Technological innovation has always been integral to health and health care, contributing to the development and implementation of new possibilities for medical intervention in diagnostic , therapeutic and preventative modalities. In recent years, however, there has been a notable proliferation of medical technologies tailored to individuals, often drawing on developments in digital technology, and frequently for use outside ātraditionalā medical locations. We have termed these technologies āpersonal medical devicesā (PMDs) ādevices that are attached to, worn by, interacted with, or carried by individuals for the purposes of generating biomedical data and/or carrying out medical interventions on the person concerned. Such technologies have become increasingly significant in both clinical and extra-clinical contexts, creating new sites and occasions for intervention, and arguably extending the purview of medicine into other locations and aspects of everyday life. The general (if tentative and uneven) shift towards technological healthcare solutions in wealthy countries reflects the increasing sophistication and miniaturisation of personal devices themselves, in addition to wider shifts towards personalised, patient-centred medicine.
In recent years, policymakers have been increasingly drawn to technological solutions for pressing healthcare challenges, such as those presented by rising levels of multimorbidity and chronic disease in ageing populations. Wearable devicesāportable and often digital technologies that individuals attach to their clothing or skināhave frequently been seen as representing the promise of new medical technologies, both within and outside explicitly medical contexts. In 2015, the Medical Director of the English National Health Service (NHS), Bruce Keogh, stated that the NHS will engage in a āhuge rolloutā of wearable devices such as wrist-mounted heart monitors and gait-sensing polo shirts as part of a ārevolution in self-careā (Campbell 2015). New initiatives in this context include the NHS Test Beds, which will trial wearable and mobile health technologies for conditions such as diabetes and mental illness (NHS England 2016). Outside clinical settings, data -generating wearable technologies are big business. While phone companies now standardly embed activity monitors and health apps into our smartphones , corporations not only market wearables as useful and fashionable consumer devices (e.g. Apple Watch, Fitbit by Tory Burch), but also increasingly use them to monitor workforce activity and productivity (Rich and Miah 2016; Till, this volume). Consumer use of wearable devices for medical and wellness purposes has risen rapidly in recent years, with UK sales of wearables estimated to reach 5 million units in 2016 (from 3 million in 2015; WearableTech 2016). Groups such as the Quantified Self movement, in which individuals use technology to undertake self-tracking activities to improve daily functioning, reflect growing interest in the use of PMDs to improve wellness and postpone sickness outside clinical arenas (Dudhwala, this volume).
Influenced furthermore by the growing presence of notions of Big Data in public discourse, the burgeoning PMD field is advancing rapidly across multiple domains and disciplines. In fact, this advance is occurring so rapidly that our conceptual and empirical understandings of PMDsāwhat PMDs ādoā in different locationsāāand the wider clinical, social and philosophical implications that may result, often lag behind new technical developments and medical interventions. Experience of previous technologies attests that this state of affairs is by no means unprecedented. When the motor car was introduced to Britainās roads, for instance, a Royal Commission of 1906 (and subsequent parliamentary discussions) focused heavily on the nuisance caused by cars raising clouds of dust by the roadside (Hansard 1908). Other and more serious problems (e.g. accidents, road rage, gridlock, negative impacts on urban design) were either not foreseen or downplayed. As Matthewman (2011: 24) notes, what technology āactually doesā in practice is ānever a final accomplishment; it always remains an ongoing processā. Furthermore, with the digital revolution in computing, and by extension all the areas of life in which computing is relevant, perhaps we are all now āSunday driversā, as Jean Baudrillard Baudrillard (Baudrillard 2005: 214) puts itāpermanently mystified and baffled by the increasingly complex, powerful, miniaturised, interconnected, and ubiquitous technologies that we increasingly rely upon. As such, it is perhaps unsurprising that scholars have yet to take full account of the manifold complexities of PMD usage in a range of settings.
