The US Food and Drug Administration has pushed forward with plans to test a fast-track process for approving technological approaches to healthcare problems, and has selected nine companies to be part of its pilot program, including Apple, Fitbit, Samsung, and Alphabet’s Verily life sciences unit. Apple has long said that the need to get FDA approval for health-related products would likely dissuade it from entering that market directly, though it’s managed to serve that market indirectly through partners taking advantage of its ResearchKit and other programs. Both Apple and Fitbit have been pursuing health-related applications for their devices, and Samsung launched a virtual doctor service as part of its Galaxy S8 launch earlier this year, so this is clearly a hot area for these consumer tech companies. The FDA deals mostly with products with diagnostic or treatment applications, which is why so much health and wellness tech tends to stop short of those categories and merely provide data and alerts. But the potential for doing more is already clear, and with faster FDA approval we could well see these companies go deeper into this field. It’s still early in this process, and there might still be other downsides including the potential for leaks while approval is being sought, which is likely to give Apple in particular pause, but this is a positive step for both the industry and for end users.
CNBC reports that Apple has recently held discussions with insurance company Aetna about providing Apple Watches on a subsidized basis to at least some of its 23 million customers. Aetna already has a program to provide Apple Watches to its employees, and both Apple and Fitbit have been talking to a variety of healthcare companies about partnerships to get wider distribution of their devices. This is the first real sign that Apple might do a deal which would be much larger in scale than anything that’s been contemplated so far. For context, Apple has likely sold just over 30 million Watches in total so far, so getting Watches to even half of Aetna’s members would be a massive boost to the business. Such a deal would likely see Apple supplying Watches at less than the usual retail price, both as a bulk discount and because the cost of acquisition would be much lower than a typical retail purchase, while Aetna would subsidize the remaining cost for its members on the basis that fitness trackers tend to improve health and fitness and therefore lower the odds of a medial issue that requires insurance coverage. The rationale there would be much the same as for insurers providing discounted gym memberships. Partnerships like this with medical providers probably have more potential than anything else to boost the addressable market for fitness-centric wearables, including the Apple Watch, because they substantially lower the cost of entry for consumers while providing strong incentives to make use of the devices. There’s obviously no guarantee any of this gets done, but it’s the kind of thing I’m sure we’ll see at least on a small scale in the near future, whether with Aetna and Apple or other pairings.
Apple Hires Head of Stanford Digital Health Center (Jun 9, 2017)
Amazon Debating Entry to Online Prescriptions Market (May 16, 2017)
Alphabet’s Verily Launches Baseline Health Study (Apr 19, 2017)
I did a deep dive on Alphabet’s Verily subsidiary a while back for my Beyond Devices Podcast, and also wrote up some of the key themes for Techpinions subscribers here. What I discovered is that Verily, perhaps more than any other Alphabet subsidiary, has been characterized by hubris in trying to solve the world’s problems with technology. Its two most high-profile early initiatives – a glucose monitoring contact lens and a Star Trek-like “tricorder” to check patients’ vitals – both turned out to be vaporware. But at the same time, Verily is doing enough interesting work that it’s managed to secure partnerships with some big names from the traditional pharmaceutical industry (see this chart from my Techpinions piece), and is working with two big research universities on what it calls its Baseline longitudinal health study. It’s that study that’s now kicking off in earnest (and for which the watch Verily announced last week will be used), as the first 10,000 participants come in for their first set of tests and measurements. The Bloomberg article here does a good job characterizing both the current state of Verily and its return to reality after that early hubris, as well as some of the issues that still dog the tech people who run Verily when it comes to privacy and other related issues. It’s very clear that some of the people in charge have very little common sense when it comes to those issues in the healthcare realm, something that’s been a problem for Google too. And of course the biggest problem with the Baseline project is that – as a longitudinal study – it will literally take years for it to deliver meaningful results. There’s nothing wrong with ambition, especially when it comes to solving the world’s big problems, but it has to be grounded in reality and good practices, especially in the healthcare realm.
