We Can Measure Almost Everything Now. So Why Can't My Doctor Tell Me What's Normal?

Wellness tech is becoming the infrastructure medicine failed to build

Disclaimer: The views expressed here are my own and do not represent my employer or any affiliated organization.

I just watched a video on social media of a wearable that promised to track cortisol in real time. It was Lume Health, a company that is building a wearable hormone monitoring platform, starting with cortisol and circadian health, and framing it entirely around better sleep, stress resilience, and daily energy. It is framed around the typical careful wellness language with no diagnostic claims anywhere. People in the comments are excited for all the potential wellness aspects.

But it hit different for me. I have adrenal insufficiency. My adrenal glands don’t reliably make cortisol on their own. You see a lot of talk about “lowering cortisol levels” but I could really benefit from having some. I take replacement steroids every day, extra when I’m sick or in times of stress, hope that my dosing is right and go through life with an emergency injection kit in case of adrenal crisis, which is a medical emergency.

Here is the thing about cortisol and managing adrenal insufficiency: there is no medical device available to patients for real time cortisol monitoring. And… even if there was, it wouldn’t be that helpful. Because the normal range for cortisol levels is not even established outside of an 8am window.

Wait… how can that be? There isn’t even an agreed-upon reference range for cortisol outside of one narrow window?! Yep.

Meanwhile, startups can raise millions of dollars and ship a consumer item that claims to show you your cortisol all day long (note, I don’t actually know how much money this specific company has raised).

How did we get here? How did wellness technology get so far ahead while the actual medicine, the diagnostic infrastructure that would make any of this data mean something, is not moving?

Don’t get me wrong, it is exciting

The science and engineering happening in the wellness device space right now is impressive. Companies are putting together brilliant teams to build and launch new devices at a faster pace than ever before, especially in women’s health. There are sweat-based sensors, DNA-based biosensor patches, saliva cartridges read by AI, earring-back wearables, all converging to make hormone tracking as routine as heart rate monitoring, in a market projected to more than double by 2035.

On the research side, a paper-based microfluidic cortisol sensor published in Nature Sensors this year successfully tracked circadian rhythm, acute stress response, and even jet lag disruption.

If continuous cortisol monitoring ever becomes clinically validated, it could change how people like me manage adrenal insufficiency. Catching a crisis trending before it becomes an emergency room visit. Titrating a dose against real data instead of guessing, not having to feel symptoms before knowing you need to up your dose. I desperately want that future. I would be first in line for it.

I’m not here to convince you which wearable devices and wellness tech are worth it. I want to highlight the gap that is more evident than ever right now.

Wellness is easier

A device can measure something with real precision, and still be clinically useless, because detection and interpretation are two different problems. Building a sensor that reliably picks up a signal is an accomplishment. But knowing what that signal means for a specific person’s health is a separate problem, because it requires large validated cohorts, reference ranges broken out by age and sex and health status, regulatory review, and years of clinical data before a number on a screen can be trusted for medical decision-making.

Wellness tech gets to skip almost all of that. It doesn’t need FDA clearance as a diagnostic if it’s marketed as general wellness. It doesn’t need a validated reference range if it’s selling you a “trend” instead of a “result” or “diagnosis”. It doesn’t need to work for the sickest people, because honestly, they’re not the target market. It needs to work well enough for a healthy person optimizing their average Tuesday.

That's not to say healthy people shouldn't have access to these devices, or to their own data. I am all for people feeling more in control of their health. But I'd be lying if I said it isn't disheartening to watch technology that could be life changing for sick people get built for healthy people instead, because healthy people are the easier, faster, more fundable market. None of this is meant to be an argument against data, or against these devices existing. My is that measuring something and validating what it means are two different things.

Regulatory and research need to catch up to innovation

Our infrastructure needs help. It needs the regulatory and research side to move at something closer to the speed the engineering and innovation side already moves at. Reference ranges for the general population. Validation cohorts that include chronically ill and disabled patients. A faster, better-funded pipeline from “we built a sensor that works” to “we know what this number means for you.” The technology proves that pace is possible.

So where does this leave sick people?

I won’t sugarcoat it, it sucks to know that the reason there aren’t medical-grade tools built for you isn’t because the technology is impossible. Sensors that could do this already exist in labs. I mean, I’ve spent years thinking about how to adapt that technology and what would be needed to build a device for my own condition. What’s missing is the validation work that would make them medical devices, rather than wellness.

Empowerment, or failure?

I am having a tough time deciding if these devices are truly empowering, at least for the chronic illness communities. Patients tracking their own bodies because no one else will. Resorting to devices only marketed for wellness as a way to have some sense of what might be going on. So call it empowerment if you want, but we also need to face the why: Using a tool that wasn’t designed for you or your condition, to try to monitor yourself because the healthcare system won’t build one for you.

The uncomfortable version of the answer to “are we stuck figuring it out ourselves” is: yes. At least for now.

It’s what happens when a healthcare system moves too slowly to keep up with patient need, and a private market moves in to fill the space. A startup can ship a hormone-tracking wearable faster than academic medicine can agree on a reference range for cortisol levels.

Honestly, I just wish the diagnostic and medical device infrastructure got even a fraction of the wearable tech momentum.

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Thanks for reading, and I hope you enjoyed this brief reflection, as I navigate life as someone with chronic illness and as a scientist in this space. If you like what you read, consider becoming a free or paid subscriber to support my work and access for others.

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