The Doctor on Your Wrist

Jawbone's Up 24 wristband
Jawbone Jawbone's Up 24 wristband

The next revolution in personal health may be the little band that tracks your steps

“The unexamined life is not worth living.” So said Socrates, and I’m trying to live up to the philosopher’s credo–in a 21st century way. On my wrist I wear a Jawbone UP24, a rubber bracelet that tracks my steps and calories burned over the course of the day. To make sure I don’t exceed the calories burned with calories consumed, I track my diet with the iPhone app MyFitnessPal, which syncs up with my Jawbone data. The Jawbone bracelet uses a motion sensor to track my sleep time, and the Jawbone app uses algorithms to calculate the hours I spend in light sleep and deep sleep over the course of the night. While I trained for the New York City Marathon, I tracked my runs with the iPhone app RunKeeper, which allowed me to see myself very slowly getting somewhat faster.

That kind of numeric detail probably isn’t what Socrates had in mind, but more and more of us are engaging in some form of digital self-examination. Research firm ABI estimates that 42 million wearable fitness and health devices will be shipped in 2014, up from 32 million in 2013. The movement even has a name–the quantified self–and its geekiest adherents go far beyond what I could bring myself to try. They carry digital cameras around their necks that capture a constant stream of visual memories and wear heart monitors and blood-pressure sensors up and down their torsos. They treat their bodies as guinea pigs and gather in meet-ups and conferences to swap stories–backed by data, of course–about the best ways to lose weight, work more efficiently and get smarter.

Hardcore disciples and those who, like me, just try to remember to wear a wearable share the same hope: that through collecting ever more information about our bodies and our behavior, we can find a better route to self-improvement. Doctors and researchers see something else in the movement too–a revolution that could change everything from how they care for recovering surgery patients to the way they administer certain medications. Tracking devices may eventually even upend how much you pay in health-insurance premiums. And they may ultimately change the way we relate to our own health.

But before you can really know thyself, you need to know thy data.

The logging of personal information has a rich history. Benjamin Franklin kept a meticulous chart book noting his progress on 13 virtues, and dieters in programs like Weight Watchers have long counted calories. But as anyone who has ever tried to keep a regular journal knows, recording it all on paper requires a commitment few of us can keep up for long. Digital self- tracking devices–often connected to the Internet through our smartphones–take the effort out of recording and compiling. You get better, more regular data, and it’s harder for you to fudge it to make yourself feel better. That also means the information is easily shareable with doctors.

To that end, hospitals are already a step ahead. The Cleveland Clinic has asked its employees and their family members–more than 50,000 people in all–to use the Pebble, an activity tracker, in the hope that it will encourage them to move more. So far, more than 18,000 people have met the goal of 100,000 steps a month or 600 activity minutes a month for six months. (That’s roughly 20 minutes a day.) There’s an added benefit: employees and family members who use the Pebble are eligible for a lower health-insurance premium.

Using Jawbone’s sleep app, I’ve seen how data analytics can make a daily difference. With Jawbone, I’ve come to understand that certain factors–stress, alcohol and caffeine–can influence how restful my sleep really is. The device’s accelerometer detects whether I’m moving and, roughly, whether I’m awake or in a light or deep sleep. The next morning, the app displays a graphic summary of my night. Over the weeks, I’ve been able to track how my sleep time has waxed and waned and how often I meet the 7½ hours I’ve set as a nightly goal.

I’ve found that I get the most sleep on weekends–unsurprisingly–but I’ve also noticed that my sleep tends to decline as the workweek drags on, perhaps because stress levels rise with each day. Just keeping track of how much time I’m actually spending awake has encouraged me to get to bed at a relatively reasonable hour and overcome the temptation to watch one more episode of Damages on Netflix.

