Total Recall: How the E-Memory Revolution Will Change Everything - C. Gordon Bell, Jim Gemmell (2009)

Part II

Chapter 5. HEALTH

‘Let’s have a look,” said the doctor.

I parted the baby-blue hospital gown to expose my chest, which was dappled with faint red blotches. The doctor peered at them appraisingly.

“Yes … well … they look a bit better, don’t they?” he said. “I think we can get you out of here by Saturday.”

It was the middle of August 2007, about a month after my second double-bypass surgery. I was in the hospital because those faint blotches might indicate a complication that could lead to another operation. I didn’t say anything, but I knew for a fact that the blotches had not changed. I knew this because I had been taking pictures of them daily with my digital camera and comparing them side by side on my PC.

The reason I kept mum was my desperation to be discharged by Saturday so that I could celebrate my birthday at home. I probably should have told him the truth, but I was miserable after almost a month of hospitalization and reasoned that I would start running a temperature if the situation became serious. The doctor, relying on his memory, discharged me. I got my wish for a birthday party at home, and the blotches eventually went away.

This episode illustrates how often professional health care strays from quantitative analysis. “How long have you had the fever?” asks the nurse, and I struggle to pick a likely time. “Do you recall what you ate before the migraine?” asks the physician, and I realize I have absolutely no clue. I was supposed to be noticing? Then there’s that pseudoquantitative classic: “On a scale of one to ten, how much pain do you feel?” Doctors hear plenty of vague and qualitative complaints: “I’ve been feeling run-down for weeks” or “I get these pains sometimes.” What a difference it would make if patients could follow their complaints with, “Here’s a graph of my temperature every hour for the past two weeks,” or “Here’s a time line of everything I’ve eaten in the last month, with times of migraines noted,” or, in my case, “Here are twenty photos of my rash, taken daily.”

In the Total Recall world, health records will be transformed into minutely detailed chronicles of vital signs, behavior, diet, and exercise along with physicians’ diagnoses, prescriptions, advice, and test results. Your e-memory software will make managing this total health record easy, and you will be healthier.


It was recently reported that a university study of more than forty hospitals and 160,000 patients showed that “when health information technologies replace paper forms and handwritten notes, both hospitals and patients benefit.” Neil R. Powe, M.D. from the Department of Medicine at Johns Hopkins University School of Medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research was the lead author on the paper announcing the findings. He said, “If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save a hundred thousand lives annually.”

Good information is central to good health care, and the old-fashioned paper-based system is inadequate. Most hospitals have not caught up with the efficiencies of our digital world. Many laboratory tests are performed needlessly because of missing paperwork. One study found that while the patient’s chart was available 95 percent of the time, 81 percent of return visits were plagued by missing information. RAND has estimated that the U.S. health care system could save an estimated $77 billion each year from the improved efficiency of electronic health records. Health and safety improvements double that figure.

The paper-based system is not just inefficient; it can be dangerous. In American private-sector hospitals and nursing homes, as many as one in five medications are given in error, harming at least one and a half million people every year, with 7 percent of those errors being potentially life-threatening.

Compounding the issue is a projected increase of chronic illness. We are in for an explosion of chronic ailments as the Baby Boomer generation passes into seniorhood through the 2010s and -20s. Eighty-eight percent of seniors have chronic conditions that require ongoing management and become increasingly expensive the longer they are left untreated. As the baby boom becomes the senior boom, our health record problems will multiply.

Thankfully, paper-based health systems are on their way to extinction. Health-care providers around the world are moving to electronic health records, keeping an e-memory of your medical records instead of paper. Being digital, they can be easily accessed, copied, or updated from anywhere within an institutional intranet or, in some cases, via the World Wide Web. The institution that maintains your records uses them to log every health-related event and transaction relating to you as a patient, from treatment records to consent forms to insurance billing to test results.

The United States Veterans Administration, which cares for the health of the nation’s ex-military personnel, has adopted electronic medical records and other computerized systems with fabulous results. It has almost eliminated prescription errors and the need to duplicate lab tests. Many private American institutions are also implementing electronic health records (EHRs). Kaiser Permanente is aiming to deploy the nation’s largest electronic medical records system by 2010, covering 8.4 million members, 431 medical offices, and 32 hospitals in 7 states. Hoping to shave down high costs of providing insurance for their workforces, a consortium of major companies, including Intel, Wal-Mart, and AT&T, are working to provide electronic health records for their employees.

