Wearable technology promises to revolutionize healthcare

IIT’S A stealth killer. When the heart chambers beat out of sync, pools of blood and clots can form. Atrial fibrillation causes a quarter of over 100,000 strokes in Britain each year. Most of these would never happen if the heart arrhythmia was treated, but it has to be found first. The tests are expensive and inaccurate, but Apple Watches, and soon Fitbits, can detect it, are much cheaper, and can save those whose lives are in danger.

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This is just one example of the revolution that is about to transform medicine. Smart watches and rings, fitness trackers and a rapidly growing range of wristbands, patches and more”portable” can record more than 7,500 physiological and behavioral variables. Some of them are more useful than others, obviously, but, as our Technology Quarterly explains in this issue, machine learning can sift through a torrent of data to reveal a continuous, quantified picture of you and your health.

These are the early days for the quantified self, and for digital health investors, it’s still a wild ride. Witness the recent crash in Teladoc’s stock price, which offers online consultations, a worrying sign for other potential disruptors. But for patients, innovation in wearable devices is just beginning. Individual companies may come and go, but wearable devices and artificial intelligence look set to reshape healthcare in three important ways: early diagnosis, personalized treatment, and chronic disease management. Each promises to cut costs and save lives.

Start with an early diagnosis. Wearable devices can detect subtle changes that otherwise go unnoticed, leading to less severe disease and cheaper treatment. Sensors will reveal if an older person’s balance is beginning to weaken. The gait and swing of the arms change in the early stage of Parkinson’s disease. Strength exercises can help prevent falls and broken limbs. Psychiatric diagnosis can be improved by tracking smartphone usage patterns, without monitoring what people see or type. A smart ring can help a woman conceive by predicting her menstrual cycle. It can also detect pregnancy within a week of conception (many women continue to drink or smoke for weeks before realizing they are pregnant).

Then there’s the promise to see people as individuals, not clones of the theoretical, average human. Most drugs work in only 30-50% of patients. In a person, eating bananas regularly moderates blood sugar; in another, it raises blood sugar to levels that, over time, can cause harm. Algorithms can turn tons of data from wearable devices into tailored prescriptions and diets for weight loss, diabetes control, and more. These diets are more effective, less restrictive and therefore easier to follow than the single type. When doctors can see a patient’s body in real time at all times, they can provide better care. In a German trial, this type of follow-up of patients with heart failure reduced mortality and days spent in hospital by a third.

And wearables can transform chronic diseases, such as diabetes. Some 80% of diseases can be prevented by changing the way people live their lives. The apps use small devices and clever tactics like those employed by a personal trainer or savvy spouse to get people to move more, eat better, and sleep more soundly. Inducing even small increases in exercise is a good thing: adding 1,000 steps (0.7 km) per day reduces mortality by 6-36% depending on your level of sedentary lifestyle. Continuous monitoring also changes the balance of care between what physicians can do in occasional brief office visits and what patients can do on their own day in and day out. America spends between $10,000 and $20,000 per year per diabetes patient and about $280 billion per year nationally, half of the total public school budget. A diabetes monitoring app has been shown to reduce cost per patient by $1,400 to $5,000.

The magnitude of all these benefits promises to be vast. The magnitude will become clearer as wearable devices create data, leading to innovation. The reason for optimism is that the technology is mature. Some 200 million devices were sold in 2020 and twice as many are expected to sell in 2026. One in four Americans owns a wearable device. Smartphones serve as a platform for innovators. In a year or two, the device on your wrist can noninvasively measure your blood sugar, alcohol, and hydration, as well as various markers of inflammation, kidney, and liver function, all of which currently require a blood test. As portable devices gain more features, users are less likely to lose interest in them and shove them in the back of a drawer.

As with any technology, wearable devices bring problems. Health data is valuable; they could be abused by device manufacturers, insurers, or governments interested in social control. Technology may not reach the poor and those who lead chaotic lives, those who need it most. But the biggest worry is that health care bureaucracy is getting in the way.

The primary responsibility for getting things done lies with the market. And developers are indeed starting to pay for rigorous studies that demonstrate the safety, effectiveness and value of their technology. A cottage industry that ranks devices and apps based on, for example, clinical effectiveness and privacy, helps doctors, insurers and governments sort right from wrong.

But healthcare professionals also have a vital role to play. Health care is a conservative industry, and rightly so, given the stakes. Yet this risks slowing the adoption of digital medicine not for legitimate security reasons, but due to the inertia of regulators, standards bodies, insurers and medical schools.

One application per day

Rules are needed to make ownership and use of data more transparent, so people understand and control what happens to their information. Standards can help developers produce usable devices. Patient data must be linked to medical record systems, which are often clumsy. Practitioners need treatment protocols on how to use new technology. Physicians must be trained and paid to offer digital treatments and examine data. Governments and insurers must figure out how to integrate technology into subsidized health care systems so busy fighting fires that they struggle to invest in prevention.

It’s a long and daunting list. But the gain, in money and in well-being, will probably be enormous. It’s time to roll up our sleeves and prepare healthcare for the age of the quantified self.

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