Health professionals are finding that simply tracking an activity can encourage people to do more of it. In Minnesota, for instance, the Mayo Clinic experimented by using activity trackers to help with postsurgery care. In 2013 the hospital equipped nearly 150 heart-surgery patients over the age of 50 with Fitbit activity trackers on their first day of recovery. The reason: older patients tend to lose mobility in the wake of major surgery, which can slow recovery. The researchers found that patients who took the most steps every day–data tracked by their Fitbits–were significantly more likely to leave the hospital earlier than those who were less active, and they were also more likely to return home rather than to a nursing facility. Doctors knew that only because they were keeping track of a data point they had never bothered to record before.

The most valuable analysis comes when researchers are able to draw on a wide pool of data. And the growing ubiquity of fitness and activity trackers has made that pool into an ocean. It’s also caused some worries–the IT security firm Symantec reported in June that fitness trackers were often vulnerable to hacking. But the data keep flowing. Jawbone users around the world have recorded more than 130 million nights of sleep–which, as the company’s vice president of data, Monica Rogati, notes, technically makes it the biggest sleep study in the world–as well as more than 1.6 trillion steps and 180 million items of food. “You take all that data, and you can see interesting patterns emerge,” she says.

For example, Rogati knows that in the U.S., people in Southern states move the least. She knows that New Yorkers have a huge swing in sleep time between the weekdays and the weekends, whereas people in Orlando–a city well stocked with retirees–get similar amounts of sleep throughout the week. During the 2013 Super Bowl, which went down to the wire, she saw sleep numbers drop nationwide–but not during the 2014 Super Bowl, a blowout that many people tuned out early in the night. She can actually see the passage of Ramadan, a month when observant Muslims fast throughout the day, in a Middle Eastern city like Dubai. “People become less active during the day and sleep more, essentially become nocturnal,” she says. “The data tell you something about the signature of the city.”

All this information will matter only if we can learn something more valuable than the fact that a boring Super Bowl leads to an earlier bedtime. In a growing trend, Jawbone uses its data to produce personalized nudges designed to encourage users to sleep more, be more active and eat better. That analysis has also helped produce the smart-alarm function for the UP wristband. The Jawbone smart alarm tracks which sleep stage you’re in near your preferred waking time and buzzes your wrist when you’re in a light stage–hopefully nudging you out of bed at the right time biologically. “Sleep is as important as fitness and nutrition,” says Jason Donahue, product manager for data and insights at Jawbone UP. “By tracking it, you can give it the attention it deserves.”

Activity trackers are far from perfect. Some are bulky and unfashionable, and all suffer from accuracy problems. A 2014 study by researchers at Iowa State University looked at top fitness trackers and found that on average, they were 10% to 15% off in calculating the calorie burn from exercise and daily activity. But with each generation, the devices are getting smaller and more precise. The highly anticipated Apple Watch is supposed to be able to detect which activity you’re doing as you do it, along with your heart rate, which helps improve calorie-burn calculations.

Jawbone’s newest device, the UP3, will track heart rate using bioimpedance sensors, which measure the resistance of body tissue to a tiny electric current generated by the bracelet. In the future, the company believes the sensors will be able to detect skin temperature, respiration, hydration and more. That means greater quantities of finer data to feed into Jawbone’s algorithms, which in turn improves the advice the company dispenses as it tries to get you to eat better, sleep longer and be more active. “No one else has been able to get this amount of data on something small enough to wear on your wrist 24/7,” says Travis Bogard, Jawbone’s vice president of product management and strategy.

The new UP will enter an already crowded fitness-tracker market. Microsoft just released its first tracker–the Microsoft Band, which promises to track heart rate and an array of other data points. The first batch of smart watches using Google’s Android Wear operating system provides fitness functions like tracking runs or bike rides. And increasingly, most smartphones from the likes of Apple and Samsung have pedometers built right in.

