How Apple Plans To Become A Big Player In Health Care - YouTube

Channel: CNBC

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If you zoom out into the future and you look back and you ask the
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question, what was Apple's greatest contribution to mankind, it
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will be about health.
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Apple's biggest contribution to the world is they invented the
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touchscreen smartphone, which is completely upended everything in the
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last 15 years.
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But it's a great sales line.
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You know, the best is still ahead.
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Apple is on a bit of a health craze.
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Something big is actually going on.
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I believe we're at the very beginning of the indispensable role of
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health tech. I think it enables a whole new network of companies, a slew
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of startup companies, to be able to capitalize on this data and help
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improve outcomes. So if there's any technology company today that's well
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positioned to pull this off and build the trust of health care
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institutions and consumers, it is Apple.
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It's an area that has not been incredibly digitized in the past 20 or 30
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years, like other sectors have been.
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And there are some very good reasons for the company's move into health
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care. Health care accounts for about 18 percent of U.S.
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GDP. That is massive.
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That is one of the last remaining markets that Apple could actually
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grow. The App Store created about five hundred billion dollars, so half
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a trillion dollars worth of economic activity.
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Absolutely huge. And I think that Apple could create a market that is
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similar in that size for health care.
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But while investors are applauding Apple's health focus, physicians are a
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bit more hesitant. You know, young people who are monitoring themselves
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with these devices, driving themselves crazy, watching their heart rate,
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getting these alerts, thinking there's something wrong with them, they
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come into my office all the time and ninety nine point ninety nine
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percent of the time what I offer them is just reassurance.
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We wanted to explore why and how Apple is growing its health care
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business, as well as the challenges the company faces.
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Steve Jobs, a rebel, an icon, dead at 56...
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Tim Cook has talked about in the past, you know, the Apple founder, Steve
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Jobs, go through cancer and health care system and realizing that they
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could make a contribution.
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I think Steve Jobs imprint was all over the company, and the culture is
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very derivative of Steve.
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But I think Tim has always been very thoughtful about health.
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And so I kind of think he views this almost in some ways as his legacy.
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The Apple Watch is seen as one of Apple's most important introductions
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into the health sector, but that wasn't its exclusive goal initially.
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It was supposed to be notifications on your wrist.
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It was supposed to be fashion.
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There was a gold one. And over time, the watch has become much more of
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the health and fitness device, and they've sort of ditched some of these
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other things because they realized that that was actually the most
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compelling use case for people.
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But the Apple Watch isn't the company's only health initiative.
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Our business has always been about enriching people's lives.
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And as we've gotten into health care more and more through the watch and
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through other things that we've created with ResearchKit and CareKit and
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putting your medical records on the iPhone, this is a huge deal and it's
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something that is very important for people.
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We are democratizing.
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When you look at Apple's spends billions of dollars every year in R&D.
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Right now, I wouldn't say the health care department or health care team
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at Apple is the biggest, but they can place a pretty big bet on it.
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And you can tell they're taking it seriously because the CEO of Apple,
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Jeff Williams, runs the health team.
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We are going to keep pushing watch forward.
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Apple has three areas of focus when it comes to health: hardware like the
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Apple Watch, software like the Health App and ResearchKit, and services
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like Fitness+, Apple's newest subscription service.
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Some people might provide the software, some people might provide the
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hardware, which is largely generic or medical device maker, but Apple
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can combine them all and kind of have a better user interface, which I
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think they see as their main edge.
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All of these devices and services revolve around the iPhone ecosystem,
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and while iPhone sales are still the majority of Apple's revenue,
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wearables and services are picking up steam.
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iPhone sales have increased an average of about four percent quarter
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over quarter and about two percent year over year.
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Since 2017, services have increased an average of about 4.5 percent
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quarter over quarter and about 22 percent year over year since 2017.
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And wearable sales have grown the most by far, increasing at an average
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of almost nine percent quarter over quarter and nearly 35 percent year
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over year since 2017.
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The revenue for wearables is already more than 50 percent more than iPod
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was at its peak. The danger to Apple is that next year a Samsung or a
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Huawai or Oppo comes out with something that really captures the
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consumer's imagination and they stop buying iPhones.
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That's a danger and really investing in this health lessons that because
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if these features, you know, really catch on and people need them, then
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they stick with Apple. Let's discuss hardware first.
