Digitised dissection: medical procedures on the internet

 

This is an excerpt from my book in progress, Digital Health: Critical Perspectives, to be published by Routledge in 2017.

With the advent of websites, social media platforms and apps, the internal organs and workings of the body have moved from being exclusively the preserve of medical students and surgeons. Digital medical devices have entered into the public arena of the internet, offering new possibilities for lay people to gaze inside the spectacle of the human body. A vast volume of computerised medical images of human life from conception to death are now readily available online. Tapping in such keywords as ‘human anatomy’ will call up many apps on the Apple App Store or Google Play which provide such details. While these apps have been explicitly designed for the use of medical and other healthcare students and trainees, they are readily available to any person who may wish to download them. The Visible Human Project developed by the US National Library of Medicine is an earlier example of how human flesh can be rendered into a digital format and placed on the internet for all to view. The developers of The Visible Human Project used digital technologies to represent in fine detail the anatomical structure of two cadavers (one male and one female). Each body was cross-sectioned transversely from head to toe. Images of the sections of the bodies using MRI and CT scans and anatomical images were uploaded to the Project website. They can also be viewed at the National Museum of Health and Medicine in Washington DC. A similar website, The Visible Embryo, displays images of embryos and foetuses from fertilisation to birth, with a week-by-week display showing the stages of foetal development. The data used for this website were drawn from digitising microscopic cross-sections of human embryo specimens held on slides in The National Institutes of Health’s Carnegie Collection of Embryos as well as from 3D and 4D digital foetal ultrasound images.

Many opportunities are provided on the internet for people who want to view detailed images of surgical and other medical procedures in their full gory detail. YouTube has become a major provider of anatomical and surgical technique videos for medical training. Some medical specialists and surgeons upload images and videos of their work to Snapchat and Instagram, mostly in the effort to promote their services (cosmetic surgeons are in the forefront in this practice). Instagram does not allow users to upload images that are considered too explicit (such as those portraying surgery on breasts or genitals), so some doctors have turned to Shapchat as an alternative forum. One infamous such specialist is Sandra Lee, a dermatologist known as ‘Dr Pimple Popper’. Her Instagram photos and YouTube videos showing her at work have received many millions of views. Perhaps the best-known Snapchatting medical specialist is the cosmetic surgeon ‘Dr Miami’ (Michael Salzhauer), who uploads detailed photos and videos of his surgical procedures (including controversial procedures like labiaplasties, or surgery designed to reshape women’s external genitals). ‘Dr Miami’ is unafraid to Snapchat images of himself brandishing a wad of body fat he has just excised in a tummy tuck. He employs two full-time staff members to manage his social media accounts.

The use of web-streaming services is employed by a number of hospitals to host webcasts of surgical procedures for any interested person to view. The US National Library of Medicine provides a list on its website of several such webcasts with hyperlinks, from numerous different American hospitals. Lay people may now even view live-streamed surgical procedures using a smartphone app and wearing a virtual reality headset to provide a 3D immersive effect, as offered by the Medical Realities company in April 2016. This technology is designed principally for training medical students, but also allows lay people who participate to feel as if they present in the operating theatre.

Pinterest, an image-curating and sharing platform, features many collections of images related to medical matters. Several of these relate to patient experiences of health, but others are curated by medical and nursing students and practising healthcare providers. Some are humorous, featuring memes, cartoons or other images designed to appeal to medical and nursing students and other trainees in the health professions. Other Pinterest photographs feature novelty commodities, again clearly directed to the same audience (for example, anatomical heart or ECG heart beat cookie cutters, human-organ and stethoscope-shaped jewellery, coffee mugs in the shape of spinal vertebrae). While these images are vastly outnumbered by the serious photographs in Pinterest collections that show anatomical images and other medical information (some of which are explicit photographic images that detail flesh, bone and blood), they offer alternative representations of the ways in which human bodies and the practice of healthcare are represented online.

