I haven’t talked much about this topic on the channel yet, but it’s one that’s interested me for a very, very long time: wearable technology. More specifically, wearable technology and how it can impact our lives … or even save them. It’s not hyperbole to say that technology like this Apple Watch can have a profound impact on the future of healthcare. I have a personal story around that too. And it’s one of the reasons why the Apple Watch is my favorite piece of technology from the past decade. How did we get here? And where is this going?
Wearable technology and the ability to scan someone to view their vitals instantly has been a part of science fiction for a long time. I grew up watching Dr. McCoy and Dr. Crusher whip out a tricorder, so they could diagnose someone on the spot. While we’re nowhere close to that level of diagnosis, there’s been interesting progress towards making science fiction a reality.
In 2013 I backed an Indiegogo project called, Scanadu Scout, which was able to take your temperature, heart rate, blood oxygenation, respiratory rate, ECG, and diastolic/systolic blood pressure at once. All you had to do was hold the device between your thumb and finger, and press a sensor against your temple. It had interesting potential, but wasn’t able to achieve the lofty promise of a real life tricorder. In 2016 they hadn’t been able to get FDA approvals and shut down the device, but it still showed a glimmer of what might be possible in the future.1
At the same time that this was happening, Apple had announced and released it’s original Apple Watch, but at that point is was only able to handle fitness tracking. But by 2018 with the Series 4 and 2019 with the Series 5 watches, they brought back health tracking to the mainstream.
The Apple Watch is a unique oddity in the technology space. It’s not the first smartwatch. It’s not the first fitness tracker than can map your steps or GPS location. It’s not the first wearable that could receive notifications from your phone. But it is the first successful, mainstream smartwatch that delivers all of those, plus the ability to detect falls, irregular heartbeats, and potentially damaging sound levels to your ears. It’s the first smartwatch that also has an entire medical research program that researchers can tap into, giving them access to not just hundreds of participants, but hundreds of thousands. From the very first Apple Watch, I bought into the vision of what this type of device could be, and what it could mean for the future of health tracking.
In 2018 Apple introduced ECG functionality on the Apple Watch Series 4. Simply place your finger on the crown and sit still for 30 seconds and you’ll get a single-lead electrocardiograph reading. The immediate access to be able to take a reading at the exact moment you feel rapid or skipped beats can be crucial information for doctors.2 Add to that the regular background heart rhythm checks that the watch performs, which can alert you if it detects atrial fibrillation or low heart rate.3 To say that these features can, and have, saved lives isn’t hyperbole. There are countless stories that have popped up in news reports over the past year of people telling stories about how the Apple Watch saved their life.4 I had a family member that had this exact thing happen not too long ago. He felt a tap on his wrist and it was his Apple Watch telling him to seek medical attention immediately because his heart rate was dangerously low. Family took him to the hospital right away and he was frighteningly close to dying, so the Apple Watch absolutely saved his life.
This is precisely why I’m so interested and excited by this type of technology; as it gets more compact and portable and is able to be with us at all times, that immediacy to diagnosis paired with smart software can make an astounding difference. The Apple Watch is only a single-lead ECG, which tests and records the timing and strength of a heart beats’ electrical signals.5 It’s effective, but limited. At this point it can only provide information about irregular heart rates and rhythms, like AFib. A standard ECG you’d get in a hospital or doctors office is a 12-lead ECG. It’s able to diagnose heart attacks and other disorders with more accuracy.
Now, I’m obviously not a doctor, but I had some personal experience recently that showed me the future potential with something like the Apple Watch. At the risk of over sharing, a few months ago I had some kind of viral infection that settled in my chest, and was having difficulty breathing with some pretty serious chest pain. My wife took me to the emergency room, which is where they gave me an 12-lead ECG to rule out a heart attack. While everything about my breathing issue turned out to be fine with some medication and time, that ECG discovered that I have something called Wolff Parkinson White Syndrome. My heart has an extra electrical pathway around my heart that can cause rapid and irregular heart beats. Basically the electrical beat signal sent to the heart can start looping around the heart and back in again, giving another incorrect signal to beat. Kind of like a feedback loop. In my case it’s not life threatening, and there’s a simple procedure that can correct it if needed, but what caught my attention was what it looks like on the ECG. A normal ECG shows a quick spike up and then down again on the heart beat. Someone with Wolff Parkinson White has a slope to the beginning of the heartbeat. That’s it. When you know what you’re looking for it’s so simple to see. Now, me being the nerd that I am, I immediately ran an ECG on my Apple Watch and looked at the shape of the rhythm and saw the slope there too. While the Apple Watch isn’t approved or tested to detect Wolff Parkinson White syndrome, it does show up in the ECG reading … and that drove home the potential of this type of wearable technology for me personally.
