Smart Toilets and the Endless Spread of Health Surveillance

The unexamined poop is not worth taking, according to the country’s finest entrepreneurs.

“The average human being has a total of zero sensors, whereas your car has maybe up to 400 sensors,” a health researcher recently told NPR’s Marketplace. “We want [the human body] to be like a car dashboard, where your engine light goes on when something is off.”

He may soon see his dreams come true. A bevy of so-called “smart devices” is invading the marketplace, promising to monitor us closely, intimately—invasively?—and continuously, and alert us to what ails us. Consumers seem eager to load up on health sensors, and this raises many questions. What is the appeal in said devices? What exactly do they help people see, which they were not seeing before—and what do they still ignore or overlook? Also, who else benefits from our fascination with these devices?

Wearable health sensors come in a dazzling variety of forms and functions. For example, there is an impressive array of “sleep tech” gadgets on offer. So many, in fact, it suggests we are obsessed with achieving optimal rest—indeed, studies bear out that Americans are quite sleep deprived. There are interactive pillows, which sense if you are tossing and turning, and adjust themselves accordingly; they can even emit white noise to help you drift off. There are smart mattresses that monitor your heart rate and body temperature, keep track of when you enter REM sleep, or notice when you snore, and issue a detailed report every morning. And the Muse S Brain Sensing Headband “gives real-time feedback on your brain activity… breathing, and body movements.”

If you want an even more thorough—and intimate—view of your body, the smart toilet can help. It will keep track of your “output,” analyze it, and issue reports. Your smart toilet can even make specific recommendations; it might suggest that you “add more salmon to your diet,” one manufacturer explains. All of the information will be conveyed directly to your cell phone. 

Imagine yourself in the future, sitting through a meeting at work when your phone dings. It could indicate a message from your spouse, or an update on your stock portfolio, or the latest CNN headline—or maybe it’s your toilet making a particular lunch suggestion. This could prove uniquely helpful if you are one of the millions of Americans whose diet is less than optimal, fending off hypertension, obesity, or heart disease. In many ways, convenience got us into this mess—think fast food, for example. Now, the convenience of smart devices promises to get us out.

Evangelizers for smart toilets at Stanford’s School of Medicine say health wearables are a key feature of “continuous health monitoring” afforded by digital technology. Previously, you would go to the bathroom, flush, and forget. But no longer. Now, every emission is a potential treasure trove of vital information.

Health surveillance is insinuating itself into our more traditional accessories, too, and may soon become a fashion must-have. Reports suggest the new model of Apple’s AirPods will be outfitted with health monitoring capabilities (Apple has not released full details on this product yet). Supposedly, the AIrPods will use “ambient light sensors” to “monitor heart rates, step counts, health conditions, and… detect head motions”—even perspiration levels, too. The AirPods may also act like clip-on finger pulse oximeters, measuring your blood oxygen level from your ear. 

As health monitoring devices become more stylish, this will make them even more appealing and popular. I dare say it may become an essential fashion statement to declare your health consciousness, and advertise it to the world. 

In that case, the sleek new Oura Ring—available in titanium or gold—will be a hot commodity. Worn on your finger at all times (except for when you periodically charge it), the Oura detects deviations in your biometric data. One reviewer marveled at how it noticed her ever-so-slight temperature drop before her period began. She was so impressed she decided to wear it always, though she couldn’t be bothered to don her own wedding band. 

Thanks to its ability to detect slight changes in body temperature, Oura has become the “wearable of choice” during COVID, revealing incipient outbreaks and telling people they were sick before they realized it. “I don’t really think I could convince people to wear an indwelling rectal probe for a week,” one health professional quipped. “But getting them to wear an Oura Ring for a week is a piece of cake.”

The NBA was so impressed by Oura’s potential to catch COVID outbreaks, it bought the device for all its players. Selling at $300 apiece (or $1000 for the diamond-studded version) and now modeled by basketball stars, I suppose Oura will make health surveillance a status symbol. This will please former NBA stars Shaquille O’Neal and Manu Ginóbili, since they are investors in Oura Health Limited. 

Founded by Finnish entrepreneurs in 2013, and now boasting an American CEO and headquarters in San Francisco, Oura initially marketed its ring—its sole product—to monitor sleep patterns. COVID looks to have changed, and elevated, the company considerably. Not only does Oura provide unmatched precision in gauging body temperature, but it also tracks slight movements throughout your day to detect total calorie burn, including your basal metabolic rate. It’s an illustration of how health surveillance’s spread (across both the planet and the various aspects of our lives) is proceeding at startling speed. 