The major differences offered by the latest digital technologies that document and monitor the human body are the continual nature of the surveillance opportunities they present, their expansion from the clinic into domestic and intimate spaces and relationships and their feedback mechanisms, which allow their subjects to ‘read’ and interpret their own bodies via biometric measurements. Medical practices that were once embodied in the flesh, including the development of doctors’ expertise in touching the patient’s body and determining what is wrong, have increasingly become rendered into software such as the video conferencing services offered in remote telemedicine technologies. Virtual bodies have been developed for medical training purposes, allowing students to conduct virtual surgery. To achieve this virtuality, the processes by which doctors practice – their customs, habits and ways of thinking – are themselves digitised. Both doctors and patients are rendered into ‘informatic “body objects”, digital and mathematical constructs that can be redistributed, technologized, and capitalized’ (Prentice, 2013: 20).

Many digital health technologies are directed at illuminating the exterior or interior of the human body with the use of metrics that may represent features of the body as numbers or graphs. The use of apps to collect information about body functions and movements, for example, generates a continuing set of images that represent the body. Biometric data serves first to fragment the body into digitised pieces of information and then to combine these pieces into a recombinant whole that is usually presented in some kind of visual form. Amoore and Hall (2009: 48) use the term ‘digitised dissection’ to refer to the ways in which biometric whole body scanners at airports operate. This term is even more apposite when adopted to discuss the fragmentation of bodies in the context of digital health. Digital technologies are able to peer into the recesses of the body in ever-finer detail, creating new anatomical atlases.

References

Amoore, L. & Hall, A. (2009) Taking people apart: digitised dissection and the body at the border. Environment and Planning D: Society and Space, 27, 444-64.

Prentice, R. (2013) Bodies in Formation: an Ethnography of Anatomy and Surgery EducationDurham, NC: Duke University Press.

 

 

 

Self-tracking citizenship

An excerpt from Chapter 5 of my new book  The Quantified Self: A Sociology of Self-Tracking.

Nafus and Sherman (2014: 1785) contend that self-tracking is an alternative data practice that is a form of soft resistance to algorithmic authority and to the harvesting of individuals’ personal data. They argue that self-tracking is nothing less than ‘a profoundly different way of knowing what data is, why it is important, who gets to interpret it [sic], and to what ends’. However the issue of gaining access to one’s data remains crucial to questions of data control and use. While a small minority of technically proficient self-trackers are able to devise their own digital technologies for self-tracking and thus exert full control over their personal information, the vast majority must rely on the commercialised products that are available and therefore lose control over where their data are stored and who is able to gain access.

For people who have chronic health conditions, for example, access to their data can be a crucial issue. A debate is continuing over the data that are collected by continuous blood glucose monitoring and whether the patients should have ready access to these data or only their doctors. As one person with diabetes contends on his blog, older self-care blood glucose-monitoring devices produce data that patients can view and act on immediately. Why should the information generated by the newer digitised continuous blood glucose monitors be available only to doctors, who review it some time later, when patients could benefit from seeing their data in real time? A similar issue arises in relation to the information that is collected on heart patients’ defibrillator implants. The data that are conveyed wirelessly to patients’ healthcare professionals cannot be easily accessed by the patients themselves. In jurisdictions such as the United States, the device developers are legally prohibited from allowing patients access to their data (see here).

There is recent evidence that the Quantified Self movement is becoming more interested in facilitating access to personal data for purposes beyond those of individuals. In a post on the Quantified Self website entitled ‘Access matters’, Gary Wolf comments that self-trackers have no legal access to their own data, which they may have collected for years. Nor is there an informal ethical consensus that supports developers in opening their archives to the people who have contributed their information. Wolf and others associated with the Quantified Self movement have begun to campaign for self-trackers to achieve greater access to the personal data that are presently sequestered in the cloud computing archives of developers. They argue for an approach that leads to the aggregation of self-tracked data in ways that will benefit other people than individual self-trackers themselves.

Some Quantified Self movement-affiliated groups have begun to experiment with ways in which self-tracking can be used for community participation and development. Members of the St Louis Quantified Self meeting group, for example, have worked on developing a context-specific app that allows people to input their moods and identify how certain spatial locations within a community affect emotional responses. They are also developing a Personal Environment Tracker that would allow St Louis citizens to monitor their own environmental impact and that of the community in which they live.