State-run medical systems can dictate EHR adoption, and even the central storage of all information. The British National Health Service is mandating a move away from paper, with a central EHR system dubbed “the spine.” The European Union adopted an e-Health action plan in 2004, which includes e-prescriptions, e-referrals, and teleconsultations.

But while there has been considerable progress toward EHRs, a lot of work remains. The San Diego County Medical Society Foundation believed in 2003 that they were only a year away from a regional information network but, as of 2007, still remain “years away from full scale EHR adoption,” according to The San Diego Union-Tribune. In Santa Barbara County, a nonprofit organization was started in 1999 to set up EHRs in hospitals and doctors’ offices. However, when a $10-million grant ran out in 2006, the effort was abandoned.

One significant hurdle is demonstrating the value of EHRs to physicians. Fewer than a third of American doctors currently use electronic records. They rightly worry that promised savings may accrue in other parts of the health-care system, leaving them with no reward for their investment. And without an agreed-upon or even a de facto national standard, they may have to scrap or retool their electronic health records if they end up betting on the wrong format.

Worse, when different systems use different standards, it is difficult, and even dangerous, to share information. For example, the code “DPT” may stand for Demerol-Phenergan-Thorazine in one system but the Diptheria-Pertussis-Tetanus vaccine in another. Imagine being admitted to an emergency room and being dosed with a drug you’re allergic to because they misinterpreted the code in your record. And yet there are some twenty or thirty commercial electronic health records on the market, most of which use proprietary data formats. Many health-care providers have watched cagily from the sidelines, waiting for a standard to be set. Fortunately, it appears that waiting will soon end, as recent years have seen spreading standardization as well as software coming to market that translates between standards.

At the same time, some health professionals are exploiting unorthodox tools for organizing and sharing medical information right now. In a recent bit of serendipity, radiologists realized that they could use iTunes, Macintosh’s popular music-management program, to manage and organize PDF files just as easily as music files. For example, radiologists generally save medical reports as PDF files in folders on their PCs. If they want to compare images from several articles, they have to pull each one out “by hand,” so to speak, and lay them side by side. But iTunes can search, describe, and rate PDFs just like music files. The physicians can search and sort PDFs according to any desired criteria and publish their “play-lists” for other doctors to see, just like music lovers do with their MP3 songs. Bring up all X-rays of fractured tibias within the past year. Show me all herniated discs in people over age seventy-five stored in my PDF files.

Health-care providers employing PHRs will have decreased costs and better service. This will bring them more business, and force their competitors to adopt PHRs as well. All signs indicate we have already reached the critical mass needed to see personal health records become universal.


The typical American can access her bank account from ATMs around the world, check her e-mail from anywhere there’s a Wi-Fi signal, and go online to see charts breaking down exactly how energy is used in her home. But if she wants to look at her own health records, she’s out of luck. The little she can view online is incomplete and spread among many sites, and in any case, most of the relevant information exists only on hand-scribbled forms and printouts stuffed into a dozen manila file folders in a dozen far-flung offices around the country.

No one institution has the full picture of her health. The hospital has one piece of the puzzle, the specialist another, and the family doctor yet another. Her insurer knows everything that has been billed but lacks most of the details, and it has no idea about her out-of-pocket visit to the naturopath, the chiropractor, and the cosmetic surgeon. Factor in the dentist, the pharmacist, the gyne cologist, the dermatologist, and the therapist. Her current general practitioner keeps his own file on her, but everything he knows about her prior medical history consists of whatever she happened to remember (or misremember) on her first visit.

American health care has been fragmenting. Driven partly by technological advances and partly by the bottom-line focus of our system, hospital alternatives are popping up all over the place. Step right up and get your full-body MRI scan in the shopping mall. Measure your blood pressure at the pharmacy counter. Drive in and get your cholesterol measured. Come into the workplace clinic for free advice. Deliver your baby at home using this highly recommended midwife.

Clearly, only the individual is in a position to be at the hub of all his health information. Only you have the right to all your health e-memories. Indeed, you may log some aspect of your health that no one else has a need or right to see. You must take ownership of your health memories.

Seeing the need, software makers have already taken action. Quicken Health can track the state of all the financial transactions associated with health treatments. This is essential for billing and insurance information for the 88 percent of us who have some chronic health problem as we pass sixty, since every medical encounter generates many pieces of paper that we are likely to have to deal with.

Microsoft HealthVault is a free service that promises to warehouse and safeguard your personal medical information that can ultimately be shared with health providers. Google Health is another such utility. These services allow you to upload and manage your own health and wellness information and to authorize third parties to “blindly” upload data to your record, without being able to access the other information therein. The third party can be a person, such as your doctor, or an organization, like an insurance company, or a private clinic, or even a third-party software application. For example, you can have your weight and blood pressure stored to your HealthVault courtesy of software developed by the American Heart Association.

I think of HealthVault for health much in the same way as Quicken or Money for finances. My financial transactions come in different types, and so do my health records. Just as banks, credit cards, and brokers are combined under one database, records from each physician are aggregated into one database. Thus you become the keeper of all your records.

Someday, collecting all your health e-memories will be a snap; today it is a challenge. When I decided to pull together my medical information in 2001, my health records were strewn across four states. I collected my medical files from general-practitioner internists; heart, eye, and other specialists; dentists; several hospitals and clinics; and the half-dozen insurance companies that have covered me over the years. I ended up with more than a thousand pages.

None of the material was in digital form, even though much of it once lived on a computer. Some came by fax because that was deemed secure while e-mail wasn’t. Some was on large negative film, for example X-rays and MRIs. I scanned all the material into MyLifeBits. It included consultation records, doctor communications, surgical reports, immunization schedules and records, pharmacy orders, optical prescriptions, gum depth measurements, explanations of benefits, lab test results, receipts, electrocardiograms, pacemaker data, and echo stress tests. Several nuclear stress tests measuring heart blood flow on film and VHS tape had been discarded. Thus the only hard data about my heart over a long time period were lost. Luckily, a 1995 angiogram film of my heart’s vessel had been retained and was useful for the surgeon on the second bypass.

I had detailed physician statements about my heart, because my mother saved them, going back to a family physician’s letter observing a murmur when I was eight years old. I was immediately confined to my bed for that summer, followed by a visit to the Mayo Clinic.

In 1956, when I was in my early twenties, a cardiologist at the Massachusetts General Hospital reevaluated my situation. His prognosis: Go live a normal life without competitive sports. All through the sixties and seventies my general practitioner assured me that a cholesterol level of 230 was normal. Maybe so, but “normal” turned out to mean “bad” for me when I had a cardiac arrest on February 27, 1983, in Snowmass, Colorado. My friend Bob Puffer gave me CPR and saved my life. I spent the next ten days in a coma in Grand Junction. On recovery I was flown by helicopter directly to a double-bypass operation in Denver. There was some concern about impact to my brain, so the doctor asked me some post-op questions.

“Who is the president?” he asked.

“It doesn’t matter,” I replied.

My friends chuckled. Everyone knew I was right back to normal.

There’s nothing like a brush with death to motivate you to make changes. My heart attack lit a fire under me to start taking my health much more seriously, which included my record keeping and self-monitoring. It was one of the factors that fueled my interest in starting up MyLifeBits. I’ve been keeping my own records since then.


Many machines in hospitals spew out paper, or even worse, no record at all, just ephemeral blips on a screen. A whole day of data collection may be summarized in the record as just “normal” or “elevated.” Even in nominally stable vital-sign data there can be patterns or brief events that could have relevance to treatment or diagnosis. Why aren’t more health-monitoring devices integrated into the information network, with their results saved?

The technology has not been there for us, but it soon will be. Abundant storage means we can afford a complete health lifelog. There is already a trend to collect and keep more data from existing medical equipment. Even more exciting, a whole host of new biosensors are coming on the scene that will expand our knowledge almost beyond imagination.

Biometric sensors are moving from the clinic to your home—or wherever you are. Diabetics measure their own blood-glucose at home from a pinprick of blood. Asthmatics breathe into palm-sized devices that measure their airflow. Finger clips can measure pulse, blood and tissue oxygen, blood sugar, the proportion of red blood cells (hematocrit), and tissue acidity (pH.)

People with sleep apnea can now be monitored, at home, in their own beds, with a variety of devices. Apnea, or brief cessation of breathing during sleep, leads to heart disease and other chronic problems. A clinical sleep apnea test involves spending the night in the clinic, covered in wires, constantly watched over by staff via cameras above the bed. In contrast, in-home methods are being developed that use finger (or toe) clips and sensing wristwatches, with microphones and infrared cameras tracking movement but protecting privacy by not recording actual sound or images.

If you belong to a gym, you’ve probably seen fitness equipment that tells you your heart rate and how many calories you’ve burned. Get ready for many more fitness sensors. Nike and Apple have partnered to develop sensors in the soles of shoes that transmit to your iPod. During your run, the iPod displays your pace, distance, time, and calories burned. After the run, the workout information can be uploaded to a workout e-memories Web site. Some gyms also have cardio equipment such as treadmills or stair steppers that can send data to the iPod to record workout data.

I bought a BodyBugg, which you wear on an arm strap against your bicep. It measures temperature, heat flux, galvanic skin response, and acceleration. Heat flux indicates how many calories I am burning. Galvanic skin resistance measures tiny fluctuations in my sweating; it’s one of the main physiological signals used in polygraph “lie detector” tests, and indicates psychophysiological parameters such as stress, anxiety, arousal, and surprise. From this data, I get a report that includes my calories burned due to activity, calories burned during rest, physical activity levels (in METs) and durations, sleep duration, and sleep efficiency.

I’m also intrigued by experimenting with smartphones that come equipped with accelerometers and GPS units. GPS and wireless signals from cell phone towers and Wi-Fi hubs can track my location and movement, which is a highly relevant component of health data. Location data can tell me how much “bonus” exercise I net in my daily comings and goings and it can show me how close I’m coming to my recommended “ten thousand steps per day” plan.

People with congestive heart failure need to track their weight gain, which may signal an increase of fluid retention due to poor circulation. They are prescribed diuretics to shed the fluid. But if their weight gain is due to increased muscle mass, from working out at the gym as the doctor ordered, diuretics are the last thing they need. Thus, scales have been developed with a handle that passes an imperceptibly mild electric current from hand to foot. Changes in electric conductivity indicate the nature of the weight gain—fluid or muscle—so patients can discern whether their weight gain is harmful or beneficial.

Another way to get health data from me is to build sensors into my clothing. Researchers at Dublin City University, Ireland, are working on fabrics that can be made into shirts that track your breathing, or in your shoes to track your steps. They also have a treated fabric that, together with a small LED light and sensor, can be used to detect the PH level of your sweat—an indicator of dehydration. Their fabrics may also be used to detect your posture (another way to track posture is with cameras, such as Alexandro Jaimes and Jianyi Liu used to warn the user in front of a PC when an unhealthy posture has been held for too long).

In the future, the most amazing sensors will be implanted inside your body. Those of us with chronic ailments like diabetes or heart conditions are likely to have implanted sensors that wirelessly transmit their knowledge to another device outside the body, such as a cell phone or personal digital assistant. These sensors will not only stream our vital-sign readings to our personal health record but will continuously monitor them for troublesome or telltale patterns. Depending on the severity or risk, they will e-mail us alerts to follow up with our doctors as soon as possible, or immediately connect us to our doctor’s office, or even autodial 911 and send for an ambulance. Cardiac devices such as my pacemaker are already being equipped for wireless communication. They pass on values undetectable outside the body, including electrical activity, intraventricular pressures, blood flow, and ejection fractions.

All of your biosensors will communicate to have their data become part of your lifelog. Manufactures like Philips already sell a line of such devices for the home that wirelessly transmit to a hub that then can forward information to a health provider. I recently bought a Bluetooth-enabled bathroom scale that automatically sends my weight to my e-memory (in this case, HealthVault) where I can chart my weight-loss progress, or lack thereof, over time.

In addition to sensors, the reduced cost and increased convenience of some lab work will expand our health lifelog. For example, comprehensive blood sampling is becoming cheap and possible to do without large volumes of blood, enabling biomarker testing that can help identify the onset of many conditions, including cancer, cardiovascular risk, and autoimmune diseases.

In November 2008 I accepted an invitation, as a Microsoft employee, to participate in a landmark digital health research study called the Scripps Genomic Health Initiative. They asked me to send a DNA sample—via spit in a bottle—to San Diego for gene sequencing. The study is aimed at understanding if people will be motivated to make positive lifestyle changes such as exercising, eating healthy, and quitting smoking after receiving their personal genomics test report.

I believe more testing will become routine, and we will log all the details of each test, not just their summary results.

You don’t have to be a multiple heart-attack victim to see how much life quality, and even years of extra life, will be salvaged by recording how well your body is functioning. Then again, even multiple heart attacks can’t get me over my loathing for dealing with batteries. The hassle factor of changing batteries all the time is just too much. Here’s a word to the wise for all the miniature-device makers out there, whether it’s cell phones or cameras or medical devices that you wear. At minimum, a standard USB cable should both charge and upload data at the same time. And, yes, I said standard—enough of your special thirty-dollar cables and cradles. The ultimate solution is that I should just be able to toss my devices on a universal charging table that recharges them wirelessly through induction, while they upload their data wirelessly to a browser-accessible place in the cloud in a format a middle-school student could read.

My loathing of batteries keeps me from using my BodyBugg most of the time. But really, I should know from experience not to skip any biomonitoring. I used to wear a Polar strap around my chest when I bicycled so I could get just the right amount of exercise. Regrettably, I didn’t wear it during a biking trip in the hilly region around the French Riviera in April 1996. I was not fully recovered from the flu, but didn’t realize that would matter. After a day of biking and a lovely dinner, I awoke with a severe pain that I attributed to “heartburn.” In fact, it was a heart attack that needed immediate attention. I had overexerted myself. By not wearing the Polar strap, I’d left myself in the dark. The consequence—a blowout of part of my 1983 double bypass—was revealed in a stress test several months later.

We are only beginning to imagine what can be tracked with implanted sensors. Combined with wearable sensors, in-home sensors, and ever cheaper, more accessible laboratory tests, a whole new universe of quantitative health is dawning.


This chapter opened with a story about my doctor relying on his memory to gauge my improvement. But doctors aren’t the only ones with imperfect memories and filtered perception. Patients don’t hear half of what they are told by their physicians, even when especially important information is discussed. I believe it would be very useful to record these sessions with our physicians to aid our memories in these times of stress.

Just remembering to take your pills is a problem. People usually don’t forget painkillers, because pain is a potent motivator, and its own reminder. But overall, patients only take about half the medications prescribed to them. Have you ever taken your medications until you start to feel better, then quit taking them days or weeks before completing their course? Have you ever left your doctor’s office all revved and psyched up to eat a healthier diet, start exercising, or floss daily only to find the new habit lasts but a week?

The good news is that quantitative health can be a shot in the arm for motivating you to take care of yourself.

You are more likely to take your medications if you can see a chart that confirms the value of the medicine. What if you had a chart on your personal Web page showing your cholesterol going down week by week? What if you got quarterly imaging scans of your arteries so you could watch as plaque dissolves from improvements in your diet and exercise regime? What if you could observe your heart and lungs in a series of images, or your vital statistics trending up or down on a chart? Quantitative health data is already being used to motivate patients, and the practice will only expand.

Your personal health record combined with biometric lifelogging can be integrated with your complete e-memory. As with everything else in Total Recall, the more integration, the better. You should be able to find all sorts of informative correlations between your health data and seemingly miscellaneous other facets of your life.

Imagine if your e-memory presented you a chart revealing a high correlation between your entertaining a certain difficult relative and a trifecta of weight gain, poor sleep, and self-imposed social isolation for a week following each of his or her visits. You’d think, Wow, I had no idea it was so bad. Knowing this, and assuming you couldn’t avoid the person by dint of filial duty, you might at the least take pains to manage your exercise, eating, and socializing in the wake of those visits.

Or what if you could see in plain-as-day graphical form that 80 percent of the time when you order a red-meat entree at a restaurant, you become on average 30 percent less productive at work and half as likely to go to the gym the day after? Armed with such knowledge, you might cut back on red meat or redouble your vigilance against lame rationalizations for not exercising.

Or what if your e-memory gave you a chart showing a connection between moderate exercise and improved sleep? That will be more effective than generic advice or nagging to motivate you to get out and walk more because your own (digitized) experience will be telling you this.

In July 2008, a year after my second bypass, I felt some slight angina pains while walking to work in the mornings. This could mean that my arteries were getting clogged again, which would be extremely bad news. So I decided to log my weight, diet, exercise, and heart rate to see if I could glean any patterns. Would eating a dip or two of ice cream have repercussions? Were the tingles in my chest related to times or distance that I walked?

I carried a small GPS tracker on my way to work, measuring the distance walked and elevations encountered—remember, I live in San Francisco. I wore a Polar heart monitor and pedometer for a record of my heart rate and footsteps. The monitor makes suggestions for my weekly workouts based on height, activity level, and my weight. With GPS and a pedometer, it can download workouts from the Internet and keep track of all my exercise.

I used my BodyBugg to look up how many calories I’d burned in the past two days, or since breakfast, or in the past ninety minutes. I compared my average burn rates on weekends versus work-days. In the evenings I checked whether I’d burned more calories than I’d consumed that day, which I could use to justify a little ice cream.

I even made a point of wearing my SenseCam during meals to see if it could give me pictorial reminders of the food I ate, as opposed to what I remembered eating. How many shrimp did I really consume? What was on that snack table in the coffee room?

I learned that the angina was related to my food intake. By increasing my exercise and reducing fat even more, I was pain-free again after six weeks. Ice cream and even low-fat cheese are verboten, just as I had given up butter and foie gras in ’83 after my first bypass. I am becoming convinced that one can eliminate plaque with a regimen of diet and exercise, just as physicians like Dean Ornish claim. If only there were a way to easily measure that buildup.

The benefits of health lifelogging are irresistible: increased self-reflection and self-knowledge, less room for denial or half-conscious fudging on your diet-tracking or time spent at the gym, improving your health habits, helping you cope with or cut down on stress by identifying its causes, alerting you when you get swept away by negative passions, and saving your life by identifying incipient strokes, heart attacks, panic attacks, and other acute episodes.


Farther down this road, we will see the advent of the e-Nurse. Timothy Bickmore of Northeastern University has developed a virtual health coach called Laura. Laura is a computer-generated character who nods and raises her eyebrows as she engages in conversations with patients.

Laura has increased the physical activity of elderly patients by 100 percent, and is used to help schizophrenics stick to their medications. While e-Nurses can never be as good as real nurses in many ways, it turns out that patients are sometimes more comfortable asking questions of a virtual health provider, rather than taking up the time or asking potentially embarrassing questions of a real person. Besides communicating with patients using an animated character, e-Nursing can take place via text messaging, cell phones, chat sessions, or any electronically mediated form of communication.

With all this in mind, you should expect to hear stories like these soon:

Sara gets an e-mail from her family’s e-Nurse, recommending that she take her son, Alex, in for a checkup. The e-Nurse has noticed that Alex’s weight, wirelessly submitted from his bathroom scale each day, is tracking lower than expected. The e-Nurse suggests that this could be a side effect of Alex’s asthma medication. Alex also puffs into a meter each day, which has likewise been wirelessly transmitting his breathing flow, and his breathing has been excellent for several months. The doctor reviews the situation and suggests taking Alex off his medication.

Her sister, Gwen, has been sharing her moods and sense of well-being with her e-Nurse. The e-Nurse begins asking questions about her diet each day. After a few months, the e-Nurse suggests a link to wheat. Gwen is tested and discovers that she does indeed have a wheat allergy. Going off wheat radically improves her moods and energy levels.

Their father, John, lies down in his bed, and a wireless unit underneath the mattress communicates with his pacemaker, downloading the story of his heart for the day. Almost every month, his medication is slightly adjusted based on pacemaker data. Several times, a trend of his weight combined with heart activity leads to messages from his e-Nurse. The e-Nurse remarks that these episodes seem to follow times the RFID sensor in the fridge has tracked chocolate ice-cream purchases. John has believed he could get away with a “little bit” of his favorite dessert, and is chagrined to learn he cannot.

Our health care has been built on limited, spotty data. It reminds me of the guy building a house mostly by “eyeballing” it, with only rare use of his tape measure, level, or square. Health care with Total Recall is like a house that is built right.


Tremendous collective benefit will be gained from pooling personal health data. A population’s worth of personal health records will be invaluable in large epidemiological studies.

Location information can be essential in discovering health-related environmental factors. The great breakthrough in understanding cholera in the mid-nineteenth century came from associating it with certain water supplies. Who knows what great strides in epidemiology might be made based on correlations between health and location data? Add into the mix diet, exercise habits, social patterns, and literally hundreds of other dimensions of how people live, and you are assuredly looking at a tool for improving public health in the same league with the greatest modern-health achievements including germ theory, immunization, and antibiotics (not to mention plumbing).

You will soon be seeing massive health studies as never before, but they will no longer be high-maintenance, expensive endeavors Instead, medical scientists will be able to ask simply for ano nymized elements of people’s e-memories. Analyzing such data across thousands or even millions of individuals, they will be able to study correlations of a sort previously confined to speculation.

Some applications won’t be anything like what researchers have thought of as epidemiological study. Google is able to track the spread of the flu by noting when people enter words like flu symptoms, aches, sore throat, cough, and fever into the Google search engine. This simple act multiplied across millions of keyboards provides an early warning system for the spread of the flu about ten days before the Centers for Disease Control and Prevention has similar information collated from emergency rooms and health departments around the country.

Total Recall promises a revolution in personal and public health.