Okay, one of the easiest places to start talking about tech is the Apple Watch. The watch, anytime, first of all, when you see any messaging from Apple about the watch, there’s always something health-related in it. And it was fascinating how it started, because Apple didn’t really know what the Apple Watch was going to be. It was an iPhone accessory, but then… would you like to send a digital heartbeat to your friend, or would you like to answer messages or get notifications? And we threw in some fitness features. And then the world figured it out. And it just turned into… Fitness and notifications. And so every single update to the Apple Watch adds some fitness or health thing, and they have to find a way to sell it to the public.
It gets increasingly more and more like, if you don’t have this, you might miss that heart irregularity that you have. And this has saved X lives so far. And here’s a letter somebody wrote from the hospital about how it saved their life. Is this okay with you? It seems like a wild way to get people to get something they don’t need. I don’t want to. Isolate the Apple Watch in this. In the tech industry, what’s happening is they’ve seen the value that health data has, and increasingly the healthcare tech industry is, and even the healthcare industry as a whole is, being run as a hedge fund. And to me, that’s where I draw the line. Because, for example, if I tell you I created, let’s say, I’m going to use this water bottle here.
Let’s say I created a group. For a water bottle that makes it less likely that it’ll slip out of my hands. But I haven’t done the research to prove that that’s the case. Are you going to be mad that I’m saying it doesn’t slip out of your hand? Not really. Right. Who cares? But now, what if I say the water that I’ve created inside here cures your depression, but I haven’t yet tested it? It’s a stretch. That’s the problem with our current healthcare tech and healthcare hedge fund industries. No one is going to that much trouble to prove that something works, because that’s expensive. And a lot of times it backfires because it proves it doesn’t work. And now you’ve killed your beautiful product.
I see. Yeah, I remember the electrocardiogram coming to the Apple Watch. And the entire time I’m watching this, I’m like. I’m going to have to review and test this watch. And I have no idea how to tell if the ECG I get from this watch is good or bad, or whether it worked or didn’t. But it’ll be the first time I ever do an ECG myself, so that’s cool. I don’t know how to evaluate that. Well, I don’t know what to do with it, to be honest, as a doctor. And most doctors don’t know what to do with it because the most common use case for the Apple Watch’s features is that it’ll tell you your heart rate is high.
There’s a potential risk that you have atrial fibrillation, which is when your heart beats irregularly at an irregular rate. I meant to show you this. Oh, did you have some? I started getting these a couple of nights ago. See that? Low heart rate. This is Marques’ athletic flex right here. That’s because you’re a fitness hypebeast. So it’s weird, though, because it’s notifying me of some health thing, and I’m like, ‘Is this good, bad?’ I don’t know. Sometimes you get a high heart rate notification. There are all kinds of things. Do people ever go to you saying, ‘Hey, my watch told me something?’ Is it ever useful? No joke. What’s today? Today is Friday. Yesterday, I was in the office.
A gentleman comes in who has a history of SVT, which is a type of fast heart rhythm. He said that after that happened to him once, he got an Apple Watch to start tracking when it happened again. But here’s the interesting part. He knows when it’s happening. He can feel it. He can feel the palpitations. He has the skills and the techniques necessary, so he had to shut it down. And it happens very rarely. But he still got the Apple Watch. Now the Apple Watch has started warning him after he plays squash that his heart rate will be high. And he started getting anxious. And then he started getting worse outcomes with his heart rhythms. So you see how the tech is fire. It works. It tracks. Things.
But what we do with that information is really problematic because, until we get some guidance and gather enough data actually to make use of it, we’re just spinning our wheels. More data means more health anxiety, more weird interventions that we don’t even know if they work or not. Yeah, the magic really is in when the watch notifies you, and specifically in how it sorts and displays the information in a useful way. Yeah, because it can measure all at once, but it’s not necessarily like, if you go through the health app and scroll for a while, there’s Tons of stuff. Your breath rate, your heart rate over time, and all these different things. VO2 max, somehow it knows. And I don’t know what to do with that information.