The Quantified Self Lab, the technical arm of the Quantified Self mvement, has also announced that it is becoming involved with citizen science initiatives in collaboration with the US Environmental Protection Agency (see here). It has now joined with the Robert Wood Johnson Foundation, an American philanthropic organisation focused on health issues, to work on improving people’s access to their personal data. Both groups are also collaborating with other partners on the Open Humans Network, which is aimed at facilitating the sharing of people’s details about their health and medical statuses as part of a participatory research initiative. Participants who join in this initiative are asked to upload the data that they have collected on themselves through self-tracking devices as well as any other digitised information about their bodies that they are able to offer for use in research studies. Part of the model that the Open Humans Network has adopted is that researchers agree to return to the participants themselves any new data that emerge from projects that use these participants’ information, and participants decide which of their data they allow others to access.

Beyond the Quantified Self movement, a number of initiatives have developed that incorporate the aggregation of self-tracked data with those of others, as part of projects designed to benefit both the individuals who have collected the data and the broader community. Citizen science, environmental activism, healthy cities and community development projects are examples of these types of communal self-tracking endeavours. These initiatives, sometimes referred to as ‘citizen sensing’ (Gabrys, 2014), are a form of crowdsourcing. They may involve the use of data that individuals collect on their local environs, such as air quality, traffic levels or crime rates, as well as on their own health indicators – or a combination of both. These data may be used in various ways. Sometimes they are simply part of collective projects undertaken at the behest of local agencies, but they may also be used in political efforts to challenge governmental policy and agitate for improved services or planning. The impetus may come from grassroots organisations or from governmental organisations; the latter construe it as a top-down initiative or as an encouragement towards community development.

Self-tracked data here become represented as a tool for promoting personal health and wellbeing at the same time as community and environmental development and sustainability. As these initiatives suggest, part of the ethical practice of self-tracking, at least for some practitioners, may involve the notion of contributing to a wider good as well as collecting data for one’s own purposes. Access to large data sets – rendering these data sets more ‘open’ and accessible to members of the public – becomes a mode of citizenship that is distributed between self, community and physical environment. This idea extends the entrepreneurial and responsible citizen ideal by incorporating expectations that people should not only collect their own, personal information for purposes of self-optimisation but should also contribute it to tailored, aggregated big data that will benefit many others, in a form of personal data philanthropy: self-tracking citizenship, in other words.

References

Gabrys, J. (2014) Programming environments: environmentality and citizen sensing in the smart city. Environment and Planning D: Society and Space, 32 (1), 30-48.

Nafus, D. and Sherman, J. (2014) This one does not go up to 11: the Quantified Self movement as an alternative big data practice. International Journal of Communication, 8 1785-1794.

 

 

 

 

 

Self-tracking practices as knowledge technologies

An edited excerpt from the concluding chapter of my book The Quantified Self: A Sociology of Self-Tracking.

As I have remarked in this book’s chapters, via the mainstream self-tracking devices and software that are available, certain aspects of selfhood and embodiment are selected for monitoring while a plethora of others are inevitably left out, ignored, or not even considered in the first place. Those aspects that are selected become more visible, while others are obscured or neglected through this process. The technologies themselves, including the mobile, wearable and ‘anti-wearable’ sensor-embedded objects and the software that animate them, tend to be the product of a narrow demographic of designers: white, well-paid, heterosexual men living in the Global North. In consequence, the tacit assumptions and norms that underpin the design and affordances of self-tracking technologies are shaped by these people’s decisions, preferences and values. Thus, for example, devices such as Apple Watch initially failed to include a menstrual cycle tracker as part of its built-in features (Eveleth, 2014); sexuality self-tracking apps focus on male sexual performance and competitive displays of prowess (Lupton, 2015); apps that use westernised concepts and images of health and the human body are inappropriate for Aboriginal people living in remote areas of Australia (Christie and Verran, 2014). How people from outside this demographic might engage or not with these technologies and how technologies might be better designed to acknowledge the diversity of socioeconomic advantage, cultures and sexual identities are subjects rarely pondered upon in the world of technology design …