This is purely for our own good, advocates tell us. “[Your] health is unique to you and requires long term measurement and personalization,” CEO Harpreet Rai puts it. “Oura is using data to reconnect people with their body.” It seems more apt to say Oura offers a totally new connection with the body, rather; most of us were not attuned to slight body temperature changes, after all. Rai claims this is uniquely empowering: “Giving consumers more control over, and insight into, their health is the future and Oura is leading the way.”

It may be less empowering, however, if we consider some vexing questions about the broader field of health surveillance. For example: will it become a full time job, managing the constant stream of biometric data from our many sensors? I imagine we will have a lot of information to study up on, and fret over. It could take a considerable part of our day just to read up and be apprised of our wellbeing. How shall we make sense of all the data? If we are indeed overloaded with information, and alerted to slight variations in our body temperature, it might be hard to know what it means—and what is serious, or not. How will we know what is normal, aberrant, or really, truly urgent? On this, Rai and company are notably silent.

Isn’t this an invitation to obsess over every health indication, no matter how trifling or minute? Will we become neurotic hypochondriacs of the highest order, scouring the data of our smart toilets and fretting over the slightest temperature bump that Oura detects? Again, crickets from the entrepreneurial class.

Health surveillance might cause as much trouble as it roots out. I never knew to worry much about my body temperature, if I was suddenly hot and sweaty, or chilled—or neither. Now I might think it is the onset of disease. The stress will not help my blood pressure. And I may have a hard time sleeping, worrying over the reams of sleep data—and the accompanying advice. Am I lying in the right position? Am I breathing correctly? Is this deep sleep—or not? Am I rested?Seriously, is this optimal restfulness?! This seems like an ambiguous goal, to say the least; when I was a new parent, five hours of sleep seemed like a boon. Or so I thought. I guess my body was lying, but Oura will wring out the truth. 

And then, of course, we mustn’t forget that health surveillance is not only, or even principally, for us. There are other interests who would eagerly listen in and monetize what they learn. It’s ironic that Oura’s CEO sells his product on the promise of autonomy. The data delivered is highly sensitive; it is precisely the stuff corporate spies could use to manipulate us. 

What if marketers learn that I am sleep deprived? Fatigue makes us prone to snacking—Doritos might double down on tempting me. Or what if my health sensors suggest I am struggling to lose weight, and not always winning the battle? This is a constant insecurity to play on, and take advantage of. An adroitly placed bathing suit ad, timed to induce maximum guilt, could be followed by health food promotions.

Who knows what else our bodies might betray about us when they are monitored by myriad devices? A wife could tune in to her husband’s heart rate; she might be alarmed to discover, when he is out of town, that it suddenly soars late at night. What could he be up to? And with whom? What if another agent accesses this information? Might it be grounds for blackmail? To paraphrase the late Joseph Heller, just because this sounds paranoid doesn’t mean it’s not plausible.

Health surveillance is nefarious because we will be especially keen to sign up for it. It may be a matter of life and death, after all. Thus, we will invite the most invasive kind of spying, where our spies take up residence within our very bodies—at our behest. 

Perhaps we will feel we have little choice but to hook up our bodies to smart devices. Enveloped in this digital economy that moves at warp speed, we cannot be bothered to pay attention to our diet and sleep habits. We will have to rely on outside monitors. Or perhaps we might feel we need said devices to give us the edge to climb to the top, stay ahead of the pack (or simply to keep up). I can be my most rested self at work, and zero in on the task at hand. I can be stronger and fitter than my co-workers and competitors. I can work longer hours, a more grueling schedule. I can tease out the very moment I am coming down with something—before symptoms emerge—and treat it preemptively, while others are mired in sickness. I may become (or at least feel) unstoppable.

It occurs to me these health devices offer quite the opposite of a connection with our bodies. After all, they relieve us of the task of listening to them. They deny us a crucial art and important life skill. We can toil along, and blithely ignore our most proximate sensors—those under the skin—opting instead to heed a smart toilet or Oura ring. 

I realize our native sensors are often not easy to hear. I realize they are often muffled, muted, slow, stubborn, and unreliable. Such are the wages of mortality, however. We are, each of us, lashed to an imperfect vessel. When we ignore or neglect this fact, tragedy often ensues. We push ourselves too hard, we overlook suffering, we make unreasonable demands, or we yoke ourselves to cruel ideals. The path to contentment, the philosophers agree, starts when we are reconciled to our imperfections—and the unavoidable, and sometimes exquisite imperfections of life.

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