A key imperative facing academic explorations of PMDs is the need to avoid uncritically embracing (and thus reiterating) either side of the simplistic divide between techno-utopian and techno-dystopian discourses. This duality frequently characterises public discourse around new technologies and encourages views of PMDs as either clinical panacea or Orwellian threat. In order to take a more balanced approach that engages with usersā experiences of PMDs in practice, nuanced, critical, and empirically grounded approaches are needed to interrogate and understand emerging issues in this field. This is so both in terms of how people experience the devices themselvesāwhat might be termed the ethnography of technologyāand also what these experiences might mean for our wider, sociologico-philosophical understandings of self and society. There is room, that is, for social scientists to stake a claim in this emerging field and to ask important questions neglected by others. Furthermore, this area also provides much āmeatā for social scientists to chew on, bringing to the fore particular relationships, conceptualisations and socialities, which in turn may impact on how we, and our interlocutors, understand and ādoā health, medicine, and the body. This volume aims to contribute to such work and to illustrate some of the key issues and salient considerations to which future research in this field should attend.
PMDs as Conceptual Starting Point
In drawing together the varied interactions between individuals, technologies and health, we also seek to reflect the diversity of these devices and some of the different disciplinary approaches to technology itself, while still holding together a central cohesive narrative that runs through these. We do this by drawing upon the concept of PMDs to foreground discussion on the intersection between people, technologies and health, and particularly those devices focused on/personalised for the individual to contribute to their well-being. The development of new concepts, such as our notion of PMDs , often contributes to significant advances in particular fields, as seen, for instance, in Donna Haraway ās seminal exploration of the cyborg (Haraway 1991) and, more recently, in Ulucanlar et al. (2013) adumbration of the notion of ātechnology identitiesā. Such concepts facilitate both originality (in terms of facilitating new and innovative ways of thinking about things) and utility (in terms of providing a central analytical focus for empirical investigations; Corley and Gioia 2011). Through the concept of PMDs, we aim in this volume to enable the development of both incremental and revelatory insights by building upon and re-framing research on a range of technologies and in a range of disciplines, while simultaneously facilitating the emergence of new forms of understanding.
The concept of PMDs may be described as a portmanteau concept, bringing together a number of elsewhere separated aspects. We coordinate the terms āpersonalā, āmedicalā and ādeviceā in order to focus attention on technologies that may be ubiquitously present, in one way or another, in an individualās everyday environment as well as in clinical settings, and whose functions either include, or are entirely devoted to, the diagnosis , monitoring and/or treatment of illness (for āmedicalā devices) or the tracking of activity and biometrics (for āwellnessā devices, although these two categories of devices may not be straightforwardly separable). This approach consciously casts a wider net than many analytical approaches, since it includes devices that are both digital and non-digital in kind, and both medical and wellness in focus. Consequently, a smartphone app or pen and paper diary that an individual carries with them to monitor diet and exercise can be just as much a PMD as the latest digital activity wristband or cutting-edge medical device. Furthermore, the concept does not exclude any specific kind of interaction with the body: PMDs can be carried in clothing or baggage, worn on the body and implanted or ingested within it. As such, the silos that tend to characterise existing research on PMDs āe.g. research on wearables, āinsideablesā (implantable devices), āsmartā garments, smartphone apps and paper diariesācan be overcome by utilising a concept that unites these seemingly disparate technologies through their shared focus on personal wellness and its obverse, illness. This focus highlights a kinship between PMDs and other, more static and less ubiquitous medical technologies such as MRI scanners, intravenous drips, or even the traditional doctorās stethoscope. However, incorporating devices upon and within the body alters our engagements with technology in potentially different ways by questioning bodily boundaries, moving beyond Cartesian mindābody dualities and raising new issues of surveillance and trust . Thus, our engagements with PMDs proffer a distinctive kind of relationship, more intimate and potentially more angst-ridden, than we may experience with many other kinds of medical technology.
A further characteristic of our approach is a concern to interrogate each dimension of this portmanteau concept, such that āthe personalā, āthe medicalā and āthe deviceā each come under scrutiny. The āpersonalā nature of such devices is not solely limited to a particular user, for example, since PMDs usage typically relies on a wide range of sociotechnical networks incorporating multiple kinds of actors (e.g. carers, clinicians, policymakers, technologists, designers) and infrastructures (e.g. manufacturing capacities, national electricity supply, telecommunications networks). Similarly, the concepts of āthe medicalā and āthe deviceā are part of wider practices, networks and understandings. As such, the concept of the PMD does not seek to close off, delimit, orāas Steve Matthewman, citing John Law (1992), puts it in this volumeāāpunctualiseā individual PMDs as they are experienced in practice, but rather encourages the critical examination of wider dynam...