Behavioral surveillance is coming to America via the cell phone. Positive psychology and well being are coming to American healthcare via Obamacare which incentivizes the implementation of wellness programs. Together they are dramatically increasing the volume of personal data collected on ordinary citizens and exposing those citizens to targeted messages, incentives and interventions designed to modify the thoughts, feelings and behaviors the surveillers (aka thought police) want to encourage. And, the genius of this system is that the citizens are voluntarily choosing to be surveilled and modified.
Today these systems are being applied to healthcare but the robust venture funding for these applications suggest the backers have already begun to imagine extending the reach to product promotions, politics, preventive policing and national security.
Take a look at ginger.io, a product of the MIT media labs. On its website Ginger.io describes itself as a mental healthcare company whose “mission is to drive better behavioral health outcomes through the use of passive mobile data and behavioral analytics.” However, to investors and academic audiences the CEO of Ginger.io describes the company as “a big data company posing as a health care company.” Direct backers of Ginger.io include venture capital firms; indirect backers include the Department of Defense (DOD).
Ginger.io offers it’s application to health plans for patients who are depressed. Users downloads an application to their cell phones that collects for analyiss. This data includes the metadata on call, email and text that is already collected by the telecoms but also cellphone sensor data that is not. Data from sensors, like the accelerometer which tells the phone you have changed the orientation of the device so the display can change from portrait to landscape, can also be used to determine when you are getting exercise. GPS data reveals the places a person visits. Phone and text data reveal levels of socialization and social networks. Analysis of vocal tone and prosody reveal emotional state. Light and motion sensors indicate when the user is sleeping. A recent survey indicates 91% of users keep their smart phones within 3 feet 24 hours a day, so the data is a goldmine.
Once installed ginger.io sends a continuous stream of data for big data analysis. Within a few days a behavioral baseline profile is created. Deviations from normal behavior are then easy to spot. In its current incarnation, ginger.io statisticians are developing algorithms to signal such things as deepening depression and risk of suicide.
In addition to behavioral surveillance and data analytics, the ginger.io ap provides behavioral intervention technologies (“bits”) in the form of targeted messages. For instance, the ginger.io ap provides daily self help tips to depressives in a number of health plans around the country. Typical messages encourage (or to use Cass Sunstein’s term, ‘nudge’) the user to get more exercise, smile more, look on the bright side, socialize more, and the like. These interventions are based on positive psychology, a movement that will be explored below. As this technology matures messages can be tailored to the individual’s specific problems.
Arguably, behavioral surveillance and the ginger.io interventions have a place. The cell phone could replace the ankle bracelet for some parolees. Monitoring groups, such as active duty military and veterans, known to have high suicide rates and low willingness to seek help could be helpful. And, a sudden increase in people spending more time in bed might indicate the spread of a contagious disease like Ebola.
However, behavioral health is a small market. Outpatient behavioral health probably accounts for less than 2% of most health plans expenditures. And the percentage of health plan patients receiving mental health care is a small fraction of the total number of health plan patients. So big data’s opportunity to accumulate large population datasets in mental health is limited.
Not so in wellness. Wellness programs are a big and growing business thanks to Obamacare incentives. Companies that a implement wellness programs can save to up to 30% of health insurance premiums, deductibles, and other costs regardless of the effectiveness of the programs. As a result the number of businesses imposing wellness plans has doubled in the last year to 46%.
The heart of wellness programs is positive psychology. The term positive psychology was invented by Martin Seligman in 1998 to extend psychology’s reach from diagnosis and treatment of mental illness to enhancing the lives of normal people. Positive psychology purports to promote health and well being by incenting high levels of exercise and sociality; supporting prosocial attitudes such as enthusiasm, happiness, bouyancy, group harmony, respect for authority; and discouraging bad habits such as smoking and overeating.
Positive psychology is an ideology that promotes conformity and mandated cheerfulness. The science behind it is pathetic. According to James Coyne, PhD, a psychological research expert known for his hooey detector, “Studies of positive psychology interventions are conducted, published, and evaluated in a gated community where vigorous peer review is (not) sought…” The field “… has failed to produce a quality literature demonstrating positive interventions can indeed contribute to human well-being. Positive psychology intervention research has been insulated from widely accepted standards for doing intervention research.”
Positive psychology is a kind of cult. Coyne remarks that “the positive psychology community is averse to criticism, even constructive criticism from within its ranks. There is dictatorial one-person rule on the (Positive Psychology) listserv. Dissenters routinely vanish without any due process or notice to the rest of the listserv community, much like disappearances under a Latin American dictatorship.”
No matter. The field of psychology has often been subject to fads of various sorts, from the orgone box to nude therapy to sensitivity training to encounter groups. What positive psychology has going for it is a distinguished psychologist like Seligman marketing it. Seligman has obtained massive grant funding for the fledgling enterprise. His positive psychology center at the University of Pennsylvania received a 31 million dollar single source contract from the DOD a few years ago, and the American Psychological Association received 125 million for providing positive psychology training to the military. The DOD seems particularly enamored of positive psychology and continues to lavish funds on centers and researchers. One of Ginger.ios collaborators, Stephen Schuller, Ph.D., works at Northwestern University’s Center for Behavioral Intervention Technologies, partly funded by the DOD, developing online positive psychology treatments. Incidentally, before Seligman’s positive psychology center took off, he was marketing positive psychology merchandise through a website, which provided, among other things, a monthly letter from the man himself.
Applications that combine behavior surveillance with positive psychology interventions are particularly well suited for wellness programs. The technology and abundance of data lend credence to a program that creates a lot of activity but once built has very little marginal cost. If these applications successfully migrate to wellness programs the opportunity for behavioral surveillance of a vast swath of the American population –85% of Americans are in a health plan—is at hand.
But how many Americans queue up to download spyware on their cell phones? Probably lots. Americans are getting used to the erosion of personal privacy. Surveillance is becoming ubiquitous and not just by the NSA. For example, 30% of Progressive insureds willingly install a car monitor so the company can surveil their driving habits. All it takes is a discount on premiums.
A wellness program is technically voluntary, but it can be an offer employees can not afford to refuse. Case in point: Honeywell International charges employees who decline the program an extra $500 a year in premiums and they lose out on as much as $1500 a year in out of pocket cost support. As a result only about 10% of employees opt out of the program. The upshot is that health plans are a vector by which behavioral surveillance of the American population could be achieved “voluntarily” and by private companies.
Who else might be interested in this data? Obviously the usual suspects: NSA, CIA, FBI, DOD, Homeland Security and the like. What about political parties? Researchers tell us that behavioral surveillance can chart the spread of political ideas that move through a community like a virus. Wall St? The same researchers say they can foretell the movements of the Dow Jones Industrial average. Police? Think of rooting out thought crime, thought criminals, and those with subversive tendencies. Corporations? What workforce won’t benefit from culling out rebellious or uncheerful “associates.”
The ultimate destination of the marriage of behavioral surveillance, positive psychology, and behavioral intervention technologies will not just be about observing what happens; it will be about shaping what is happening. As Dr Johan Bollen, a leading researcher in the field has observed, the promise of big data is to “to better manipulate trends, opinions and mass psychology.”
What could go wrong?