Power to the people: on spreadsheets

Now here’s something to stop you dead in your tracks: apps that measure sexual performance. Wow. Or as Homer Simpson would put it “Doh!”

Of course. Self-tracking sex apps (like ‘Spreadsheets’ illustrated here). Slip your smart phone under the pillow and it will measure how often, how deep, how loud.

Then upload your data and get your Don Juan rating. Obvious but unthought of. At least by me. And probably you. Till now. But now you know.

For some reason these apps seem to be mainly aimed at men. Can’t think why. The apps for women in this area are more about tracking your fertility, your responsiveness. 

Either way, another black box cracks open under the steely gaze of your smart phone – also known as Everyman’s and Everywoman’s personal Panopticon.

What you had thought was hidden, personal, warm, private, wet, messy, loving, mutual, biological becomes quantified, cool, social, competitive, digital.

And suddenly you’ve got Big Data in bed with you looking at you with its big appy eyes. After all, your data wants to be shared doesn’t it? Just like soft little puppies want to be played with. For what’s the point of doing anything – even sex – in today’s world if you don’t share it with everyone?

Share, but don’t expect anything back

Of course, later, you may feel different. A certain post-upload tristesse may set in. Shooting your wad of data into the cloud is always a one way street. Social media may seem like the essence of give and take but when it comes to commitment issues online is unforgiving.

The data upload function is way more effective than the ‘please forget all about me’ function. You ain't going to get no satisfaction when it comes to getting off of this cloud.

This involuntary sharing of personal information runs all the way from the tiny tithe of personal information that Google extracts from every search we make, through the impossibility of controlling our online identities, out to the siren calls of care.data.

Arising from it is something that Deborah Lupton, an Australian researcher, calls ‘participatory surveillance’ in a paper analysing sex apps. By this, she means the process by which we willingly undertake our own measurement and so internalise our own policing.

It may be tempting to think of participatory surveillance as a conspiracy of them against us but in truth we are entirely complicit. We can’t wait to know how we measure up, how many followers we have.

So it is we, unbidden, who are uploading the lat and long of our lives, the precise coordinates of our desires and the intricacies of our intimacies.  If we are to be fully exist in the 21^st century, then it seems we must not only be seen, measured and compared; but submit willingly to the process.

This is not just happenstance. The brain is, above everything else, a social organ. So give it a million new ways to be social via the web and you’re probably going to get something that looks a lot like participatory surveillance no matter who is in charge.

An appy era for medicine

Where does all this leave medicine? Well, being optimistic, it could lead to a new ‘mutual medicine’, in which healthcare provision is shaped in positive ways by the forces of social media and participatory surveillance.

In this vision, telemedicine takes off when it is embedded in social media – not commissioning. And forget all that health promotion stuff. The savings that depend on people not doing drugs, drink or donuts will only start rolling in when groups of people use self-tracking apps to share their progress with friends and using effective ways to allocate public approbation – or shame – via social media.

Best of all, NICE and the whole shambolic purchaser-provider split could be disintermediated by MOODOCs – Massive Open OnLine Disease Orientated Communities – where large self-regulating communities of patients, clinicians and researchers decide on and implement minimum standards of care for each condition within an agreed budget envelope.   

There are of course many ways in which this could go. A pharma-funded future looks very different to one built around patient-clinician communities. But look at the sectors where this citizen-led, peer-to-peer process is more advanced – journalism, music, banking, MOOCs and the universities – and it is clear that most of this will happen outside the citadels of medicine.

Medicine in the social age will likely be built despite politicians and professionals not because of them.  So look not to what medicine can do for the people but to what the people are going to do to medicine.

Paul Hodgkin

Paul Hodgkin is founder and chair of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield.

Until 2011, Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.