Do We Know Too Much About Ourselves?

Last week, Oura announced it filed for an IPO. The smart-ring maker reported $1.21 billion in revenue for the nine months ended June 30, up 74% from the same period a year earlier. Oura has over five million paid members. There is, apparently, a very large market for waking up and finding out how well you slept.

The news got me thinking about my own relationship with health data. I wore a Whoop religiously for a couple of years and it controlled my life before I rid myself of its high-performance knitwear handcuffs. I currently own an Eight Sleep, which while I strongly endorse based on my personal enjoyment, also collects data that I generally do not look at. Over time, I have become less convinced that knowing more about myself, more frequently, necessarily helps me live better.

But my skepticism comes with a confession. I live in a constant state of exhaustion. Every year, I go to my doctor for a checkup and complain that I am always tired. And every year, I pray the bloodwork will finally reveal a thyroid problem or a hormone imbalance that explains it.

I realize that is a strange thing to wish for. But a diagnosis might come with a treatment (or really, an easy solution). The explanation I keep getting, that I am tired because I do not sleep enough, requires the deeply inconvenient intervention of going to bed.

That is part of why I understand the appeal of the health-testing industry. A number can offer an explanation, something specific to work on. It can also offer permission to believe that the answer is more complicated than the one we already have.

Over the past few years, I have watched people organize their social lives around protecting a sleep score. A late dinner or an occasional night out with friends becomes a threat to tomorrow’s results. Eventually, the pursuit of better health starts to make their lives smaller. I admit, I was once a victim to this mindset. There is something peculiar about spending an evening alone so your wrist can congratulate you in the morning.

Sleep is important. So are friendships and having a life you enjoy. Those tradeoffs deserve more consideration than a datapoint can provide.

I want health information to help me make a decision worth making. Sometimes that means changing a habit or starting treatment. Sometimes it means sensible monitoring, reassurance, or deciding that a finding needs no intervention. Collecting information without that judgment can leave us with plenty to worry about and very little worth doing.

The same concern becomes more consequential when we move from sleep scores to blood tests and scans.

Function Health markets more than 160 lab tests annually, spread across initial and follow-up testing. It offers a much more extensive look at your biology than most people associate with an annual physical. Its appeal is obvious to anyone who has left a rushed appointment wondering whether their doctor really had time to listen.

I have never used Function or a similar testing service, but I can see why someone would. Making useful tests easier to obtain could help people identify risks and get appropriate care. A person whose test uncovers a treatable problem has every reason to be grateful.

Function also says clinicians review results, members receive explanations and summaries, and a healthcare provider calls about critical findings. I’ll call that meaningful support. The company says its service complements a patient’s existing medical care. The question I want answered is how reliably all those pieces connect once someone has a result they need help understanding.

Anyone who has opened a lab report knows the pull of a number marked outside the normal range. You can feel perfectly fine until the report gives you a reason to reconsider. Ignorance is bliss.

But a reference range has to be interpreted. Healthy people can have results outside it, and people with illness can have results inside it. Exercise, medications, timing and other factors can affect particular tests. A result acquires meaning through the patient’s symptoms, history and the reason the test was ordered.

At C.O. Bigelow, I see the desire to act on numbers most often in conversations with customers about supplements. Testosterone replacement comes up often too. Once someone believes a number needs improving, a product that promises to improve it becomes very appealing.

The important work happens before that purchase. With testosterone, for example, the Endocrine Society recommends diagnosing deficiency using compatible symptoms and consistently low levels, with repeat morning testing to confirm the finding. A number viewed in isolation does not meet the bare minimum standard.

A better-looking report is not, by itself, evidence of better health. Before we begin trying to move a number, someone should be able to explain what improving it is expected to accomplish for this particular person.

Whole-body scans (like the ones offered by Prenuvo) make the appeal of looking harder especially powerful. Who wants to miss a cancer that could have been found early? I certainly would not. The possibility of finding something treatable before symptoms appear is quite compelling.

The difficulty is that a scan can also find something harmless, something that would never have caused trouble, or something whose significance is unclear. An uncertain finding may lead to repeat imaging, specialist appointments or a biopsy. Those follow-up decisions can be reasonable once the finding exists, even when the benefit of doing the original screening scan was uncertain.

In its statement on “preventative” total-body MRI screening, the American College of Radiology says there is insufficient evidence to recommend it for people without symptoms, risk factors or a family history suggesting underlying disease. It also raises concern about nonspecific findings leading to unnecessary procedures and expense.

Finding an abnormality and helping a person are separate achievements. We need evidence about the second one before treating the first as an automatic success.

Medicine already accepts this principle in other settings. The U.S. Preventive Services Task Force recommends against routine blood screening for genital herpes in people without a known history or symptoms. False-positive results and uncertain benefit are part of the reason. In someone without symptoms, a false-positive result can create anxiety and stigma without providing a clinical benefit.

An unexpected result can cause irreparable harm to how someone feels about their body and their relationships without providing a clear path to better health. That possibility belongs in the decision to order the test.

I can already hear the reasonable objection: my doctor barely has time for me, I can afford the testing, and I would rather know. “We should be proactive, not reactive, with our health.”

I get it. Patients have good reasons to look for attention and answers elsewhere. A clinician who dismisses every concern creates an opening for a company willing to investigate all of them. Telling people to trust the system becomes a difficult pitch when the system keeps making them feel ignored.

But that failure is precisely why I want more responsibility from primary care. As I wrote recently in The Prescription Is Not the Care, patients are being asked to perform too much of the work of managing their own treatment. Extensive testing can add another assignment unless someone takes responsibility for what follows.

I believe testing should be chosen and interpreted by a clinician who owns the next steps. A signature on a lab order is only the beginning. The work includes deciding what to investigate, explaining uncertainty, arranging appropriate follow-up and checking whether the plan helped.

Patients should have access to their results and a say in those decisions. They should also have someone qualified to turn to when a result is frightening or confusing. Access to information should come with support worthy of the decisions it can provoke.

AI can help explain terminology and organize questions. Clinicians can use it as a tool, too. Whatever technology is involved, a named professional still needs to exercise judgment and take responsibility for the interpretation and follow-through. A reassuring answer on a screen does not establish that relationship.

I would judge these services by the quality of the decisions they help people make. Useful prevention deserves investment. So does the less marketable work of explaining why a finding can safely be left alone. A patient who leaves reassured, without another purchase or procedure, can still be an excellent outcome.

Giving up my Whoop was an acknowledgment that I had allowed a device to become far too involved in my life. I want to enjoy dinner with my friends without worrying about what my recovery score will look like tomorrow. Caring about my health should leave some room for enjoying it.

What worries me is how easily we can get accustomed to feeling that something must need fixing. A good night’s sleep needs confirmation. A normal result invites a search for a more optimal one. There is always another measurement available, and eventually we can spend so much time evaluating how we are doing that we barely notice how we feel.

I will keep going to my doctor and taking useful findings seriously. But I would also like to be able to feel well without having to prove it to myself every morning. Maybe we know too much about ourselves.

Giddy up!

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy