Know thyself. It’s an old adage that has new resonance in the digital age. Today, you can buy smart devices that monitor your heartbeat, blood pressure, exercise habits, water intake, sleep, mood, menstrual cycle, sexual activity, and meditation patterns, not to mention your poop. The internet of things has turned into what academic and author Andrea Matwyshyn has termed the “Internet of Bodies” with the promise of selling you insights about your “quantified self.”
The desire for self-awareness is not new, but these data offer a different twist on enlightenment. Millions of Americans live with a smartwatch that reminds them to stand, breathe, and take a few more steps to meet their daily exercise goals. This helpful (and healthful) algorithmic prompt only works, of course, because your smart device is tracking your bodily activity. It literally knows you are breathing, which can be helpful to police if for some reason you stop. The data we produce—from our step count to our DNA—is increasingly coming under surveillance.
Not all of this surveillance is unwelcome. Many medical professionals have embraced digital tracking to help their patients. Smart pacemakers measure heartbeats. Digital pills record when someone last took their medication. Smart bandages can warn of early infection. These innovations offer the potential to improve medical outcomes by linking data in and on our bodies to our digital health records. They rely on small sensors that can be placed in watches or implanted in medical devices, allowing you to monitor your own vital signs or to check on friends and family members with health issues.
Of course, there are potential downsides to making medical data so available. Digital pills might inform your doctor (or parole officer) that you’ve stopped taking your psychiatric medication; it’s no coincidence that the first such pill approved by the FDA treats schizophrenia and other mental health disorders. In addition to helping with your marathon training, the data from your smartwatch can identify times when you are using cocaine or having sex.
Recent laws criminalizing abortion raise the stakes of collecting this kind of information. Almost a third of women use period trackers to monitor their reproductive health. Many of these apps—such as Flo, used by 48 million women—collect information about the user’s mood, body temperature, symptoms, ovulation, and sexual partners, as well as their location. Even if a user kept the result of her pregnancy test off the app, her missed period, combined with weeks of recorded nausea, would offer a pretty good clue as to her condition. In states that have restricted abortion access, prosecutors could use this data as evidence of a crime.
In states where abortion remains legal, reproductive information might find its way into the hands of marketers instead. In 2023, the Federal Trade Commission fined the “femtech” company Premom for selling data to third parties, including Google and companies in China. Premom, like Flo, which also settled a complaint by the FTC, did not disclose the fact that it was sharing this personal data—which, in the case of Premom, included information about “sexual and reproductive health, parental and pregnancy status, as well as other information about an individual’s physical health conditions and status.”
Some femtech companies have tried to protect personal data by limiting the amount they collect and localizing it on the device, refusing to log IP addresses, or creating an anonymous mode, but companies and users are still at the mercy of court orders. US companies are bound by US laws, and when abortion is criminalized in a state, data that could provide evidence of an abortion is subject to warrant requests by investigating agents. The only way to avoid turning over the data is by not collecting it, which is difficult for a business predicated on collecting data.
The rise of mental health apps and online therapy has exposed another vector of self-surveillance. The online therapy company BetterHelp has over 2 million users who benefit from their online and mobile mental health services. You can sign up and answer questions about your mental health issues (such as problems with depression, intimacy, or medications), and they provide connections, advice, and resources to help. Then, they turn around and sell your personal data to Facebook and other targeted advertising companies—or at least they did until 2022, when the FTC brought a complaint against BetterHelp and its subsidiaries to stop the practice and ultimately imposed $7.8 million in fines.
