Experiencing objectified health: turning the body into an object of attention

Empowerment: Freud, Canguilhem and Lacan on the ideal of health promotion

Empowerment is a prominent ideal in health promotion. However, the exact meaning of this ideal is often not made explicit. In this paper, we outline an account of empowerment grounded in the human capacity to adapt and adjust to environmental and societal norms without being completely determined by those norms. Our account reveals a tension at the heart of empowerment between (a) the ability of self-governance and (b) the need to adapt and adjust to environmental and societal norms. We address this tension by drawing from the work of Freud, Canguilhem, and Lacan. First, we clarify through a discussion of Freud's notion of sublimation that it is difficult to assess empowerment independent of any social valuations, but also that it is no less problematic to make it dependent on social valuations alone. Second, we draw from the work of Canguilhem to show how empowerment can be understood in terms of the individual's capacity to tolerate the aggressions of a multiplicity of environments. Third, using Lacan, we show how empowerment requires incorporation of social and symbolic norms, without necessarily rendering ourselves a mere product of these norms. Finally, we demonstrate how the views of these authors can complement one another, resulting in a more sophisticated understanding of empowerment.

The health digital twin to tackle cardiovascular disease-a review of an emerging interdisciplinary field

Potential benefits of precision medicine in cardiovascular disease (CVD) include more accurate phenotyping of individual patients with the same condition or presentation, using multiple clinical, imaging, molecular and other variables to guide diagnosis and treatment. An approach to realising this potential is the digital twin concept, whereby a virtual representation of a patient is constructed and receives real-time updates of a range of data variables in order to predict disease and optimise treatment selection for the real-life patient. We explored the term digital twin, its defining concepts, the challenges as an emerging field, and potentially important applications in CVD. A mapping review was undertaken using a systematic search of peer-reviewed literature. Industry-based participants and patent applications were identified through web-based sources. Searches of Compendex, EMBASE, Medline, ProQuest and Scopus databases yielded 88 papers related to cardiovascular conditions (28%, n = 25), non-cardiovascular conditions (41%, n = 36), and general aspects of the health digital twin (31%, n = 27). Fifteen companies with a commercial interest in health digital twin or simulation modelling had products focused on CVD. The patent search identified 18 applications from 11 applicants, of which 73% were companies and 27% were universities. Three applicants had cardiac-related inventions. For CVD, digital twin research within industry and academia is recent, interdisciplinary, and established globally. Overall, the applications were numerical simulation models, although precursor models exist for the real-time cyber-physical system characteristic of a true digital twin. Implementation challenges include ethical constraints and clinical barriers to the adoption of decision tools derived from artificial intelligence systems.

Limiting medical certainties? Funding challenges for German and comparable public healthcare systems due to AI prediction and how to address them

Current technological and medical advances lend substantial momentum to efforts to attain new medical certainties. Artificial Intelligence can enable unprecedented precision and capabilities in forecasting the health conditions of individuals. But, as we lay out, this novel access to medical information threatens to exacerbate adverse selection in the health insurance market. We conduct an interdisciplinary conceptual analysis to study how this risk might be averted, considering legal, ethical, and economic angles. We ask whether it is viable and effective to ban or limit AI and its medical use as well as to limit medical certainties and find that neither of these limitation-based approaches provides an entirely sufficient resolution. Hence, we argue that this challenge must not be neglected in future discussions regarding medical applications of AI forecasting, that it should be addressed on a structural level and we encourage further research on the topic.

Interpreting fitness: self-tracking with fitness apps through a postphenomenology lens

Fitness apps on mobile devices are gaining popularity, as more people are engaging in self-tracking activities to record their status of fitness and exercise routines. These technologies also evolved from simply recording steps and offering exercise suggestions to an integrated lifestyle guide for physical wellbeing, thus exemplify a new era of "quantified self" in the context of health as individual responsibility. There is a considerable amount of literature in science, technology and society (STS) studies looking at this phenomenon from different perspectives, linking it with the sociology of self-surveillance and neoliberal regimes of health. However, the human-technology interface, through which the micro- (behavioral) and macro- (social) aspects converge, still calls for extensive examination. This paper approaches this topic from the postphenomenological perspective, in combination with empirical studies of design analysis and interviews of fitness apps, to reveal the human-technology link between the design elements and people's perception through the direct experiences and interpretations of technology. It argues that the intentionality of self-tracking fitness app designs mediates the human-technology relations by "guiding" people into a quantified knowledge regime. It shapes the perceptions of fitness and health with representations of meanings about a "good life" of individual success and management. This paper also gives a critique of current individual, performance-oriented fitness app designs and offers the possibility of seeking alternatives through the multistable nature of human-technology relations-how altering interpretation and meaning of the design with a cultural or social context could change the form of technological embodiment.