There’s a nice scoop here for CNBC, which reports that Apple has had a team working on non-invasively monitoring glucose levels for diabetics for five years or more. What’s fascinating here is that Steve Jobs apparently came up with the idea, which gels with a theory my podcast co-host Aaron Miller has that Jobs’ own illness precipitated Apple’s investment in what became the Apple Watch. Tim Cook has said in the past that he didn’t want to build diagnostic or treatment features into the Apple Watch because of the laborious and unpredictable FDA approval process, but it seems the company isn’t averse to working on health-related technology elsewhere. Diabetes has been the focus of a number of Alphabet’s Verily healthcare initiatives too, and remains one of the most widespread chronic illnesses in the world, with an estimated 9.3% of the US population suffering from it and 415 million around the world. One source says 12% of global healthcare spending goes on treating diabetes, so it’s a big target to go after for anyone investing in health tech. But creating products around all this would be a huge departure for Apple, which generally creates general-purpose technology, though there are obvious ties to the fitness features of Apple Watch and the HealthKit and ResearchKit initiatives.
Nokia Making Big Move Into Digital Health, Relaunching Withings As Nokia This Summer – Forbes (Feb 27, 2017)
This is where things are going to get interesting – on the one hand, you now have HMD Global launching Nokia phones, and on the other you have the entirely separate company called Nokia launching its own consumer gadgets under its own brand. So there will be both smartphones and fitness devices in the market carrying the same brand, which have nothing to do with each other. It looks like Nokia is going to kill off the Withings brand it acquired and make a big push into health and fitness. As a non-consumer brand since its sale of the phone business to Microsoft, this is going to be an uphill battle for Nokia, and especially in a crowded and somewhat stagnant wearables market. Withings produced some interesting devices over the last several years, but it’s never had significant market share, and I’m not convinced Nokia will change that. Health (as opposed to pure fitness) is certainly one of the more promising aspects of this broader space, and it looks like Nokia is investing there, with a HIPAA-compliant Patient Care Platform among other elements. That may be its one opportunity to succeed where others have failed.
Verily is one of the most fascinating Other Bets – in some ways, it’s the most completely removed from much of the rest of what Alphabet/Google does, both in terms of its focus and in terms of the business model, which has largely involved partnering with big pharmaceutical firms so far. (We devoted a big chunk of an episode of the Beyond Devices Podcast to Verily a while back, so if you’re interested it’s probably worth a listen – I also wrote a brief summary of my findings here.) Getting outside investment is an interesting way to reduce Alphabet’s exposure to the risks associated with what are rightly called “Bets”, while also potentially allowing these businesses to move faster than they could with Alphabet cash alone, and move into new markets – Temasek is Singaporean, but invests heavily in China. I’m curious to see whether we’ll see this model applied to additional Other Bets, or whether it’s another unique facet of the Verily business which we won’t see repeated elsewhere.
Apple’s CareKit apps get enhanced security option – Mashable (Jan 11, 2017)
From the beginning, Apple has been extremely careful with its HealthKit developer tools, making some really granular choices about how data is shared (my favorite example is that developers can’t even query whether or not there is insulin data, because its presence would suggest diabetes). Now, CareKit is getting end-to-end encryption for better HIPAA compliance, through a partnership between Apple and a third party (here’s the official Apple announcement). We’re going to see lots more partnership work by Apple to solve some of the thornier problems relating to both HIPAA and FDA compliance as it gets deeper into healthcare.
The specifics of this story aren’t as important as the trend that’s emerging ever more clearly – almost any device that’s connected to the Internet is potentially susceptible to hacking, and the more critical the device’s intended function is, the more serious any potential breach can be – in this case, life threatening. The challenge is that most of these devices – along with cheap web cams and many others – were not designed with watertight security built in, and it’s almost impossible to add that on after the fact. So we’ll see lots more of these stories in the coming years, which will put off potential customers, while giving an advantage to IoT and smart home vendors who prioritize security.
Critics of all stripes have found fault with Mark Zuckerberg and Priscilla Chan’s philanthropic efforts, but there’s no doubting the commitment to effecting real change here. On balance, I’m inclined to think this is a good thing, though it’s worth continuing to evaluate the methods and structure of the Initiative.