Are we in the Overton Window for medical wearables? : Part-3

The journey from tracking to gatekeeping - are we at the Overton Window for wearables yet?

In political theory, Overton Window is that tiny sliver of opportunity, when an idea, previously poised at the precipice of acceptability, gains enough momentum to become mainstream, aided by supportive events, policies or socio-cultural and economic phenomena that lend legitimacy to the idea. Today, this concept is applied to ascertain the level of mass adaptation of an idea or product, much like the bell curve is used to define what is “normal”.

Is the wearable technology market, valued at over USD 100 Billion today, at the Overton window yet? How do we judge this? What are the parameters at play here?

An article by Deloitte on wearable technology in healthcare, perhaps serves as the best starting point for this discussion. Stipulating that, given the marked increase in comfort levels of both consumers and healthcare professionals with wearable technology, the article postulates that the market for wearables is likely to expand with newer offerings, and some 400 million are expected to be shipped by 2024 (from the present 100 million).

The article traces the tangent of the wearables by usage, stating that while consumers began to interact with smartwatches as a means to manage their fitness journey, they are now increasingly being used to monitor chronic health conditions.

This has been made possible by the growing technological fortitude of smartwatches – they are now able to track not just the heart rate, but some, like Apple Watch and Samsung Galaxy, have even gained FDA approval for detection of atrial fibrillation, irregular heartbeat patterns that are a major cause of strokes.

Doctors agree that while not unconditionally accurate, smartwatches are right 90% of the time in alerting the user about abnormal variations in heart rhythm. This can be paradigm altering for heart patients who are susceptible to strokes, as unlike heart monitors that are able to capture heart activity for a specific time frame, smart watches can do the job 24/7, revealing patterns that could heretofore be unimaginable to track in such detail.

With expanding competencies of sensors and semiconductors, smartwatches are employing groundbreaking technologies photoplethysmography to identify chronic health risks, such as hypertension by screening for blood pressure and blood volume. Coupled with the greater inclusion of Artificial Intelligence to analyze the generated data, smartwatches have an unmistakable potential to change the dynamics of the health industry, at least as far as the hypertensive 1.3 billion adults, or over 240 million heart patients across the world are concerned.

Take the case of another virulent chronic illness, diabetes. If ever a disease were to assume the ignominious title of being the Grim Reaper of our times, diabetes could very well assume that notoriety, with nearly nine million people suffering from type 1 diabetes, according to nonprofit BeyondType1. Around 3.5 million people would still be alive if the silent killer could have been abated.

Picking the finger to test blood glucose levels, even the at home ones, are slowly becoming passe. Today, Continuous Glucose Monitor (CGM), a small wearable device tracks blood glucose in real time, allowing both you and your healthcare provider to have a better grip on your diabetes management. The three part CGM includes a miniscule sensor that is inserted in the body fat in a quick and painless motion without professional help, a transmitter placed on the skin and your smartphone to collect the data. CGMs can be customized to send alerts for abnormal glucose levels and even be combined with insulin pumps to drive optimal diabetic care.

Devices like the CGMs blur the line between consumer electronics and medical devices, introducing the flair of consumer technology to the beleaguered and unfortunately, inequitable healthcare system. These smart patches, as the Deloitte report calls them, are developed by medical device companies for singular usage.

Though modest in their functionalities, these smart patches are the harbingers of the changing frontiers of healthcare, giving greater push to Personal Health Informatics, where self-management of a disease through improved health literacy creates better outcomes for the patient, where they become empowered to participate in the treatment of the disease or condition.

Given the crossover from consumer technology to healthcare that the wearables are enabling, it would be safe to say that the Overton Window is ripe to enter when medical professionals and regulators validate the data they generate and, importantly, when consumers find wearables as a necessity, rather than an option, in their personal health management. There are also larger questions on cyber security and socio-cultural impacts to consider.

So, are we there yet? Let’s explore this category-wise.

The medical community has been wary of putting technology in the hands of patients (remember the time your doctor told you not to Google your symptoms?) However, this scenario drastically changed with COVID-19, when e-health became crucial to offset the pressures on the healthcare system.

Deloitte’s biennial survey of over 600 physicians in 2020 revealed that despite 90 percent of essential requirements of imparting virtual healthcare were absent in their practices, the respondents envision a future over the next decade, where there will be “radical interoperability” at play – there will be changing business models in healthcare to integrate more of virtual medicine, focus on prevention and well being, and, interestingly, streamlining and integration of data from wearables.

There is, however, one caveat – if the data cannot make them more efficient as caregivers or if it is not included in their workflow, they aren’t interested in using it. This seems to be changing, as Some are also skeptical about how accurate the data is and the way it is collected by patients, as false positives further strain an already troubled system.

Next, let’s talk about regulators. Despite the wealth of health offerings that smartwatches and other non-medical wearables provide, the majority are not recognised as medical devices by the FDA. Big tech companies also want to avoid falling into the regulatory regime, as that would mean slower time to market and increased costly investments in clinical trials and other such requirements as bound by the relevant regulation.