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The Apple Watch is a standout among the companies health initiatives.
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Not only does the most recent watch offer ECG recording and heart rate
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monitoring, it also includes blood oxygen monitoring, which is very
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medically-minded and not a huge selling point for the average consumer.
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Apple does not report revenue made from the Apple Watch alone, but
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wearables, a category that includes Apple Watch, along with products
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like iPods, contributed about six point five dollars billion in revenue
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in quarter three of 2020.
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The estimates of watches that have been sold are, you know, 60 million
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over the years, 70 million over the years, and if the average selling
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price is around 300, 400 dollars, that's a lot of money.
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That's substantial. That's, you know, that could be its own company.
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The tagline is, The future of health is on your wrist.
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And so I think they're being very intentional about saying that this
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device is not just a wearable, it is really about health.
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Some of the biggest names in medical equipment include Abbott, Johnson
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and Johnson and GE Healthcare.
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But Apple is not really competing with these companies right now.
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It's way outside of their wheelhouse.
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It's basically an entire new kind of business.
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There's a lot of regulation there.
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Innovation is much slower for obvious reasons, because we have to ensure
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safety at each step of the way.
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And so I think that Apple is very, very unlikely to be making a
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pacemaker anytime soon.
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Apple also provides software solutions like HealthKit, which was
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announced back in 2014, and ResearchKit, which helps health care
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professionals use data from Apple devices for medical research.
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Their devices are used widely in hospitals, for example, nurses
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frequently use iPhones or iPads to track medication administration.
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I use my iPhone on rounds to look up patient data.
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When it comes to medical records, right now that market is completely
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dominated by Epic, one company based out of Wisconsin.
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There's a lack of inter compatibility.
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It's very difficult and expensive to switch systems.
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And so because of that, there really just hasn't been much competition
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and innovation. That's where Apple comes in.
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Apple has a reputation of innovating a stale market, and the company has
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already struck deals with some of the biggest health care institutions
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to get health records on the Health app.
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Well, I think the hardware ecosystem that they've created with the
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iPhone, with the watch, and I think ultimately with AirPods as well, are
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the tools that will allow them to kind of collect health data for
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patients and then build those tools for developers to create unique
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applications that help treat patients in new ways.
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And that's what's really exciting to us, is the combination of all
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three. Most recently, Apple announced Fitness+, a subscription workout
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service that will join Apple's lineup of other plus services like Apple
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TV+ and News+.
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Fitness+ is taking on competitors in the health and wellness category
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like Peloton and other at-home fitness programs, and with the pandemic
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keeping so many people at home, it was an ideal time to strike.
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But Peloton does have a leg up on Apple.
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Peloton has created devices that Apple hasn't created.
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They've got the connected treadmill, they've got the bike, and so there
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are some limitations, I think, in terms of how much Apple can really
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provide in terms of the level of experience that Peloton has created.
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There are some unique challenges in the health care space.
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For example, Apple has regularly complied with the FCC for all of its
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wireless products, but devices that deal with your health have to answer
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to another federal entity.
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Looming over the horizon is the Food and Drug Administration.
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And if you do certain things like test glucose for diabetes testing, you
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will be regulated as a medical device and for good reason.
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If you get the glucose meter wrong, you can kill people.
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Apple has many electrical engineers that can explain why this is
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completely compliant with FCC rules, whereas the medical people, you
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know, they have to hire, they're building that team.
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It's a totally different ballgame. The company has flown under the radar
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of major regulations, thanks in part to its classification as a fitness
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and wellness device manufacturer, not a medical device manufacturer.
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In fact, the Apple Watch has a De Novo classification under the FDA,
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meaning it is a medical device for which general controls alone, or
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general and special controls provide reasonable assurance of safety and
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effectiveness for the intended use, but for which there is no legally
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marketed predicate device.
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Apple really wants to say, "this is your health buddy.
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It's basically a medical device.
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You know, you need this to track your vital signs." But legally, they
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got to be like, "this is about wellness.
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This is about, you know, fitness.
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This is about health as opposed to medicine."
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So Apple's relationship with the FDA is growing more complex as it adds
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more medically focused sensors, but some physicians are not convinced
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that all their patients need the information coming from these sensors.