That puts extra pressure on a company like Jawbone that produces dedicated activity trackers. There’s a lot riding on the success of the UP3, which Bogard and other executives at Jawbone were already using when I visited the company’s San Francisco headquarters in early October. But the excitement at Jawbone was generated less by the devices than by the data they produce–and the unexpected lessons Rogati’s team of data scientists could produce from all those bits and bytes. One wall of Jawbone’s open-plan office was covered with data stories generated by tracking millions of users, ranging from how the World Cup affected sleep patterns to a list of the most popular foods by time of day. (Beer: very popular after midnight, not so much before noon.)

Bogard believes that the future of self-tracking isn’t about the tracker; it’s about the self and the data it produces. “Our belief is that the tech itself should disappear,” he says. “The technology becomes an enabler to help us become more human.”

Once tracking has become ubiquitous, it could produce a health revolution. Right now, doctors have to wait for us to feel bad enough to bring our bodies into the shop; until we do, they’re in the dark. Data tracking could make it a lot easier for someone who is, for example, trying to manage a weight problem–especially if the data could be automatically uploaded to a doctor’s office. No more lying about how much you exercise or snack.

And personal data can mean personalized health care. The real winner may be not the company that makes the best device but the one that can produce a meaningful signal out of the noise of personal data. “No one thing works for everyone,” says Andrew Rosenthal, the group manager for wellness and platform at Jawbone. “We can help steer people toward the health solutions that work best for them.”

But as someone who began practicing self-quantifying for this story and has since become all but addicted to it, I can say there’s a personal side to this movement as well. So much of our health today feels out of our hands, the province of medical professionals. Self-quantifying has allowed me to take control of my health, to track and tweak my habits, to make myself a better person. Today I feel like a test group of one–but I’m in charge of the experiment, and I benefit from the results. You can count on it.


TIME climate change

China Shows It’s Ready to Grow Up on Climate Change

President Barack Obama and Chinese President Xi Jinping attend a press conference at the Great Hall of People on Nov. 12, 2014 in Beijing.
Feng Li—Getty Images President Barack Obama and Chinese President Xi Jinping attend a press conference at the Great Hall of People on Nov. 12, 2014 in Beijing.

China lives up to its responsibilities on global warming

The U.S. diplomats wandering around the Copenhagen airport in the aftermath of the 2009 U.N. climate summit looked like the walking dead. With reason—those talks, billed as the most important climate negotiations ever, were pure torture for almost everyone involved, just barely saved from total collapse by the last-minute creation of the relatively weak Copenhagen Protocol. And while there was plenty of blame to go around, including for the U.S., much of it was directed at China, which consistently blocked negotiations throughout the summit and almost managed to torpedo the protocol. No wonder the American negotiators looked so exhausted—they’d just spent a fortnight grappling with a country that seemed firmly opposed to doing anything about global warming.

But China, it seems, has changed. The climate deal worked out between Washington and Beijing on Wednesday—you can see the details in this post by Emily Rauhala— won’t come close to saving the planet on its own. No, the deal isn’t binding, but few international agreements really are.

While together China and the U.S. account for 40% of the world’s greenhouse gas emissions, this marks the first time that the world’s two biggest carbon emitters sat down and agreed together to limits on future greenhouse gas emissions, however voluntary. And more importantly, it marks what seems to be a very different approach by Beijing on international climate diplomacy—and perhaps on diplomacy more generally.

As Michael Levi at the Council on Foreign Relations notes, the fact that Beijing chose to work together with the U.S.—usually an antagonist on climate and other issues—may be more meaningful than the emission targets themselves:

China has typically gone out of its way to assert its independence in anything climate-related. That approach would usually have led it to announce major goals like these in a clearly unilateral context – even if they were developed in tandem with the United States. Rolling them out together with the United States says that China is increasingly comfortable being seen to act as part of an international effort.

Environmentalists hope that the announcement from Beijing will inject a little momentum into flagging global climate negotiations, which begin shortly in Lima and are meant to culminate with a real global deal in Paris at the end of 2015. Perhaps. But while it might seem as if a problem like global warming can only be solved with a global deal that covers every country, the reality is that just a handful of countries account for nearly all greenhouse gas emissions—China and the U.S. first among them. What they do—alone or in concert—is what will ultimately matter.

