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Embr Labs’ watch-style Wave device lets the wearer regulate body temperature (warmer or cooler) regardless of their environmental surroundings. (Photo courtesy Embr Labs)
Wearable medical technology is here and improving lives. What comes next?
BY MATT VILLANO
TEN THOUSAND STEPS IS SO 2020.
A study published earlier this year in the medical journal JAMA Network Open indicates 7,000 steps per day is the new secret to good health. Researchers from across the United States participated in the study, which determined taking 7,000 steps per day during middle age can keep a person’s arteries healthy and reduce the risk of premature death by up to 70 percent. Of course, the best way to count daily step totals is with the help of a wearable device that keeps track while we go about our lives.
Once the stuff of fantasy novels, wearable technologies are becoming more and more prevalent with every passing month.
A 2021 report from the Consumer Technology Association predicts the market for wearable gadgets will get a boost from the overall booming consumer tech market, which is expected to generate a recordbreaking $487 billion in revenue in 2021. The report projects that shipments of connected health monitoring devices — such as smart thermometers, pulse oximeters, and blood pressure monitors — will grow to 13 million units and earn $740 million in revenue by the end of the year, an increase of 17 percent. What’s more, the total revenue of health and fi tness tech will reach 1 billion, a 12 percent growth over 2020, according to the report.
Looking farther into the future, other reports predict the wearable market could top $265.4 billion by 2026.
A few factors are driving this growth. First, the rising popularity of connected devices and the Internet of Things (IoT, see sidebar on page 62 for more information), along with the rapid growth of a technologically literate global population, are anticipated to fuel the demand for wearable technology. Second, the rising prevalence of chronic diseases and obesity has contributed to the adoption of wearable health products, such as activity trackers and body monitors, that provide real-time information on the user’s overall well-being.
In many ways, says Kreigh Moulton, a retired cardiac electrophysiologist based in Calistoga, wearables provide the Holy Grail of medical technology: increased prevention. “Taking the lead from the medical technology industry, physicians have become increasingly better equipped to monitor the progress of certain diseases and disorders through the use of wearables. Their adoption has increased participation by patients in their disease management, which, in turn, can improve outcomes. Whether it’s on or in your body, these devices have the potential to improve one’s health.”
Odd as it may seem, doctors aren’t in a position to help patients before they get sick. Medical research and development do that. Preventive measures is an entirely diff erent matter, as it works to forestall or avert a potential problem from developing in the fi rst place. PREVENTION FIRST
As Moulton suggests, wearables are currently being used to collect and report real-time information related to day-to-day events and physiological data, such as quality of sleep, heart rate, blood oxygen level, blood pressure, cholesterol level and calories burned (to name a few). Patients and doctors alike can leverage this information to make healthier choices overall.
To this end, many smartphone and smartwatch companies are now adding blood oxygen (Sp02) sensors to their devices as standard, as well as other monitors that provide warnings when data suggests a wearer might be in poor health. Software sold with these devices also has the capability to analyze data and make suggestions about how we might improve our health.
Fitbit (which is now owned by Google) and Huami (the company goes by mazfi t in North America) both make watches that include built-in thermometers to track body temperature and alert patients when their temperature rises in a way that suggests a viral infection. AliveCor, a company in Mountain View, Calif., has devised a piece of hardware (called KardiaMobile) and a related app that eff ectively gives patients a personal G machine in their pocket.
Denver, Colo.-based BioIntelliSense has devised something called the BioButton, medical-grade technology that monitors a host of vital signs for up to 60 days at a time. Dr. James Mault, a former cardiopulmonary technician, founded the company and has boasted that these types of wearables are key steps toward a new frontier in medical technology. his is an opportunity to fi nally make, or help make, remote patient monitoring something that is ubiquitous — and I mean, truly ubiquitous, in the sense that the simplicity, the cost eff ectiveness, and the benefi cial outcomes can fi nally be realized, Mault told an industry podcaster earlier this year.
Products like Mault’s yielded benefi ts during the COVID-19 pandemic because they were all wearing vital-sign monitors 24/7, BioIntelliSense employees were able to return to the o ce well before workers in other industries. Another wearable that achieved widespread adoption during the pandemic: so-called smart masks that fi lter air, amplify sound and check how well people are breathing.
