Apple and Google could save millions of lives, says this heart doctor

  • Apple, Fitbit, and Google create health devices that work well but won't have much clinical impact, writes Dr. Jeffrey Wessler
  • To have more impact on health, they should target devices at consumers who can benefit most from more exercise, do small randomized clinical trials, and link devices to doctors.
Using a GymKit treadmill with Apple Watch
Apple
Using a GymKit treadmill with Apple Watch

I'm a physician who has helped care for thousands of patients over the past decade. Each day I see people with serious heart problems: heart attacks, arrhythmias, heart failure and beyond.

I also see a flurry of new consumer health devices and software from major tech companies, like the Apple Watch, Fitbit, and Google's revamped Fit app, and I can't help but think they won't have any real clinical benefit.

These companies could very easily design solutions with significant clinical benefit without having to go through extensive regulation. Here are three ways they could do it:

Give the devices to the people who will benefit most. By targeting interventions to specific populations at higher risk for certain outcomes — for example, heart disease — they would provide a fighting chance that interventions such as increased exercise will help people who actually need it and will benefit from it. While these are commercial companies who obviously want to turn a profit, they could work with insurance companies to offer subsidies for targeted patients as long as there's a clear clinical benefit. Apple has explored doing this with Aetna, for instance.

Compare outcomes of people using the device to those not using it. The randomized controlled trial is the cornerstone of creating data in clinical medicine. By demonstrating improved outcomes in a group using the device in a specific way, it will provide evidence for patients and clinicians to use the device to improve health.

Link the device to the doc. Many devices are exceptional in their ability to recognize when someone is in need of more help — dropping activity levels, abnormal variants in heart rate, or low oxygen levels. To really make a difference for this person — get them to the right care, at the right time, in the right place - and the result could be early diagnoses, appropriate management, and improved outcomes.

Start small

If Apple and Google want to really make a difference in healthcare outcomes they should flip their regular business models for these devices and start small, not big.

The first randomized trial of aspirin was conducted in the early 1970s among 1,239 men in the United Kingdom who had already had a heart attack. Today, aspirin is taken by over 40 million Americans each day, and is responsible for cutting the number of heart attacks by about 20%.

Imagine if Apple and Google followed a similar pathway: choose a high risk population to test their devices, run a randomized controlled clinical trial, and provide a clear pathway to link the neediest patients to the right care. The outcomes could be spectacular — and if they aren't, we will know very quickly to move to the next idea.

Dr. Jeffrey Wessler (@Jwessler on Twitter) is a cardiology fellow at Columbia University Medical Center and founder of the preventive cardiology company Heartbeat Health.