Friday, April 28, 2023

Apple Medicine

From The Drift Magazine:

Electric Bodies | Medical Technology Takes Over

We begin in a forest. The camera pushes through a clutch of trees to a clearing that reveals a drop into a ravine. “The owner of this watch has taken a hard fall,” Siri says. We’re listening in, apparently, on an automated 911 call on behalf of Bob B., who crashed while mountain biking and went unconscious. She provides “an estimated search radius of 41 meters” in her familiar clipped dialect — presumably saving the day. Although this is an ad for the Apple Watch, neither customer nor product is seen even once; we’re meant to assume that both are lying somewhere below our field of vision, the latter more active and alert than the former. The implication, underlined by a moody score, is that in a moment of crisis, technology can come to the rescue. 

Through a growing focus on healthcare monitoring in recent years, Apple has positioned its wearables as essential accessories for the technophile and the casual hypochondriac alike. In another video called “Dear Apple,” users read letters addressed directly to Tim Cook, crediting their Apple Watches with saving their lives in various emergencies. Several are cardiac in nature, but others involve adventure-related injuries — falling through river ice, slipping on the job, confronting a bear. In some cases, the Watch’s specific health functions alert the user to medical issues, though the device also comes to the rescue simply by virtue of its function as an unlosable phone — a wrist-bound conduit to 911. By conflating crises looming inside the body with external menaces lying in wait, Apple pitches its Watch as the ultimate asset in a hazardous and uncertain world. 

As a marketing strategy, fear works. When it launched in 2015, the long-hyped Apple Watch seemed like a failure: sales dropped 90 percent in just over two months following release, Fitbit was winning the wearables space, and even celebs were taking their Apple Watches off. (A Fast Companyarticle — headlined “Why the Apple Watch Is Flopping” — winkingly called out early endorsers like BeyoncĂ© and Karl Lagerfeld for appearing to have ditched the accessories in a matter of weeks.) The tide turned when Apple marketers lit on the idea of branding the Watch as a way to ward off mortality, rather than just another symbol of ambient luxury. Though the first model featured a heart-rate tracker and fitness rings gamifying basic activities like standing and walking, Apple slowly increased its focus on health and fitness over subsequent releases, eventually introducing manual period tracking, an electrocardiogram (ECG) feature, glucose logging, and a redesigned Health app that could better integrate with other devices and third-party fitness apps. By late 2017, Apple Watch sales had surpassed those of Fitbit, and today, Apple owns about a third of the wearables market. In the process of securing its market dominance, the company has helped to turn obsessive physical monitoring from a niche hobby of the rich and fit into a commonplace ritual, with tens of millions of customers opting in. 

But acclimating the public to the project of technological management of the body requires more than a few years of shrewd marketing. For decades, the American medical establishment has championed electronic medical devices as acceptable complements to, or even replacements for, more familiar treatment modalities, transforming yesterday’s harbingers of an impersonal cyborg future into today’s gold standard of “care.” And these devices have spawned a global industry with a market cap in the hundreds of billions. In the U.S. alone, millions — including me — live with electronic medical devices like retinal implants, insulin pumps, and pacemakers, relying on them for everything from improved sight to moment-to-moment survival. More than a million pacemakers are embedded worldwide each year, with some 200,000 in the U.S. Over 100,000 implantable cardioverter-defibrillators (ICDs), battery-powered devices that can shock a heart out of irregular rhythms and prevent cardiac arrest, are inserted stateside every year, around half of the estimated global total. And one calculation puts the number of U.S. users of continuous glucose monitors at over two million. 

It’s tempting to see constant self-monitoring as a way to avoid the worst pitfalls of the healthcare system. But as medical technology reaches beyond the very ill and into the realm of the ordinary consumer, companies like Apple and Google exploit both the logic and the deficiencies of professional healthcare in their efforts to bring everybody under their surveillance. Implantable devices embody the drawbacks of financialized healthcare, with medicine outsourced to private industry and placed in the hands of profit-motivated consumer-technology manufacturers. Meanwhile, manufacturers of these supposedly tightly regulated devices are allowed to behave like everyday tech companies — skirting accountability, dropping products without notice, leaving customers stranded — which should complicate our willingness to let existing tech companies move so seamlessly into the business of monitoring and treating our bodies. Rather than liberating us from the problems of the healthcare system, commercial wearables are furthering one of its central trends: the merging of patient and consumer into one compliant subject....

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