There is no shortage of skeptics picking apart the U.S.-China deal—David Stout has a good roundup of them here. Any time governments make promises about action they won’t carry out for more than 15 years—long after today’s leaders are out of office—there’s reason to be skeptical. Climate diplomacy is like dieting: tomorrow is always a lot easier than today.

However, the very fact that China is publicly willing, in concert with the U.S., to dedicate itself to emissions targets that will be challenging is a sign that there is political will in Beijing to move on climate change, as well as political confidence that technological means will be there to do so without cramping the country’s all-important economic growth. It’s a sign, as Fred Kaplan writes in Slate, that China understands that “with great power comes at least some responsibility.”

That fact, more than the specifics of emissions cuts or timeframes, is what really made the China-U.S. climate deal historic.

TIME ebola

Why Ebola Isn’t Really a Threat to the U.S.

Members of Bellevue Hospital staff wear protective clothing as they demonstrate how they would receive a suspected Ebola patient on Oct. 8, 2014 in New York City.
Spencer Platt—Getty Images Members of Bellevue Hospital staff wear protective clothing as they demonstrate how they would receive a suspected Ebola patient on Oct. 8, 2014 in New York City.

Ebola will not likely spread within the United States

Give us this—when Americans overreact, we do it all the way. Over the past week, in response to fears of Ebola, parents in Mississippi pulled their children out of a middle school after finding out that its principal had traveled to Zambia—a nation that is in Africa, but one that hasn’t recorded a single Ebola case. A college sent rejection notices to some applicants from Nigeria because the school wouldn’t accept “international students from countries with confirmed Ebola cases”—even though Nigeria has had less than 20 confirmed cases and the outbreak is effectively over.

The American public is following its leaders, who’ve come down with a bad case of Ebola hysteria. That’s how you get even-tempered politicians like New York Governor Andrew Cuomo musing that the U.S. should “seriously consider” a travel ban on West African countries hit by Ebola, while some of his less restrained colleagues raise the incredibly far-fetched possibility of a terrorist group intentionally sending Ebola-infected refugees into the U.S. It’s little surprise that a Washington Post/ABC News poll found that two-thirds of Americans are concerned about an Ebola outbreak in the U.S.

They shouldn’t be—and two events that happened on Monday show why. WHO officials declared Nigeria officially “Ebola-free.” And in Dallas, the first wave of people being monitored because they had direct contact with Thomas Eric Duncan, the first Ebola patient diagnosed in the U.S., were declared free of the diseases.

Nigeria matters because the nation’s is Africa’s most populous, with 160 million people. Its main city, Lagos, is a sprawling, densely populated metropolis of more than 20 million. Nigeria’s public health system is far from the best in the world. Epidemiologists have nightmares about Ebola spreading unchecked in a city like Lagos, where there’s enough human tinder to burn indefinitely.

Yet after a few cases connected to Sawyer, Nigeria managed to stop Ebola’s spread thanks to solid preparation before the first case, a quick move to declare an emergency, and good management of public anxiety. A country with a per-capita GDP of $2,700—19 times less than the U.S.—proved it could handle Ebola. As Dr. Faisal Shuaib of Nigeria’s Ebola Emergency Operation Center told TIME: “There is no alternative to preparedness.”

But Nigeria’s success was also a reminder of this basic fact: If caught in time, Ebola is not that difficult to control, largely because it remains very difficult to transmit outside a hospital. For all the panic in the U.S. over Ebola, there has yet to be a case transmitted in the community. The fact that two health workers who cared for Duncan contracted the disease demonstrates that something was wrong with the treatment protocol put out by the Centers for Disease Control and Prevention (CDC)—something CDC Director Dr. Tom Frieden has essentially admitted—and may indicate that the way an Ebola patient is cared for in a developed world hospital may actually put doctors and nurses at greater risk.