With both technologies, patients can share data with doctors in one of two ways, via on-demand download during an appointment, or by automatic upload to the cloud. ventually the thinking is to have devices pass along information in real-time so doctors can get an up-to-the-minute sense of how their patients are doing.
LOCAL CONNECTIONS
Wearable devices have become important parts of medical treatment programs in Sonoma County.
At Kaiser Permanente Santa Rosa, Dr. Lakshmi Aggarwal evaluates whether continuous glucometers (CGMs) and insulin pumps would help her patients with Type-1 diabetes manage their condition more eff ectively. A CGM is a small device attached to the skin’s surface with medical grade adhesive; a small sensor wire extends under the skin from the device, monitoring the wearer’s glucose uctuations in real time and, in some cases, “talking” to an insulin pump, which can adjust the amount of insulin it delivers to prevent high or low blood sugars. CGM’s have “revolutionized” treatment for some of her patients who would have gotten themselves into life-threatening situations if not for the technology. he main benefi t is with what we call hypoglycemia unawareness. This is where someone does not recognize when their blood sugar goes dangerously low,” says Aggarwal, an endocrinologist whose formal title is diabetes quality consultant. “CGMs can help people with hypoglycemia unawareness recognize a low blood sugar before it is too late. These devices can help patients avoid those serious lows. They can literally save lives.”
Medtronic has developed a wearable CGM that surveils diabetes in precisely this fashion. hough the company has o ces in Santa Rosa, the lab in Northridge, Calif., developed this tool.
According to Ali Dianaty, vice president of product innovation for Medtronic, the technology is part of a new diabetes treatment dubbed the hybrid closed loop system. With this system, the technology uses real-time glucose readings and calculates a personalized amount of insulin to deliver based on your needs,” she wrote in an email. “It also autocorrects and adjusts for individual needs, so people don’t have to think as much about their diabetes. They can also be confi dent that, over the longterm, they have the results and data they need for healthy outcomes.”
USING THE DATA
Then there’s Carium, a Petaluma-based software company that’s received local attention in recent years for its involvement with digital health projects involving wearables. With patient permission, the projects collect input from multiple wearables on multiple patients and translate that information into actionable data that participating doctors can use to change the course of medical treatment overall. O and founder Mike Hatfi eld describes his company as the “omnivore” of medical and other health-related data, and says its approach is data collection and mining on a fundamentally human scale. Lots of people wear pple Watches, these devices will be able to take blood pressure readings frequently and passively throughout the day, Hatfi eld explains. Once you tap into that data, think about the possibilities: Most people see their doctors once or twice a year — that’s two data points. But what if you could tap the data about someone’s wellbeing every day? That’s 365 data points. hat can make a huge diff erence. We have thousands of people currently using Bluetooth-connected blood pressure monitors to feed measurements into Carium
— MIKE HATFIELD, CARIUM
WHAT IS IOT?
The Internet of Things, or IoT, refers to the billions of physical devices around the world that are now connected to the internet, all collecting and sharing data. Connecting up all these di erent objects and adding sensors to them adds a level of digital intelligence [that enables them to] communicate real-time data without involving a human being. The Internet of Things is making the fabric of the world around us smarter and more responsive, merging the more responsive, merging the digital and physical universes. digital and physical universes.
Source: www.zdnet.com Source: www.zdnet.com
on a daily basis. That’s what we’re unlocking.”
One of Carium’s initial pilots involved working with the Petaluma Health Center One to manage and support patients with ype 2 diabetes. While the active phase of the pilot ended in 2019, some of its participants are still using the Carium app on an individual basis. The company has active engagements for hypertension management with the enter for Wellbeing and another healthcare group in Sonoma County.
Hatfi eld expects to see wearable technologies in the form of rings and gloves in the not-too-distant future — any form factor that patients can wear naturally, eff ortlessly, and without intrusion has a high probability of success, he predicts. That said, there are challenges ahead for the wearable technology market.