Apple, for instance, sought the long-drawn out approval for the EKG feature to detect atrial fibrillation, as we saw above, but completely side-stepped this for its pulse-oximeter feature.

The company did this to work around the regulation – by marketing it as a wellness product that performed the same functions as a medical grade device, it could take it to the market as long as it did not claim that it could diagnose or treat medical conditions.

This type of “regulatory arbitrage” is deemed unsafe for consumers, as such unchecked marketing could create a situation where consumers rely on it for medical decisions, despite the company’s disclaimers. The solution may not be the prerogative of tech companies that design the wearables, but they should be cognizant that if regulators were to sit up and glean the development in the wearables space with a patient safety approach, this could impact innovation in the space.

Questions of cybersecurity also cannot be ignored – a growing concern for both medical professionals and consumers. Despite the advances of wearable tech, the Deloitte article states that 60% of smartwatch owners are worried about the safety of their data, with horror stories emerging of 60 million health records through wearables getting exposed due to unsecured data bases. Fitness trackers may have helped solve crimes, but criminals could also prompting people, especially the elderly and those suffering from dementia, to overdose on their medications.

Let’s now look at consumers, the actual drivers of the wearable movement. Consumers are the stakeholders in the wearable game, where intuitively, the principles of design perhaps have the greatest impact. We’ve already seen with Google Glass, how poor understanding of consumer needs can sound the death knell for products. Consumers may not know what they want, but they certainly know when a product doesn’t work for them.

There are several factors at play here. The wearables industry was initially targeted at youngsters, who were enamored by technology and understood its functionalities. With the COVID-19 pandemic, older adults are viewing technology in a more positive light.US based AARP, a non profit interest group for older persons nearing retirement age found in its 2021 Tech Trends Survey that the use of wearables among seniors increased from 17% to 27%.

Considering the expanding aging population (By 2030, one in six people will be over 60 years old) and that several health risks, such as cardiovascular disease are associated with this demographic, there are both opportunities and challenges to designing products that will satisfy their requirements. For instance, the American Heart Association said in its recent Scientific Session that while more than half the patients with heart disease are over 65, only 12 percent of those surveyed use wearable devices to monitor their health. 

If the wearables industry were to truly enter the Overton Window, it is essential to nudge consumers into accepting medical wearables as easily as they would a fitness tracker or a smart watch. The task at hand would be to address the fickle mindedness on part of the consumer – how to keep the consumer constantly engaged and faithful to the product.

The big questions in product design are often the most simple ones – What problem can the product solve? Does it address the challenge without taxing the user? Does it provide any singular experience? Does it live up to its promise? Does it appeal to the senses?

A great design may not translate to a successful product, unless it meets the needs that the user may not even be aware of. Achieving such levels of sophistry in wearables, particularly one is challenging to say The CGM, for instance, requires a change of sensor every two weeks. How does one ensure that the consumer faithfully maintains this schedule?

The answer perhaps lies in cutting down the noise to keep things simple, elegant and most importantly, empathetic to the needs of the user. This is something that Whoop, a fitness coaching wearable and app does well. 

Targeted at athletes and highly active individuals, the Whoop band – which may not necessarily be a wristband, it could even be strapped to the Whoop Body smart clothing, measures several physiological parameters, including heart rate variability and skin temperature throughout the day to track where you fall on the strain score – a concept developed the the brand to identify the amount of cardiovascular stress you experience while training, at home with family, during sleep.

It then uses this number to coach you to calibrate your training goals, based on your recovery from the previous score. Since it collects a questionnaire every morning about the previous day, it is able to tell you exactly how much rest and recovery you need before taking on the training targets for the day.

What appeals to customers to Whoop is the fuss-free approach to fitness – there are no distractions, as the device has no display or GPS. The next-gen battery technology means you can seamlessly place the wireless charging puck behind the band – both waterproof, a definite advantage for active people on the go. While training, an alert sounds when you’ve reached your “optimal strain” levels; while sleeping, it sounds an alarm to wake you up when you’ve achieved your required rest.

The positioning of Whoop as an empathetic coach who understands what your body and mind are experiencing, rather than merely tracking what you do, is what appeals to Whoop’s adherents, and perhaps what medical devices should be doing – understanding the consumer in their entirety and helping them work on themselves.

Wearables, particularly, medical wearables therefore, are the zeitgeist of the changing face of healthcare – one that is remote rather than institutional, one that is patient led, rather than patient fed. Hastened by rapid technological developments and the COVID-19 pandemic, as we’ve seen above, it is safe to say that we are at the Overton Window.

The wearable may not be your doctor or counselor yet, but it’s safe to say that today, wearable technology is today your health accountant. The future lies in not treating this window as the end-goal, but a launchpad for newer opportunities to explore where no one’s gone before, something Apple taught us when it busted the window. 

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