“You do things that are much more aggressive with patients: intubation, hemodialysis,” National Institute of Allergy and Infectious Diseases head Dr. Anthony Fauci said on CBS’s Face the Nation on Sunday. “The exposure level is a bit different, particularly because you’re keeping patients alive longer.” But now that U.S. health officials understand that additional threat, there should be less risk of further infection from the two nurses who contracted Ebola from Duncan—both of whom are being treated in specialized hospitals.

Even the risk of another Duncan doesn’t seem high. For all the demand to ban commercial travel to and from Ebola-hit West Africa, this region is barely connected to the U.S. in any case. Only about 150 people from that area of Africa come to the U.S. every day—less than a single full Boeing 757—and many airlines have already stopped flying. But there have been relatively few spillover cases even in African countries that are much more closer and more connected to Guinea, Sierra Leone and Liberia. Besides Nigeria, only Senegal has had cases connected to the West African outbreak—and that nation was declared Ebola-free today as well. (There have been cases in the Democratic Republic of Congo, but that’s considered a separate outbreak.) The worst Ebola outbreak ever is raging in three very poor nations—but it seems unable to establish itself anywhere else.

None of this is to deny the scale of the challenge facing Guinea, Sierra Leone and Liberia, where the Ebola has fully taken hold and the disease is still outpacing our efforts to stop it. But West Africa is where our fear and our efforts should be focused—not at home, where Ebola is one thing most of us really don’t have to worry about.

TIME portfolio

See Powerful Photos of Blind Children Getting Their Sight Back

Anita and Sonia Singh were born into darkness. Like millions of people around the world, the two girls came into the world with congenital cataracts, robbing them of all but the faintest awareness of light and dark. In a congenital cataract, the lens of the eye is clouded from the moment of birth, leaving the pupil a milky white or gray. A person with the condition—if left untreated—will be blind for life.

India, where Anita, 5, and Sonia, 12, were born, is home to an estimated 12 million of the 39 million blind people in the world. The good news about congenital cataracts is that the condition is curable with a simple surgical operation, one that takes as little as 15 minutes, provided the work is done when the patient is young enough for the brain to recalibrate to the light. In India, such an operation might cost $300—at least several months’ salary for an average rural worker. For those like Anita and Sonia, who live in a small village in rural West Bengal, that means the real cause of their blindness is poverty. For their families, the effort of caring for the two girls— who can never be left alone and can’t go to school—makes escaping the grinding cycle of poverty all but impossible.

But an organization called WonderWork is trying to change that. The New York City–based NGO works with local surgeons in developing countries, providing training and funding that enables the doctors to perform basic surgeries—including cataract removal—that can make an incredible difference to an individual and life. WonderWork brought Anita and Sonia to a team of doctors based at the Vivekananda Mission Hospital in West Bengal who were able to treat their cataracts before the girls were condemned to a life of permanent blindness. At a cost of just a few hundred dollars, they were given the gift of sight.

For a project called First Sight, the photographer Brent Stirton followed Anita and Sonia from their small village to the operating table and back. He captures the limitations and small joys of a life lived in darkness, as when Anita and Sonia feel the rain fall on a rice field while their parents labor in the paddies. He accompanies them as they leave their village for the first time in their lives, arms wrapped around each other on the seat of a bus, on the way to a life-changing operation. And he’s there, after the surgery, when the bandages around their eyes are unwrapped and the two girls see for the first time in their lives, and the darkness is lifted.

The problems of extreme poverty can seem overwhelming, leaving our hearts frozen by the sheer scale of human suffering. But the efforts of groups like WonderWork show that it takes only a few hundred dollars to make a life changing difference. After a few months of rehabilitation, Anita and Sonia should see perfectly. And Stirton and his camera were there to witness the dawning of that light.

Brent Stirton is a world-renowned Senior Staff photographer for Reportage by Getty Images based in New York. In 2013, he won the Environmental Vision Award from POYI. LightBox previously featured his work on Congo’s gorillas.