At the same time as self-tracking practices are reductive and selective, they are also productive. They bring into being new knowledges, assemblages, subjectivities and forms of embodiment and social relations. In Chapter 2 I referred to the four types of technology identified by Foucault, which work together to produce knowledges on humans. Acts of reflexive self-monitoring involve all four of these knowledge technologies. Via prosumption, self-trackers generate data on themselves (technologies of production); they manipulate and communicate the symbols, images, discourses and ideas related to their own data and the devices that generate these data (technologies of sign systems); they are involved in strategies that are designed to assist them in participating in certain forms of conduct for specific ends (technologies of power); and all of these practices are overtly and deliberately directed at performing, presenting and improving the self (technologies of the self).

What is particularly intriguing about this expertise is that it both operates at the level of the ‘nonexpert’ (the self-tracker), where it is configured, and is inextricably interbound into the digital data economy and the forms of government regulation of the body politic. The authority of the knowledgeable expert on human life is dispersed among members of the lay public to a greater extent than ever before. However, the shared nature of this authority and expertise also undermines the power that self-trackers possess over their own information. Reflexive self-monitors are able to generate their own truth claims about trackers’ own bodies/selves, but these trackers are increasingly unable to control how these truth claims are used by other actors or what the potential ramifications for their own life chances and opportunities are once these data come under the control of others.

 

Pregnancy apps and gender stereotypes

Pregnant women and those experiencing the early years of motherhood have used online forums for many years to share experiences and seek information. Now there are hundreds of apps that have been designed for similar purposes. As part of an integrated research program looking at apps and other digital media for pregnancy and parenting, I have been researching these apps using several approaches. In a survey of 410 Australian women who were pregnant or who had given birth in the past three years, I found that almost three-quarters had used at least one pregnancy app, while half of the women who already had children reported using a parenting app (see here for an open access report on this survey and here for a journal article about it).

With Gareth Thomas from Cardiff University, I have also conducted a critical analysis of the content of pregnancy apps themselves. This involved analysing all pregnancy-related apps offered in the two major app stores, the Apple App Store and Google Play. We examined the app descriptions, looking for how the developers marketed their apps and what they offered. See here and here for articles that have been published from this analysis.

This study found that the apps designed for pregnant women represent pregnancy as a state in which women must maintain a high degree of vigilance over their own bodies and that of their foetuses. Many apps promoted this level of self-monitoring, often seeking to render the practices aesthetically-pleasing by using beautiful images of foetuses or allowing women to take ‘belfies’ (belly selfies) and share these on social media.

Among the most surprising of our findings were the large numbers of pregnancy-related games designed for entertainment. These include pregnancy pranks such as fake foetal ultrasounds to fool people into thinking someone is pregnant. We also found many games for little girls that are on the market. The encourage girls to give pregnant women ‘make-overs’ so that they will ‘feel more confident’ and look beautiful, ready for the birth. Some even let players perform a caesarean section on the characters, who remain glamorous and serene even on the operating table. The types of messages about pregnancy and childbirth that are promoted to their young female users are troubling.

Other apps are directed at men who are becoming fathers, although there were far fewer of these apps compared with those for pregnant women. We noticed from our analysis of these apps that even though quite a few of them are marketed as being written ‘by men, for men’, they typically portray the father as a bumbling fool, who requires simplistic or jokey information to keep him interested in the impending birth of his child. Men are advised not to stare at attractive women and to constantly reassure their partners that they find them attractive. Foetuses are compared to beer bottles so that men can learn about foetal development in supposedly unthreatening ways.

Our overall finding, therefore, is the highly stereotypical gendered representations of pregnant women and expectant fathers in these apps. Women are encouraged to use apps to achieve the ideal of the self-monitoring ‘good mother’, closely tracking their bodies because they have their foetus’s best interests at heart in every action they take. They are expected to celebrate their pregnancy and changing bodies – there is little room for ambivalence. Their male partners, on the other hand, are assumed to be uninterested and to require nudging to act in a supportive role to their partners.  And little girls are encouraged to accept and perpetuate the ‘yummy mummy’ stereotype in playing the pregnancy games that are marketed to them, and to view caesarean sections as a quick and easy way to give birth.

