Recently a friend of mine replaced his recalled Fitbit watch with a more expensive, but more versatile, Apple watch. (The recall was caused by multiple reports of Fitbits that were overheating and injuring users, but the irony of a health-related consumer product causing burns is a subject for another day.)
A biomedical engineer by profession, he showed me how the Apple watch can even display his electrocardiogram (EKG) in real time. You press a button on the side of the watch, thereby completing a circuit that includes your arms and heart, and right there on the watch’s screen is the same kind of wave that we’re used to seeing in hospital bedside monitors costing many thousands of dollars.
While I was glad for him that he no longer has to worry about sustaining wrist burns from his watch, it turns out that any fitness or health-tracking device that provides instant health information has the potential to cause harm in the form of the nocebo effect. Strangely enough, finding out too much about the immediate state of your health can make you feel less healthy.
Tim Culpan, writing in Bloomberg News, points out that “nocebo” (Latin for “I shall harm”) means the opposite of “placebo” (“I shall please”). A placebo is a medication or treatment that has no objective scientific basis, but is perceived by the patient as being helpful. For unclear reasons that have to do with the mind-body interface, placebos often lead to objectively measurable improvements in health.
Culpan cites studies in which researchers reminded concussion victims of their history of head injury, and that reminder by itself made them perform worse on cognitive tests. Another example he quotes is the online comment of a fitness guru, who complained about his sleep-tracking watch app.
He’d wake up after what he felt was a good night’s sleep. Then he’d look at his watch, and it tells him that actually, he was X percent lower in REM sleep than he should have been, or whatever. Suddenly, he doesn’t feel as rested as he did before he looked at his watch.
The nocebo effect is a lot more widespread than we think. How many drug ads are aimed not at making you feel better, but at lowering some number that diabetics or hypertensives are told is the key to their health and well-being?
The A1c average-glucose-level test for diabetics and the blood-pressure test for high blood pressure are both things that consumers can now do in the comfort of their own homes — or discomfort, if the numbers aren’t what we want.
Economics is at work as well. What begins as a means to an end — measuring blood sugar or blood pressure to avoid the serious negative consequences of diabetes or hypertension — subtly and gradually becomes an end in itself, as patients begin to obsess over the numbers and small shifts up or down that probably have no statistical significance. But they demand lower numbers from their doctors at any cost, which the pharmaceutical companies are glad to assist with.
The golden mean
As with so many other areas of life, one can have too much of a good thing, even if the good thing is personal medical data. Because the problem originates in one’s mind, that is where we need to deal with it, and the best advice I have come across to deal with the nocebo effect comes from an unlikely source: G.K. Chesterton.
Chesterton is nobody’s idea of a poster boy for good health habits. He drank (in moderation), he was fond of cigars and mildly baffled by anyone who questioned the propriety of his smoking habit, and in later life he weighed upwards of 300 pounds before dying of congestive heart failure at the age of 62 in 1936.
But while he lived, he lived with a gusto and joie de vivre that made him a model for how to enjoy life, and health while it lasted. Health as such was not an obsession with Chesterton, but in his voluminous writings he made a few remarks that can guide our health-data-obsessed age toward more helpful attitudes.
In his book Heretics, while countering the eugenicist tendencies of H.G. Wells, he remarked,
“The mistake of all that medical talk lies in the very fact that it connects the idea of health with the idea of care. What has health to do with care? Health has to do with carelessness.”
In Orthodoxy, he has this to say along similar lines:
“The mere pursuit of health always leads to something unhealthy. Physical nature must not be made the direct object of obedience; it must be enjoyed, not worshipped.”
He points out a profound truth that applies to obsessions with health as well as with any other created thing: if enjoyment turns to worship, freedom has turned into slavery. We can make ourselves unhappy by pursuing the happiness of good health to the exclusion of the rest of what life has to offer.
My friend with the new Apple watch is a pretty well-balanced individual, and I think he’s not going to let himself be waylaid into checking his EKG compulsively and noting tiny changes in the waveform, as his training would allow him to do. (If it was me, I’d just be happy to see any wiggles at all.) But the nocebo effect is a reminder that our health accessories and toys can lead us down a road to unhealthy concern with information that in most cases can be safely ignored.