Health Wearables – Grail delay

The Holy Grail of blood pressure is delayed. 

• It looks as if Apple is delaying its plans to include blood pressure monitoring in the Apple Watch for two or three years, once again indicating how difficult this is to get right and how important it could be once it is finally ready for the market.
• When it comes to wellness, blood pressure and blood glucose are the Holy Grail of wearables as these conditions affect over 2bn people worldwide and are badly monitored at best.
• Measurement is still conducted either with a cuff that crushes the arm or a needle in the skin and is both invasive and does not always give a clear picture of what is happening inside the user’s body.
• This means that anyone who can measure these reasonably accurately and un-invasively stands to make a lot of money as well as upend an entire industry.
• It also offers the possibility of moving from single points of data to continuous monitoring which could greatly improve insight although a lot of very careful data management and analysis will be required to make it work well.
• It is not for want of trying and I am aware of several companies who all violently disagree with each other, but who are all trying to measure one or both of these biometrics using some form of light.
• Some are using lasers, others are using LEDs. Some make their own sensors while others use off the shelf sensors and rely on their software to interpret the signal.
• However, all of them are trying to measure blood pressure and/or blood glucose through the absorption of a green light that is integrated into a wearable of some kind.
• The one exception is Leman Micro Devices which relies on squeezing the finger into a groove and then measuring when the capillary collapses to estimate blood pressure.
• This sounds easy but there is clearly much more to it as I have been aware of this approach for many years, but it is only very slowly inching towards being ready for market.
• Apple was hoping to include blood pressure in the 8^th version of the Apple Watch (see here) which should be launched this year but it looks as if Apple has been struggling with accuracy and that the feature will be delayed for some time.
• Blood pressure is the least controversial of the two biometrics and there is one company that has FDA approval for a device called BioBeat that it intends to sell for inpatients that are not constantly monitored and are outside of the ICU.
• The goal is to be able to replicate a cuff reading to within 8mm of mercury but this is very difficult to verify.
• This is because whenever one moves one’s arm, the pressure of the blood in the arm changes and it also changes depending on activity, diet and time of day.
• This complicates the issue so much that a proper measure of blood pressure is measured medically by a reading in the morning and a reading in the afternoon taken in a specific way and averaged over four days.
• The other problem that one faces is what I refer to as the “too much data problem” which is that constant monitoring could spike anxiety as normal changes during the day are misinterpreted by the user.
• Apple’s delay gives the other offerings time to get their products into the market and if they are able to succeed where Apple has failed, then they are likely to become the subject of a bidding war.
• Blood glucose takes this one step further where a constant measurement within a 15% margin of error is required but where most players think that this accuracy will never be achieved from a wrist-mounted device.
• Two that disagree are Rockley Photonics which has been working with Apple on research in this area and LifePlus which is about to come to market with a device that will measure both metrics.
• I continue to think that this is an area with a lot of promise and one where when / if someone cracks it, a lot of money will be made but it may still be a long wait.