SAN FRANCISCO — In the last months of Steve Jobs’s life, the Apple co-founder fought cancer while managing diabetes.
Because
he hated pricking his finger to draw blood, Mr. Jobs authorized an
Apple research team to develop a noninvasive glucose reader with
technology that could potentially be incorporated into a wristwatch,
according to people familiar with the events, who asked not to be
identified because they were not authorized to speak on behalf of the
company.
It was one of many medical applications that Apple considered
for the Apple Watch, which debuted in 2015. Yet because many of the
health features proved unreliable or required too many compromises in
the watch’s size or battery life, Apple ended up positioning the device
for activity tracking and notifications instead.
Now, the Apple Watch is finding a medical purpose after all.
In September, Apple announced that the Apple Watch would no longer need to be tethered to a smartphone and would become more of a stand-alone device.
Since then, a wave of device manufacturers have tapped into the watch’s
new features like cellular connectivity to develop medical accessories —
such as an electrocardiogram for monitoring heart activity — so people
can manage chronic conditions straight from their wrist.
What’s
happening with the Apple Watch is one of the first signs of a leap
forward in the utility of wearable devices. Many people had wondered why
they would need a smart watch at all when most already carried more
powerful smartphones with them. But as the Apple Watch becomes capable of handling more medical tasks on its own, they may now have an answer.
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“This
is an important step in the evolution of wearables,” said Tim Bajarin,
president of Creative Strategies, an advisory and research firm. “The
Apple Watch can now be on you all the time doing this type of medical
monitoring.”
The
Apple Watch has dominated competitors in the nascent smart watch
market, but it has not taken a place alongside the iPod, iPhone and iPad
as the next breakthrough Apple product. Apple does not disclose
specific sales numbers for the watch, but the company has said its sales
have risen 50 percent compared with a year earlier for three straight
quarters. An Apple spokeswoman declined to comment further.
A
digital health revolution has been predicted for years, of course, and
so far has been more hype than progress. But the hope is that artificial
intelligence systems will sift through the vast amounts of data that
medical accessories will collect from the Apple Watch and find patterns
that can lead to changes in treatment and detection, enabling people to
take more control of how they manage their conditions instead of relying
solely on doctors.
Vic
Gundotra, chief executive of AliveCor, a start-up that makes portable
electrocardiograms, said this would put patients on a more equal footing
with doctors because they would have more information on their own conditions.
“It’s changing the nature of the relationship between patient and doctor,” he said, adding that doctors will no longer be “high priests.”
Last month, AliveCor introduced a band for the Apple Watch
with a built-in electrocardiogram, or EKG, to detect irregular heart
activity such as atrial fibrillation, a form of arrhythmia and a
potential cause of a stroke. AliveCor uses the watch’s heart rate
monitor to alert patients to take an EKG when their pulse quickens or
slows unexpectedly.
The
band, known as the KardiaBand, was the first Apple Watch accessory
approved by the Food and Drug Administration. When a thumb is placed on
the band’s sensor, EKG readings are taken in 30 seconds and sent
wirelessly to the patient’s cardiologist. That helps resolve one of the
biggest headaches in detecting atrial fibrillation — catching it during
an episode so a cardiologist can properly assess it.
Elena
Remus, 36, a digital marketing consultant from Alameda, Calif., has
experienced what the KardiaBand can do. She had suffered heart
palpitations on and off for the last five years, but there was little
her doctors could do because they were never able to catch the incidents in real time.
Shortly
after buying a KardiaBand for her Apple Watch a few weeks ago, Ms.
Remus felt the onset of palpitations as she was making morning coffee.
She looked down at her watch and saw that her normal heart rate of
around 75 beats a minute had surged to 205 beats a minute. She started
taking an EKG reading on her wrist and was finally able to record the
activity, allowing her doctor to diagnose her condition as
atrioventricular nodal re-entrant tachycardia — or in nonmedical speak,
an abnormally fast heart rhythm — and plan a course of treatment.
“Now, I don’t feel like I’m going to pass out at home alone,” Ms. Remus said.
Apple is also looking for its own medical breakthroughs. Last month, the company announced a joint research study
with the Stanford University School of Medicine to see whether the
Apple Watch’s heart rate sensors could detect irregular heart activity
without an electrocardiogram to notify people who might be experiencing
atrial fibrillation.
Apple
is also looking at potentially building an electrocardiogram into
future models of the Apple Watch, according to a person familiar with
the project, who spoke on the condition of anonymity because the details
were confidential. It is unclear whether the EKG development, earlier reported by Bloomberg, would be introduced; such a product would most likely require F.D.A. clearance.
Separately,
Apple is continuing research on a noninvasive continuous glucose
reader, according to two people with knowledge of the project. The
technology is still considered to be years away, industry experts said.
The
current solution used by many diabetics is also coming to the Apple
Watch. Dexcom, a maker of devices measuring blood sugar levels for
diabetics, said it was awaiting F.D.A. approval for a continuous glucose
monitor to work directly with the Apple Watch. Continuous glucose
monitors use small sensors to pierce the skin to track blood sugar
levels and relay those readings through a wireless transmitter.
Kevin
Sayer, Dexcom’s chief executive, said that patients could opt for a
monitor to communicate directly with the watch for convenience, but that
the big payoff could come with combining sleep or activity data from
the watch with glucose readings from its device to find correlations.
“We’re just beginning to unlock the potential of that data,” Mr. Sayer said.
Health
care professionals said there was a risk of too much information. Dr.
Khaldoun Tarakji, a cardiac electrophysiologist at Cleveland Clinic,
said doctors needed to guide patients about who would benefit from more information and how much data was the right amount.
“We
need to think about when too much information becomes just noise,” said
Dr. Tarakji, who has worked with AliveCor to test KardiaMobile, a
portable electrocardiogram that works with iPhones.
A flood of information, albeit potentially useful, may overwhelm doctors instead of assisting them. Initially, KardiaMobile patients sent their doctors
an email each time they took an EKG reading. The flood of emails became
confusing and raised questions about where the doctor should store that
information. In response, AliveCor introduced a software platform for doctors that could populate the readings from patients and help detect early signs of atrial fibrillation.
“A
wearable device does not equal a wearable physician,” Dr. Tarakji said.
“As a medical community, we have to be intelligent about how to use
these new technologies.”