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There are definitely situations where, as a doctor, I appreciate and
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value the data coming in from an Apple Watch.
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It's when the watch is driving the disease rather than the other way
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around that things get into trouble.
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If you look at the the distribution of ages that own an Apple Watch and
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the distribution of ages that have atrial fibrillation, they are
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inverse. So, the people who have Apple Watches are the ones who are
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least in need of continuous monitoring for atrial fibrillation and vice
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versa. Privacy is also a concern as health data is incredibly sensitive.
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Luckily, Apple has a good track record when it comes to privacy.
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Because the business model involves selling hardware, they can make the
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argument more coherently that it's not actually in their interest to
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sell your health information to a third party.
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Because if that were uncovered that they were doing that, then it would
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be a massive blow to that primary source of income, which is the
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hardware side. I don't think anybody's going to trust Facebook medical
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records anytime soon.
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The future of Apple's health initiatives look positive.
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Having control of that end to end experience lets them do things that
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other device makers can't do.
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And I think that's why they are so well positioned in digital health, is
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they can collect that data, they can create seamless experiences for the
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consumer, and they can also let that data be leveraged by those third
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party app developers that ultimately, I think power kind of the next
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wave of digital health with Apple.
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The company has already tackled heart rate, electrocartiography, blood
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oxygen levels, but there is so much more that can be developed.
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Blood glucose monitoring is something Apple has discussed, which is also
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been on the radar of some other companies.
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This would be a huge breakthrough for people with chronic conditions like
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diabetes. It would be an immense story kind of overnight.
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I don't necessarily believe that it's possible because these are such
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challenging things to do from just a technical and scientific
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standpoint. This stuff is half.
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This stuff is really hard, you know, taking sensors that really exist,
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you know, and miniaturizing them and making 10 million of them all work.
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Whether there's any actual benefit for non-diabetic people monitoring
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their sugar continuously is totally unknown.
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Unfortunately, that's not going to stop devices from being introduced to
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the consumer market to do precisely that.
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And already there are several in the pipeline.
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Products like iPods might find usefulness in Apple's health and wellness
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line-up, too. I think over the long term, what Apple's device actually
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becomes is a medical device that sort of delivers treatment to patients,
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which is, I think, really the coolest thing that they could do with
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their ecosystem. And so an example might be somebody that might have
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depression or chronic pain, they could wear an earpiece – it could even
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be an AirPod – that delivers a very small stimulation to the brain and
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it actually helps treat the underlying disease.
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Now, Apple is not alone in its pursuit of those health care dollars.
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Google began organizing its health initiatives under the name Google
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Health in 2018, and now it boasts over 500 employees.
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Amazon bought PillPack, a prescription medication delivery service in
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2018 among other health initiatives.
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This is three and a half trillion dollar market just in the U.S.
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A third of that is wasted spend and it's that wasted spend that
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technology companies are going after.
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And it won't just be one technology company that disrupts, it will
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likely be many.
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But Apple is trying hard to become a global leader in health.
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The company recently partnered with its first country to prove that
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point. Singapore is now willing to reward people for achieving certain
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healthy behaviors and meeting their goals by giving them money.
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Apple announced it would partner with the Singaporean government to give
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resident Apple Watch users up to 380 Singapore dollars after two years
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of better health practices like meditating, exercising and maybe even
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taking a Covid-19 vaccine when it becomes available.
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There is clearly a lot that can be achieved in the health care sector.
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It's a really big area.
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Yep, we're just getting started I think.
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People want to maintain good health, and the people who have the
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interest, time and money to get devices or tools to monitor their health
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are going to continue wanting to do so.
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The question is just whether those devices actually add anything useful
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for the person versus just giving them more information to worry about.
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Apple has entered a new battleground with its health initiatives.
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Peloton, Abbott medical devices, Epic medical records software, these
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are all competitors Apple is just now stepping into the ring with.
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And it's still unclear who in 10, 20 years will be the winner.
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I think that the advantage Apple has is obviously that they already have
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a really great and powerful brand in the minds of consumers, and they've
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got a billion people around the world who are using an iPhone, that
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platform that they always build on top of.
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It fits in with Apple's conception of itself as a company that is trying
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to do good, you know, leave the world better than they found it.
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Financially, it could be huge, massive, bigger than the iPhone.