Bryan Walsh is a senior editor for TIME International & an environmental writer. Follow him on Twitter @bryanrwalsh.


Time for Change on the Climate

Some of hundreds of thousands take part in the People's Climate March through Midtown, New York
Adrees Latif—Reuters Hundreds of thousands of people showed up for a march before a major U.N. summit on climate change in New York City

The public is agitating for action on global warming—but will politicians listen?

The hundreds of thousands of protesters who marched through New York City on Sept. 21 made one thing very clear: climate change is no longer just an environmental issue. The People’s Climate March was an effort to demonstrate that there is popular will to push for action on climate change, for practical reasons that go well beyond just saving the planet. “People are making the argument in the streets,” says Naomi Klein, a Canadian activist and author of the new book This Changes Everything: Capitalism vs. the Climate.

That argument is finally reaching the ears of some world leaders. At the U.N. climate summit on Sept. 23, more than $200 billion was promised to support clean energy and climate resilience among developing countries. “Our citizens keep marching,” said President Barack Obama in a speech at the summit. “We cannot pretend we don’t hear them.”

There’s just one problem. The country whose actions will do the most to decide the future of the climate is the one country that is the least responsive to public will: China.

If preventing major climate change required only developed nations like the U.S. to cut carbon, we might be fine. Greenhouse-gas emissions in most rich nations have been falling in recent years, the product of slower economic growth and a shift to cleaner sources of energy.

(WATCH: Incredible Timelapse of The Earth Changing Over 3 Decades )

But the vast majority of carbon being emitted over the coming decades will originate in rapidly growing developing nations—and China most of all. Already China is responsible for 28% of global carbon dioxide emissions, more than the U.S. and the European Union combined. Sixty percent of the growth in global emissions since 2002 is due to China. And while the U.S. has still emitted the most carbon historically since the industrial era began, it won’t be long before China takes that title as well. The argument that Beijing has long used—that climate change is the sole responsibility of the West—will no longer hold water.

To its credit, China has made real efforts in recent years to slow the growth of its carbon emissions and clean up its energy supply. China is the largest producer of solar and wind power on the planet, and when you include hydropower, renewables make up 20% of its energy mix—higher than in the U.S.

But that progress is being more than offset by a single trend: growing consumption of coal. Coal-fired power plants are the single biggest contributor to man-made climate change, and in 2012, China consumed nearly 4 billion tons of coal—almost as much as the rest of the world combined. China is projected to add the equivalent of a new 500-MW coal-fired power plant every 10 days for the next decade, at a time when countries like the U.S. are moving to reduce coal consumption. If that happens, the world’s slim chance of averting potentially dangerous global warming will vanish.

So it wasn’t encouraging that Chinese President Xi Jinping chose not to attend the U.N. climate summit, sending Vice Premier Zhang Gaoli to address the international body instead. (The new Indian Prime Minister Narendra Modi—whose country is also on a pace to significantly add to climate change—was also a no-show.) Zhang said that by 2020, China would aim to reduce its emissions of carbon per unit of GDP by 45% compared with 2005 levels, and that the country wanted to have its total emissions peak “as soon as possible.” But that won’t be enough.

Of course, the reality is that no country is truly doing enough to avert warming. Despite the growth of renewable-energy sources like wind and solar, global emissions of greenhouse gases jumped by 2.3% in 2013 to record levels. This summer—the months of June, July and August—was the hottest on record for the globe, and 2014 is on pace to become the hottest year overall. We’re losing the fight.

The protesters who came out to the People’s Climate March in New York—and to the thousands of other events held that day around the world—will keep pushing their leaders to do much more. In China, where something like the climate march could never have happened, citizens won’t have that opportunity. But Chinese leaders should still be listening. Like it or not, they have a growing responsibility to deal with one of the biggest challenges the world faces. As Obama said at the U.N.: “Nobody gets a pass.”

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