actor to millions of people is mind-boggling. Not just T.V, but the internet, with it’s discussions and reviews, interviews, photos, videos, the never ending streams of algorithm generated links- and suddenly, you have been divided and replicated, pieces of you, true or untrue, but still pieces of you scattered to distances you would never otherwise reach, being viewed by people whose names you will never pronounce in your lifetime. A few years ago, only a few had power to create cyborgs out of others.
Today, to be a cyborg is to be your own self-scripted show. All it takes is a mobile phone
The idea of being able to do a test run of a strong portion of your identity seems a strange concept on the surface. In reality, however, we practice most things we do in one way or another. In fact, as children, we get TONS of practice watching others and trying things out ourselves when it comes to gender roles. This is not so different from learning muscle memory, practicing a sport or an instrument or method acting, for instance. So it seems in fact quite natural to me that we would finally develop a space for testing out our “authentic” selves (this paradigm of consideration is, I think, why we erroneously find the concept of identity something you shouldn’t have to practice). Identity is something that can be changed and learned as any other skill, honing the way we present them to ourselves and to the world and learning what we find acceptable for ourselves and what others find acceptable and bridging the gap. I think we do this every day, however it is usually in incremental and hard-to-see small ways. We for sure can’t know how good we are at something, and often times even how much we like it and feel comfortable with it, like a sport, until we have a point of reference to compare ourselves to. We compare ourselves to other people, or systems of metrics that others have come up with. We get feedback from these people and from these measurements every day, and we navigate the world with them in mind. But the nature of something like gender reassignment or some career changes or losing a limb is not incremental, it’s a radical, very conscious change that others can see so visibly compared to the previous state, and I think this is why it’s so uncomfortable for many. And why the idea of practicing becoming a dragon is just as “ridiculous” and such a powerful statement, because it is not far off from how different any one person’s desired alteration in their life might be compared to what they are used to. And probably why there has to be a manufactured world to practice it in, because the real world and real life are constructed around a system of small daily tweaks and learning.
While reading this piece, I was having a similar reaction to the description of the hooks piercing through his skin and stretching as what was being described as the audience’s reaction. Obviously this is normal, as that is how we get absorbed in written storytelling and put ourselves in others’ shoes. But what are the exact differences in how much we are feeling these reactions between different mediums. Sometimes the medium is purely written, aural, or visual. Other times it is some combination of a multi-sensory experience. From a performance perspective, I would be much more interested in a piece that explored these simultaneously disparate and alike experiences by juxtaposing them next to each other in isolation or something of the like, exploring the space between them and finding how to leverage them in a way that gives you much more control in providing an experience for spectators. Often times, a piece like this one of Stelarc just reeks a little bit of shock-factor-driven to me, instead of providing a new insight or nuanced experience.
As a side note, which my intuition says is related to the way you experience someone else’s pain through different mediums, I am interested in understanding why it is also so different from when you actually are going through the pain firsthand. I once put a jewelry-saw blade through my finger, it literally sticking out of both the front and back of my finger, and just yesterday I lightly staple-gunned my finger (I should not be trusted with sharp objects). Both times, I have found it “cool” and weird and funny. I have always wondered why it is so much easier for me to stomach my own physical damage than to see or hear about someone else’s. Why does my own body seem less fragile, why is it more comical when it’s me, even after the adrenaline rush is out of the picture and there’s just a foreign object sticking through me? Am I dissociating and no longer seeing my own finger as my finger on some level, whereas when it’s someone else’s mangled digit I’m actually associating it with my own healthy one and that inevitable comparison makes it quite obvious and uncomfortable that the injured finger is not ok?
(Quinn posting for Suvi)
The two things that stayed with me from this article are the desperate quest for fulfilling an identity of self and how much that fulfillment can depend on the perception of others. This article made me realise how much amputation could mean to some people’s sense of self, no different from another’s need for rhinoplasty or a man;s need to correct a receding hairline or a women’s need to lose weight. All of these in the end are bound by the singular thread of self identity and what they do to enhance or detract one’s sense of what it means to be truly themselves. What struck me though was how our current state of perception determines whether some people ever get to experience that sense of self. If anyone tried to tell a women that she cannot get breast augmentation or that she was wrong to lose weight, there would be hell to pay. But the force of moral judgements placed on amputation because society somehow sees it as perverse and because we self proclaimed “normal” people can’t really understand it, does nothing to detract from the importance of it’s case. For the longest time and even in some places today, homosexuality is a cause of suppression, denial, shame and violence; it steps on certain society’s perception of “what is right and normal” and is clamped down upon, fettering the desires and rights of gay men and women. Their identity then is held captive to the prevailing norms and beliefs. So too with amputation. WHile there is something grisly and un-understandable about a person’s need to handicap themselves, how can we ever know what it means to them. They describe the experience as being freed, of finding themselves of feeling right in their bodies again. This quest has been or continues to be ours too, so it should be familiar, should evoke a sense of empathy.
