One of the themes of The Decision Tree - both the blog and the book - has been the idea of self-tracking: the notion that when people monitor their health, they are more likely to improve their health. In the aggregate, that's true - research shows that when people start to track or even care about their health (when the start to feel vested in it, and in control of it) they tend to have better outcomes. That's a powerful and important message, one that I believe hasn't really gotten widespread recognition - and I hope one benefit of the book is that this message will spread and help change people's lives (as well as the approach of care providers, who may have heretofore been reluctant to engage their patients in their own care).
But as I've been talking about these ideas in recent weeks, one frequent and important question has come up repeatedly. I'll paraphrase it like so: Does self-tracking scale? Or, as a non-geek would say, Is self-tracking just for geeks? Do you have to be a nerd to do it? In which case, is it a realistic strategy for the rest of us, those of us who aren't comfortable with data and navel-gazing and tricked out gadgets? In other words: Is this a transformative strategy for mainstream society, or a trick for the marginal few?
Well, good question.
My answer comes in two parts. First, I completely acknowledge that right now, most of this self-tracking stuff is for the geek crowd. It's got all the hallmarks of a early-adopter phenomenon: the tools aren't always easy to use, they don't always work right, and the whole idea is a bit complicated. In other words, there's lots of friction to the notion. But early-adopters, as the term implies, tend to pave the way for the rest of us. They iron out the kinks and spot the bugs that make the next generation of tools and technologies easier and friendlier to use for all of us. I see every indication that the same thing is happening here. And in this case, the upside isn't just a better way to watch television (the way Tivo early adopters paved the way for DVR ubiquity), but a better way to be healthy. That's a big upside.
Second, what's happening with self-tracking today is rather remarkable. It's not just the idea that tracking tends to help people make better health decisions (though that's true, and that's huge in itself). It's the idea that the principles of self-tracking tend to synch up, rather remarkably and serendipitously, with the principles of effective behavior change.
This is no small thing: there have been literally billions of dollars spent in recent decades researching how to get people to behave better (i.e., less self-destructively). The result has been a great set of basic understanding of 1) what we should do for better health and 2) how we can do it. Unfortunately, these principles have tended not to scale beyond the resources of any one research project. In other words, a research project will spend a lot of money figuring out how people should behave, but just when they prove their point, the money runs out and the project is over. The insights may be published, but there's almost never that necessary second step that puts those insights into action.
Until now. Consumer technologies that let people track their own health results synch up - to a remarkable extent - with the insights of research. Part of it's coincidence, and part of it is planning, but whatever the reason, the fact is that technology has finally progressed to the point that these insights - which boil down to giving people access to their data and then letting them share and compare their data with others - are the mainstay not just of research, but also of the nascent self-tracking industry.
Case in point: the iTunes apps store. A year or so ago, I did a post on this blog about the new health apps that touched on self-tracking. There were about 10 apps. Today, there are more than 5,000 apps that touch on self-tracking in the Apps store. Yeah, some of them are crap, and many of them are rip-offs. But surprisingly, many of them - including many free ones - are quite well thought out, easy to use, and intuitive.
In other words, they're not just for geeks. They're for all of us. This is a big idea. And it's going to get bigger.