While the Apple Watch is the first truly mainstream wearable that offers incredible health tracking features, the research side of what Apple has built is just as impressive. Apple introduced an entire platform called ResearchKit and CareKit that allows both researchers and customers to participate in massive medical research projects and to track their medical conditions. As with all research, one of the biggest challenges is getting enough people into a study to get meaningful data. ResearchKit provides access to millions of participants. In 2018 Stanford University ran a heart study using ResearchKit that included almost 420,000 participants,6 and I was one of them. That’s the largest virtual medical study in history. Typical studies might get anywhere from dozens to a few thousand participants.7 As platforms like ResearchKit, and wearables like the Apple Watch, gain more adoption, it’s opening up incredible opportunities for research studies.
In November of last year, Apple announced three studies. Harvard and the National Institute of Environmental Health Sciences are running a women’s health study, which is studying menstrual cycles and the relationship to conditions like polycystic ovary syndrome, infertility, osteoporosis, and menopause.8
There’s also a study being conducted by Brigham and Women’s Hospital and the American Heart Association that’s looking at early warning signs of atrial fibrillation, heart disease and declining mobility.
And the University of Michigan is studying how long-term sound exposure impacts stress levels and cardiovascular health. This last one is only possible because of the new Apple Watch Series 5 sound level monitoring feature.
Time will tell if this type of wearable technology paired with massive software platform research meets up with expectations. I’d recommend checking out the Medlife Crisis YouTube channel for a cardiologist’s take on the Apple Watch. He’s also very excited about the potential here, but gives some interesting insights on keeping our expectations in check. And directly related to the topic of this video, he has another video about a device from AliveCor, which is a tiny, portable six-lead ECG that he used on a flight to India. It’s a big step up from what an Apple Watch is currently capable of providing, but is the size of a small pack of gum and can help diagnose someone’s condition on the go with more accuracy. Again, another example of why I’m so optimistic on where wearables and other portable health technology is going.
The business opportunity
I use my Apple Watch to remind me of upcoming appointments, to quickly respond to a text message, control the playback of a podcast while I’m walking the dog, and to even open the trunk of my Tesla. And while all of those range from useful to just fun, it’s the health tracking aspects of the Apple Watch that set it apart. And it’s those features that I think are revolutionary and underrated by many of us talking about tech on social media. Apple sold $24.4 billion worth of products in their “wearables, home and accessories” category in the last year.9 They don’t break out the exact number of Watches in their quarterly numbers, but the research firm Strategy Analytics estimates that in Q3 2019 Apple sold around 6.8 million watches.10 Apple accounts for about half of all smartwatches sold, and the next closest competitors are Samsung with about 13% and Fitbit with about 11%11. And the move towards smartwatches is taking a huge bite out of traditional watch sales. Fossil Group has seen sales drop by nearly $1 billion over the past couple of years.12
At this point, this is still Apple’s game because platforms like Google WearOS are still lagging way behind in user experience, hardware performance, and usability.13 Given enough time Google will most likely work out the kinks, and Qualcomm will hopefully produce better silicon that can compete with Apple’s performance of their processors. But for right now, Apple has a commanding lead over everyone else in those categories. The trend line for wearable and smart technology is pretty clear though, and in time others will catch up.
Looking at the more macro view, the wearable and health technology industry is growing quickly. One analysis expects to see it grow over 17% by 2024. Another that wearables will reach $54 billion by 2023. Business Insider Intelligence research estimates an annualized rate of 10% growth by 2023. And it goes way beyond just smartwatches. Things like smart fabrics that can help monitor blood oxygen levels and heart rate. Or a Philips wearable biosensor that can track temperature, heart rate, and respiratory rate.14 And Omron’s wearable blood pressure monitor. And this is only scratching the surface of what’s out there and what’s to come. The future of wearables and healthcare is going to be exciting to watch.