If Our Fitbits Were Plugged Into Us
Implanted AI health monitors are almost upon us
by Antonija Burčul
NEW YORK — The year is 2027. Annie, a 27-year-old software engineer in New York, is suffering from a genetically inherited immune illness that affects her thyroid.
Annie’s teenage years were a struggle, marked by anxiety attacks and chronic tiredness. That was until the arrival of Alfred, an artificial intelligence voice assistant. This landmark innovation, launched in 2020 by health company 3point14, combined wearable technology with DNA sequencing tools and biometric sensors. The device analyzes the wearer’s genome and monitors changes in her blood, her vital signs and her body’s response to food intake on a daily basis.
The most visible part of Alfred, which Annie nicknamed Alfie, is a wristband similar to a Fitbit. Unlike a Fitbit, though, Alfred is attached by invisibly small nano-needles to Annie’s skin. The patch can’t be felt by the wearer — it more resembles a tattoo than a circuit board. But linked to this minute plug-in are several computer chips implanted in Annie’s body to act as sensors, monitoring things like bacteria in her gut and skin.
The chips also send out tiny polymer particles — thousands of times smaller than a human hair — into Annie’s bloodstream. The particles, covered in hooks, bob through her circulatory system like tiny underwater probes. These are Alfred’s main monitoring system: When a particle encounters its target (for instance, a protein carrying iron, a shortage of which would suggest anemia), it lights up and emits a signal back to the chip, which takes a reading from the number of signals.
Alfred is a more advanced version of wearable devices that were developed back in 2016, including one patented by Google that year to fight cancer. They were clunkier then, sending data back to a lab computer, but all the building blocks were already there.
Meanwhile, in 2027 Annie was promoted to head up a new engineering team, and her responsibilities greatly increased. Her stress levels rose, she began to gain weight, and her thyroid hormone blood values grew to dangerously high levels.
Those reactions prompted Alfie to issue a warning. A message appeared on Annie’s wrist bracelet telling her to follow a strict set of guidelines or else her insurance premium would rise significantly, as the risk she would need to take medication increased.
For Alfie was also connected to Annie’s Aetna health insurance, which now was able to adjust regularly as it made live assessments of her lifestyle. Overloaded with work, though, Annie didn’t take Alfie’s daily advice too seriously, until a second warning came in.
“Annie, your current data suggests increased inflammation in your gut,” the message said, this time heard inside Annie’s head wired through her nervous system. “Please take these supplements to improve the health of your gut bacteria and strictly adhere to the dietary plan. If you do not adhere to your 3point14 “Happy Body” plan, your premium will rise by 28.5 percent to $257 a month.”
The warning scared Annie. She has heard about the risk of ignoring AI assistants when they go into the warning mode. One of Annie’s friends with diabetes had seen her premiums skyrocket after ignoring a warning.
Your AI assistant will see you now
In the decade up to 2027, AI assistants had progressed from performing mundane daily tasks, like turning on the lights and playing music, to becoming health coaches and medical advisers. They were very effective, helping reduce the prevalence of a range of lifestyle diseases, like Type 2 diabetes, by up to 40 percent.
Wearable health technologies had moved from step-tracking fitness bracelets, like Fitbit, which in the early days were often discarded after a few uses, to chips implanted under the skin and capable of speaking to users through sophisticated brain-computer interfaces.
Sufferers of autoimmune disorders, where a person’s own immune system begins to attack itself, particularly benefited from the new tools. In 2016, thyroid conditions were among the most prevalent autoimmune conditions, affecting more than 20 million Americans and ranking at the top of the list of conditions requiring prescribed medications. Left untreated, such conditions caused depression, anxiety and huge weight gains that proved difficult to reverse, contributing to the global obesity crisis.
Previously, the variety of autoimmune symptoms had made it extremely difficult to combat the condition. Machine-learning algorithms changed that. The algorithms were able to sort through huge amounts of data collected from patients through their wearables to find common patterns in people’s symptoms and genetic profiles, allowing them to group suffers into useful categories. In this way, the machines were able to predict the most effective prevention plans for each patient, eventually leading to the virtual disappearance of such illnesses.
“Less than 5 percent of people using our system come to the point where they need to be put on medications, and 95 percent of them successfully return to their prior condition in less than a year,” said Joanna Kolonikowsky, the chief AI officer of 3point14, the maker of Annie’s device.
Partnered with several of America’s largest insurance companies, 3point14 rapidly became a fixture of Americans’ daily lives, along with its slogan: “Life is as easy as pie!”
Pharma fights back
But the advance of the AI health monitors was not easy, however. While the health benefits of AI assistants like Alfie were clear from the start, the health care industry was not universally in favor of the new technology.
The success of AI assistants actually hurt the profits of several big pharmaceutical companies, as many chronic illnesses became scarcer. An intense lobbying campaign and efforts in the media from the pharma companies saw some like 3point14 repeatedly called before hostile congressional commissions, and several states initially passed blanket bans on the wearable devices.
Just as disruptive services like Uber, Airbnb and Skype provoked radical changes in the regulatory landscape as the public took to them in the 2000s, the mass use of AI health assistants also set the pace of government regulation, often getting ahead of it.
Despite broad public acceptance of the tools, not all AI companies behaved responsibly. Some sold their patient data to marketing companies, effectively providing companies with a live feed of their clients’ bodies. Annie noticed it when she realized that her social media profiles were filled with tampon ads right before her period was supposed to start.
The U.S. Food and Drug Administration responded by creating a legal framework where the sole owners of the health care data were the users themselves, and it also sought to tighten up the legality of monitoring. A number of punishing lawsuits chastened the industry, but suspicions that companies were still secretly exploiting people’s health data persisted.
Most controversially, the devices worsened the gap in access to health care in the U.S. Insurance companies supplied AI monitors like Alfie for free, along with cheaper premiums. Though wearing the devices was technically not mandatory, premiums were automatically far higher for those who didn’t wear them or chose not to wear them constantly. At the same time, cut-rate insurers provided cheaper devices that provided far less effective treatment recommendations while still imposing penalties for ignoring them. Many of those already ill were forced to simply go uninsured.
Some people suffering from long-term illnesses also resisted wearing the devices out of fear their employers would find out. Trying to appeal to them, companies ran campaigns targeting such people, including offering the devices for free and creating support programs, which were very successful for some health conditions. HIV charity BloodFree’s “get implanted” week this year saw hundreds of people get devices in New York. For those suffering from conditions like AIDS, the devices meant fewer visits for checkups at the doctor.
Annie was a part of the support program for people with thyroid conditions. Her own feelings about her device were mixed. When she was able to obey it, she noticed she felt physically better. Her treatment was better organized, and she felt it let her live a more normal life. But its warnings were stressful, and its connection to the insurance companies made her feel powerless.
In any case, not wearing it no longer seemed much of an option — it was unavoidable.
References
1. Google Nanoparticle Phoresis patent https://patentscope.wipo.int/search/en/detail.jsf?docId=US130905048&recNum=13&maxRec=14852&office=&prevFilter=&sortOption=Pub+Date+Desc&queryString=PA%3AGoogle+&tab=NationalBiblio&
2. Lunshof et al. From genetic privacy to open consent, Nature Reviews Genetics, 2008.