At the core, it is also instinctual. To see a healthy person amputate their legs or arms goes against all our survival instincts, against our darwinian instincts to constantly further ourselves, to evolve. We cannot comprehend disabling ourselves or “handicapping” ourselves as we tend to see it. In the end though, we often court rejection, pain and even death everyday in our quest to find ourselves, to be who we think we should be. In this case, the difference is that unlike with the idea of homosexuality, we haven’t caught up with amputation-as-an-identity perspective.
(Quinn posting for Suvi)
The mode of happiness as described by Carl Elliot is so different from the way we are taught to think about it, but on reading the chapter, you realise the truth that was sitting quietly by the whole time, just waiting for us to recognise it. “Tyranny” is a good word for a phenomenon that is now akin to a global cause. As Phillippe Soupault puts it, happiness is not merely a right, it is a duty for most people. Carl hits the nail on the head when he traces the root of this to choice, to putting success or failure of one’s life into people’s hands, to make the human being responsible for finding his own way to “fulfillment” or “purpose”. I agree with this because I was born into a different way of thinking. In India, the notion that karma (or your past deeds) have led to your present circumstances create a very different response. After the sinitial shock of the glaring poverty subsides, visitors to India almost always remark on the lack of edge, the tension of violence that seems to exist in so many similarly poverty ridden places in South America, Africa etc. Many Indians attribute this to the belief in karma, to the quiet acceptance that their present circumstances were their way of working off bad karma. The legitimacy and ‘rightness’ of this view is irrelevant. For if this is true, then it lends weight to Carl’s belief that being able to place destiny outside of you- on God, Karma, fate, Universe, etc takes away the anxiety of being responsble for your life’s outcome. The believers of this particular line of thought have other anxieties of course-whether they’ve sinned, whether they fasted enough to please God, but at least they know what they need to do. The other camp meanwhile is bewildered and bereft, constantly in doubt, veering from one idea to the next, unsure as to the validity of their ‘truths’, which they will fiercely defend till the next idea seems to be better than their existing one, at which point they will just switch.
This is the condition in which we presently find ourselves – an ever anxious, frenzied peoples, cowering behind too-shiny masks that just barely fit. From time to time, the mask will slip to reveal the terror we live in-the terror of being wrong, of being left behind, of not having a template. We profess that we want the freedom to make our choices, to govern our lives, decrying every form of authority and pulling down classes, divisions and every hierarchy that exists, declaring equality to be the ideal. But is it? While it’s easy to make grand moral statement about class and other divisions based on work, etc the truth is that a lot of people from my generation have lamented the presence of seemingly infinite choice. If you cannot succeeed with so much choice than the fault is surely your own. We hesitantly wonder whether the fixed roles of our parents and grandparents generations were not somehow more conducive to peace. Not happiness, because our grandparents didn’t really talk or think about it too much. But in their dutiful fulfilling of what they saw as their roles-as breadwinners, caregivers, etc, there was contentment in a job well done, in a tangible standard they could meet and to me and so many others, that quiet contentment was closer to happiness than the nebulous, teasing, will o’ the wisp version we pursue today.
This piece taught me humility too. I’ve been one of those people who’ve shaken their heads at a friend’s talk of botox, at the impressive line up of augmenting ‘magic potions’ that line their bathroom cabinets. I failed to see that my own behaviour was just a different magic potion. My drugs of choice are meditation, pranayama, NLP and personal growth books. My struggles are ego and shadow and all the Vedantic, and Jungian ideas that are the counterparts to the ‘American’ search for self. I too believed that freedom was my greatest gift, until the lack of clear roles at work, in relationships and in life in general makes me feel a ship that’s lost it’s anchor. And yet I found my comfort in my spiritual legacy-I choose to believe in the Vedantic/Buddhist proposition, and in doing so, have chosen to stay in the game in order to get out of it.
(Quinn posting for Suvi)
Francis Fukuyama’s post is less fear mongering (as some post comments suggest) and more a nuanced look at the unforeseeable possible effects of human self modification. His idea that “Modifying any one of our key characteristics inevitably entails modifying a complex, interlinked package of traits, and we will never be able to anticipate the ultimate outcome” merits serious reflection and discussion. The fear with the perspective of the enthusiastic transhumanist is that the process is seen as a simplistic straightforward linear transformation or change, resulting in just what they have imagined. But the truth is so much more complex. To be human is not merely a physical phenomenon. It is so closely allied with emotional moral and spiritual “truths” that a mere biological modification of a human is just part of he story, and whether that story has a happy ending or a bad one, is as Francis Fukuyama extolls, hard to predict.