Living Digital Data research program

People’s encounters and entanglements with the personal digital data that they generate is a new and compelling area of research interest in this age of the ascendancy of digital data. Members of the public are now called upon to engage with a variety of forms of information about themselves and to confront the complexities of how these details are used by others. Personal digital data assemblages are configured as human bodies, digital devices, code, data, time and space come together.

 

Personal digital data assemblages smartart

Personal digital data assemblages

 

Over the past few years I have been researching the social aspects of personal digital data: how people understand and conceptualise these data, how they use their data, what people know about where their personal data go and how their data are used by second and third parties.I have analysed the metaphors that are used to describe digital data, the politics of digital data, the types of data that are collected by apps and self-tracking devices, how people use these software and devices and how personal digital data are materialised, or rendered into visualisations or three-dimensional objects. I have sought to theorise the ontology of personal digital data, drawing particularly sociomaterialism, feminist technoscience, cultural geography and sensory studies. (See My Recent Publications for further details.)

I am bringing these research questions together under a program that I have named ‘Living Digital Data’. This title builds on my conceptualisation of digital data as ‘lively’ in a number of ways.

 

 

Lively data smartart

Lively Data

 

 

The first element of the vitality of digital data relates to the ways in which they are generated and what happens thereafter. The personal digital information that is constantly generated contributes to data assemblages that are heterogeneous and dynamic, their character changing as more data points are added and others removed. Digital data may be described as having their own social lives as they circulate in the digital data economy and are purposed and repurposed. Second, digital data constitute forms of knowledge about human (and nonhuman) life itself and hence possess another type of vitality. Third, personal digital data have impacts on people’s lives, shaping the decisions and actions that people make and those that other people make about them.  The profiles constructed from these data can influence decisions about the opportunities people have to travel, access employment, credit or insurance, the people that they meet on online dating sites, the knowledges that they hold about themselves and their bodies and those of intimate others. Finally, personal digital data are forms of livelihoods, contributing to the commodification and capitalisation of information. Indeed, they may be described as a form of biocapital, which possesses many forms of value beyond the personal: for research, commercial, security, managerial and governmental agencies.

This approach recognises the entanglements of personal digital data assemblages with human action. Not only are personal digital data assemblages partly comprised of information about human action, but their materialisations are also the products of human action, and these materialisations can influence future human action.

Rather than refer to data literacy or data management skills, I take up the term ‘data sense’ to encapsulate a broader meaning of ‘data sense’ that includes human senses (sight, sound, touch, smell and taste) and how these are part of people’s responses to data and also acknowledges the role played by digital sensors in the act of ‘sense-making’; or coming to terms with digital data.

 

Data sense smartart

Data Sense

 

My 2015 publications

Here are my publications that came out in 2015.

Book

  • Lupton, D. (2015) Digital Sociology. London: Routledge.

Book chapters

  • Lupton, D. (2015) Digital sociology. In Germov, J. and Poole, M. (eds), Public Sociology: An Introduction to Australian Society, 3rd St Leonards: Allen & Unwin.
  • Lupton, D. (2015) Donna Haraway: the digital cyborg assemblage and the new digital health technologies. In Collyer, F. (ed), The Palgrave Handbook of Social Theory in Health, Illness and Medicine. Houndmills: Palgrave Macmillan.

Peer-reviewed journal articles

Report

  • Lupton, D. and Pedersen, S. (2015) ‘What is Happening with Your Body and Your Baby’: Australian Women’s Use of Pregnancy and Parenting Apps. Available here.

Medical diagnosis apps – study findings

Over 100,000 medical and health apps for mobile digital devices have now been listed in the Apple App Store and Google Play. They represent diverse opportunities for lay people to access medical information and track their body functions and medical conditions. As yet, however, few critical social researchers have sought to analyse these apps.

In a study I did with Annemarie Jutel we undertook a sociological analysis of medical diagnosis apps, and two articles have now been published from the study. Annemarie is a sociology of diagnosis expert and we were interested in investigating how these apps represented the process of diagnosis. We drew on the perspective that apps are sociocultural artefacts that draw on and reproduce tacit norms and assumptions. We argue that from a sociological perspective, digital devices such as health and medical apps have significant implications for the ways in which the human body is understood, visualised and treated by medical practitioners and lay people alike, for the doctor-patient relationship and the practice of medicine.