For starters, many of the bleeding-edge devices aren’t 100 percent accurate yet a problem, since lives are at stake. Kaiser’s Dr. Aggarwal notes that, in addition to their CGM, many patients are still encouraged to prick their fi nger with a lancet and administer blood drops into a glucometer to either calibrate their CGM or verify high or low readings. She adds that, to maximize benefi t from a GM, one has to administer
insulin, either via injection or insulin pump, after receiving a high reading from the sensor.
Bandwidth is another potential challenge, particularly since so many wearables connect to the internet. As more and more citizens begin using wearables, cities will need to lean on 5G wireless for additional bandwidth to accommodate these tra c requests. (Many reports suggest most of the nited States will have G by the end of 2022.) WHAT’S NEXT
he future of wearables is a bit of a green fi eld. So long as doctors and or tech gurus can dream up a new technology, it’s likely someone will make it reality. Imagine the possibilities: real-time alerts at the earliest (often undetectable or unrecognized) signs of everything from ovulation to a respiratory or asthma attack, an oncoming epileptic seizure, or even the presence of certain cancer cells in the blood. (All these options are either already available or undergoing study in anticipation of approval by the U.S. Food and Drug Administration.).) he possibilities seem infi nite, but it’s never a seamless development process. Says Moulton, “As is the case with any medical technology, widespread adoption never happens overnight and never gains real momentum until critical mass is reached. For every one product on that road to success, there are probably ten that came and went and no one ever knew.” hat said, he continues, Wearables will slowly insinuate themselves into our existence without much fanfare — as they should.” The retired cardiac electrophysiologist knows of at least one company working to bring personal wearable blood pressure cuff s to market which, when coupled with a device like the KardiaMobile, will “provide even more meaningful cardiac data.”
Experts predict wearables will get smaller and lighter over time — not surprising, considering how much smaller and lighter they’ve gotten even in the last fi ve years. Dr. lbert H. itus, professor and chair of the department of biomedical engineering at the niversity of uff alo in New York, says the challenge now is to improve the technology of consumer wearables to bridge the gap between “fun, tracking, and making exercise a game to promote wellness” toward more “medical-grade” sensing technology.
“Predicting the future is a guessing game, but looking at the technology today and where it came from, it’s safe to assume wearables will have more functionality and be in forms that go beyond a watch,” Titus says. He adds that, for true wearable medical devices, the challenge is to continue to improve the sensing, reduce invasiveness, and increase connectivity with user devices (such as smartphones) to enhance usability.
Fitbits and smart watches have shown us how wearable technology can help improve our health. Now it’s up to the medical and tech communities to realize and actuate the life-changing possibilities this sector off ers.
About the author: Matt Villano is a freelance writer and editor based in Healdsburg. Learn more about him at whalehead.com.
NON-MEDICAL WEARABLES
In addition to medical applications, laypeople are leveraging wearables individually. Many local runners and cyclists use smartwatches to track daily steps, heart rate, and respirations per minute during sleep. Skip Brand, owner of Healdsburg Running Company, says these uses are recreational but important, nevertheless. “Some of this technology can really help if you’re training for a big race,” he says.
Other personal health-related wearables have also made an impact in recent times, including: • Cove, a “stress canceling technology” that is worn over the ears in the same way as a headset (above).
It uses vibrations applied to specifi c parts of the head that can, according to developers, create a clinically proven stress-reducing and sleep-enhancing e ect. www.feelcove.com • Upright Go is a small wearable device that helps patients train themselves to employ healthier posture using biofeedback. It produces a small vibration when the person wearing the device is slouching. The biofeedback vibration helps users to form better overall posture behaviors and reduce the possibility of future spinal problems. www.uprightpose.com • Embr Labs’ watch-style Wave device lets the wearer regulate body temperature (warmer or cooler) regardless of their environmental surroundings. www.embrlabs.com • Wearables that take the form of clothes. The Nadi X yoga pants track and give feedback on the wearer’s posture, while Neviano connected swimsuits detect the strength of ultraviolet light and can send warnings to the wearer’s smartphone app if levels are too high. www.wearablex.com; www.spinali-design.com These are just a few of the wearable options found with a quick internet search. They aren’t even the only products in their categories, by a long shot. The truth is, we could devote 10,000 words to di erent wearables and still wouldn’t scratch the surface of what’s available — or what might possibly come next.