The concern for what modification means for equality is according to me, valid but maybe exaggerated. While the idea of designer babies and finding enhancement in a bottle are not ideal scenarios, equality today is an illusion anyway. Backgrounds, education, wealth, opportunity, luck, all play a huge part in determining one’s chances. People are always left behind in one way or another so citing self-modification as a possible cause of that is less of a concern for me than the former reason.
When I try and look for evidence of the trend towards body-modification in my own life, I know that although I’ve never been attracted to the idea of drugs, pharmaceutical or otherwise, I am drawn to the thought that certain illnesses, esp those of the brain may have the capacity to be reversed or changed if we could access them under non-lab circumstances. I’ve been reading the China study which points to Animal protein as a factor that turns the cancer gene on(excuse the general bad terminology). Where does modification, both physically and in it’s purpose begin and end. If I could get access to a device that could make a certain set of neurons to fire together in certain conditions that benefitted me, would I not be just a teeny bit curious to try it out? And would I try and justify that by using words such as “non-invasive”, natural, etc? Oh yes, I would.
I hate to need help or to have to ask for it, but at some point in my life I was prescribed a pill to fight a disease and everyday I took the pill it felt like I was facing my own lack of power. I think that was what Carl Elliot meant when he said: “we take the tablets, but they leave a bitter taste in our mouth”.
Yes, there is part of me that instead of being happy that I can get some help out of science and technology is just really mad that I’m not like that by myself.
Talking about the market of happiness, I can say that something about this reading tells me that we live in an era where people just have a major problem on understanding the process of things and are just obsessed with results. We don’t seem to have time do deal with frustration and we don’t seem to understand the importance that feeling frustrated has in our own happiness.
Another point that intrigues me a lot regards control. My experience is that the more we try to control things the more we notice ourselves powerless and I just love the idea of an spontaneous life, rather than a super planned on. Knowing how to go with the flow or to adapt is as pivotal as the plans and all the energy we invest on the things we want to create to ourselves.
When it comes to the obligation of being happy, I must say I totally identify with the concept Carl Elliot brings to the debate about seeking happiness as a duty and forgetting that it makes more sense to see it more as a right.“Americans frantically pursue prosperity, and when we finally get it, we are tormented by the worry that se might have gotten it quicker”.
Besides the total lack of ability to enjoy happiness it seems that in our free time we our able to punish ourselves by the simple fact we are not happy. “Whoever is unhappy is suspect”.
Growing up in a city like Rio de Janeiro a lot of times I’ve felt a bit lonely even when surrounded by a lot of people and a lot of conversations. Most of my best friends were always talking about juices, diets, the beach and so on. As for me I got really frustrated with the limitation of the subject and I remember feeling out of place and understanding that I had to found my own people. That is one of the reasons I decided to become a journalist. Because I wanted to talk about issues I was interested about and everyone around seemed unworried or unpleased in doing so. Besides, I wanted a lot of explanations for a zillion questions that were always around anything I started thinking about and I had a huge pleasure thinking about my thoughts. Finally, I learnt I was one of those question-everything-people-type and I could be in peace with my “nature” after choosing my profession.
Thinking about the feeling that I’ve just described above and the chapter that I read I had to ask myself: Was my desire of wanting to find my own people more legit then people that want to have their legs cut off? My immediate response to that before reading the chapter would be yes, but after diving into the shades of the matter I can just say, probably not! In fact, I feel happy that they kind of have a voice or a place to have some voice right now and at the same time I am scared to death that more people feel that this is the way to go just because they read something about it.
When it comes to different people and their struggles I can say that what has definitely been rearranging a whole new world is the internet. “On the internet you can find a community to which you can listen or reveal yourself, and instant validation for your condition, whatever it may be”. + “They thought they were crazy, they thought they were alone, and this group reassures them that they are not. From a therapeutic point of view, this kind of community-building may have mixed results. It gives the wannabes solidarity, but it also nourishes and shapes a desire that might otherwise wither away or take another form”.
Eventually it all comes down to the fact that what you are attracted to or not attracted to is part of who you are. So, if we are here discussing about a desire, a fetish, an obsession or a disorder, that’s not the problem. My impression is that the problem – whatever the name we choose to give – becomes a larger then life till there is nothing else but it and I think we just don’t know how to deal with new problems yet – like having a lot of people wanting to have have limbs cut off. Beyond that, I would day the lines between mental disfunction and ordinary life are not as sharp as some psychiatrists like to pretend.
Making a link with the transhumanism text I find myself an old soul or just incompetent to foresee what Francis Fukuyama calls the next stage as a species. That is because I think we are transforming ourselves constantly and I do think we wake up every day different versions of ourselves and I just think the choice of words are too drastic. On the other hand I do admire the interest and the questions: If we start transforming ourselves into something superior, what rights will these enhanced creatures claim, and what rights will they possess when compared to those left behind? If some move ahead, can anyone afford not to follow?
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