In one article, published in Social Science & Medicine, we focused on self-diagnosis apps directed at lay people. We undertook a search using the terms ‘medical diagnosis’ and ‘symptom checker’ for apps that were available for download to smartphones in mid-April 2014 in the Apple App Store and Google Play. We found 35 self-diagnosis apps that claimed to diagnose across a range of conditions (we didn’t include apps directed at diagnosis of single conditions). Some have been downloaded by tens or hundreds of thousands, and the case of WebMD and iTriage Health, millions of smartphone owners.

Our analysis suggests that these apps inhabit a contested and ambiguous site of meaning and practice. The very existence of self-diagnosis apps speaks to several important dimensions of contemporary patienthood and healthcare in the context of a rapidly developing ecosystem of digital health technologies. They also participate in the quest for patient ‘engagement’ and ‘empowerment’ that is a hallmark of digital health rhetoric (or what I call ‘digital patient engagement’).

Self-diagnosis apps, like other technologies designed to give lay people the opportunity to monitor their bodies and their health states and engage with the discourses of healthism and control that pervade contemporary medicine We found that app developers combined claims to medical expertise in conjunction with appeals to algorithmic authority to promote their apps to potential users. While the developers also used appeals to patient engagement as part of their promotional efforts, these were undermined by routine disclaimers that users should seek medical advice to effect a diagnosis. While the cautions that are offered on the apps that they are for ‘entertainment purposes only’ and not designed to ‘replace a diagnosis from a medical professional’ may be added for legal reasons, they detract from the authority that the app may offer and indeed call into question why anyone should use it.

In our other article, published in the new journal Diagnosis, we directed attention at diagnosis apps that are designed for the use of medical practitioners as well as lay people. We analysed 176 such apps that we found in Google Play and the Apple App Store in December 2013. While 36 of these were directed at lay people, the remainder were for medical practitioners. The Diagnosis article mainly concentrates on the latter, given that our other article was about the self-diagnosis apps for lay people.

Our research suggests that these apps should be used with great caution by both lay people and practitioners. The lack of verifiable information provided about the evidence or expertise used to develop these apps is of major concern. The apps are of very variable quality, ranging from those that appear to have the support and input of distinguished medical experts, specialty groups or medical societies to those that offer little or nothing to support their knowledge claims. While at one end of the spectrum we can see apps as a delivery system for information which has been subject to the conventional forms of academic review, at the other extreme, we see apps developed by entrepreneurs with interests in many topics outside medicine, with little input from medical sources, or with inadequate information to ascertain what the sources might be. The lack of information provided by many app developers also raises questions about how users can determine the presence of conflicts of interest and commercial interests that might determine content.

The cultural specificity of digital health technologies

Digital health technologies configure a certain type of practising medicine and public health, a certain type of patient or lay person and a specific perspective on the human body. The techno-utopian approach to using digital health technologies tends to assume that these tacit norms and assumptions are shared and accepted by all the actors involved, and that they are acting on a universal human body. Yet a cursory examination of surveys of digital health technology use demonstrates that social structural factors such as age, gender, education level, occupation and race/ethnicity, as well as people’s state of health and their geographical location play a major role in influencing how such technologies are taken up among lay people or the extent to which they are able to access the technologies.

An American study of the use of some digital health technologies using representative data collected by the National Cancer Institute in 2012, for example, found no evidence of differences by race or ethnicity, but significant differences for gender, age and socioeconomic status (Kontos et al. 2014). Female respondents were more likely to use online technologies for health-related information, as were younger people (under less than 65) and those of higher socioeconomic status. People of low socioeconomic status were less likely to go online to look for a healthcare provider, use email or the internet to connect with a doctor, track their personal health information online, using a website to track to help track diet, weight or physical activity or download health information to a mobile device. However they were more likely to use social media sites to access or share health information. Women were more likely than men to engage in all of these activities.

While there is little academic research on how different social groups use apps, market research reports have generated some insights. One report showed that women install 40 per cent more apps than men and buy 17 per cent more paid apps. Men use health and fitness apps slightly more (10 per cent) than women (Koetsier 2013). A Nielsen market report on the use of wearable devices found that while men and women used fitness activity bands in equal numbers, women were more likely to use diet and calorie counter apps (Nielsen 2014).

As these findings suggest, gender is one important characteristic that structures the use of digital health technologies. The digital technology culture is generally male-dominated: most technology designers, developers and entrepreneurs are male. As a result, a certain blindness to the needs of women can be evident. For example, when the Apple Health app was announced in 2014, destined to be included as part of a suite of apps on the Apple Watch, it did not include a function for the tracking of menstrual cycles (Eveleth 2014). Gender stereotypes are routinely reproduced in devices such as health and medical apps. As I noted in my study of sexuality and reproduction self-tracking apps, the sexuality apps tend to focus on documenting and celebrating male sexual performance, with little acknowledgement of women’s sexuality, while reproduction apps emphasise women’s over men’s fertility.

App designers and those who develop many other digital technologies for medical and health-related purposes often fail to recognise the social and cultural differences that may influence how people interact with them. Just as cultural beliefs about health and illness vary from culture to culture, so too do responses to the cultural artefacts that are digital health technologies. Aboriginal people living in a remote region of Australia, for example, have very different notions of embodiment, health and disease from those that tend to feature in the health literacy apps that have been developed for mainstream white Australian culture (Christie and Verran 2014). It is therefore not surprising that a review of the efficacy of a number of social media and apps developed for health promotion interventions targeted at Aboriginal Australians found no evidence of their effectiveness or benefit to this population (Brusse et al. 2014).

Few other analyses have sought to highlight the cultural differences in which people respond to and use digital health technologies. This kind of research is surely imperative to challenge existing assumptions about ‘the user’ of these technologies and provide greater insights into their benefits and limitations.

Quantifying the sexual and reproductive self

I have just had an article accepted for publication in the journal Culture, Health & Sexuality, to be published in a special issue on medical and health technologies. The article looks at mobile smartphone apps for self-tracking and quantifying sexual and reproductive functions and activities. A pre-print version is available here.

This is the abstract for the article:

Digital health technologies are playing an increasingly important role in healthcare, health education and voluntary self-surveillance, self-quantification and self-care practices. This article presents a critical analysis of one form of these technologies: mobile apps used to self-track features of users’ sexual and reproductive activities and functions. After a review of the content of such apps available in the Apple App Store and Google Play store, some of their sociocultural, ethical and political implications are discussed. These include the role played by these apps in participatory surveillance, their configuration of sexuality and reproduction, the valorising of the quantification of the body in the context of neoliberalism and self-responsibility and issues concerning privacy, data security and the use of the data collected by these apps. It is contended that the apps represent sexuality and reproduction in certain defined and limited ways that work to perpetuate normative stereotypes and assumptions about women and men as sexual and reproductive subjects. Furthermore there are significant ethical and privacy implications emerging from the use of these apps and the data they produce. The article ends with suggestions concerning ‘queering’ such technologies in response to these issues.

Update : This article has now been published – details here.

Self-quantification researcher network

Heather Patterson of New York University and I have set up a self-quantification and self-tracking research network. This forum is intended for anyone interested in the social, cultural, political, legal or ethical aspects of wearable technology, biosensors, digital health, mobile health, big data and algorithms, ubiquitous computing or similar topics.

Messages appropriate for the list include but are not limited to the following:
• Announcements of upcoming events/conferences/talks/seminars;
• Announcements of new or forthcoming publications;
• Invitations for research collaborations;
• Calls for conference or contributions to edited books or journals;
• Information about requests for grant proposals;
• Announcements for job openings that may be of interest to list members;
• Pointers to information on new, interesting innovations in this research area; and
• General comments or questions about relevant topics.
We welcome researchers of all disciplines, including media and cultural studies, internet studies, information privacy law, sociology, anthropology, philosophy, information science, business, medicine, and engineering; as well as colleagues working in advocacy, government, and industry. Please contact Heather at hp33@nyu.edu if you would like to join the list.