It’s for entertainment purposes only for now. The one feature on the Apple Watch that is really exciting is the fall notification feature. Yes. And you have a story of it going up on a roller coaster. No, no, not a roller. That’s one that’s happened to a lot of people. Actually, car crash detection is the one on the roller coaster. But I’ll be running. around during a frizzy practice and chasing somebody around a field long enough, you’ll stumble, and you’ll get a little vibration that says, ‘Are you okay? Did you fall? Did you need me to call SOS?’ See, that’s the cool feature. It’s a flex, though, because if you made someone fall hard enough that they get the Apple Watch notification, that’s pretty fine.
I’ve never thought of it. You break someone’s ankles hard enough that they… Yeah, the watch is like, ‘Are you good, bro?’ Yeah, I’m good. Yeah, there’s a lot. I feel like the… We keep saying Apple Watch because it’s the one that seems to plug it in the most, but, like, obviously… Pixel, Garmin, Samsung, they’re all doing it. And they all started focusing on health and fitness activity tracking first. And now. They have gone into more of these, like AFib VO2 max, like uh, fall detection, more things that feel like the past. I’m trying to live an active, healthy lifestyle, and I’m warning you about your regular health habits. I wanted to go over, like, can we split that into two?
Maybe. From what you said already, it seems like a lot of it seems nonsensical, but if we can, not nonsensical, but. I think it’s less useful. Okay. And every time we weigh in—kind of a medical intervention—we weigh the risk-benefit, right? So if I prescribe surgery, a medication, everything has risks and benefits. In fact, if something doesn’t have a risk, that means it probably doesn’t even work anyway, because it has to have the opposite effect if it does something. So, with this Apple Watch, I feel like we’re getting data. Very limited benefit of what we can do with said data, but definite harms that I’m seeing as a result of health-related anxiety that’s being fueled by all these alarms. So that’s how I make my decisions.
It’s very simplified. Do you use any trackers yourself? So, for example, I used to wear an Apple Watch myself, and I remember watching a UFC fight. And because I’ve been in the ring, yeah, I got an alert for the first time that my heart rate has been elevated for an extended period while sedentary. While watching it. Yeah, while watching it. That happened to me in hockey playoffs this year. I was like, so that you know, you’re anxious. That makes sense. Yes, exactly. You know that’s happening, though, so it’s easy to dismiss that. abnormal heart rate and stuff. It’s more about the times when you’re not quite feeling it, and you get that. You said you’ve already had it. Do you think it’s stuff like that?
How much is that affecting you guys? In the medical field, just getting calls and patients who are like you said—anxiety, specifically. My watch told me, ‘Okay.’ So now we’re talking about the anxiety and the not health important, I guess, vital disease notifications, like random, like fast heart rate, all that. But now let’s talk about the atrial fibrillation notification, because that’s the one that could actually have healthcare implications. We have no idea what to do with it in the healthcare setting when you get a random alert like that. Yes, we can put on a halter monitor, monitor you for seven days, which is a little thing you wear on your chest. It monitors it. If you have symptoms like palpitations, you could notify them.
So when we read it back, we can go back to the time when you pressed it, and you had symptoms. Because patients often have some electrical irregularity in their hearts. Feel it, but then we didn’t do the EKG when that was going on, so we don’t know what’s going on. So the halter allows us to do that. But in general, when we have atrial fibrillation, we have rules of how we decide to treat it. How often does it happen? We use age-based scoring systems. There are other medical history factors, like little things. But if it happens very, very rarely, and the person’s otherwise healthy with no medical history, which is most of the time what happens when we get these calls.
What we do with it, we don’t have good evidence to decide. We could put the halter monitor on, but then it doesn’t catch anything. Then, two weeks later, the Apple Watch catches something again. We still don’t know what to do. Yeah, there’s a classic example in the keynote. I got this notification, and I thought it was weird. I went to a doctor, and the doctor confirmed it. This thing saved my life. Yeah, and the fitness things we wear have such a wide range. There are so many of them out there that inevitably, a couple of those stories are real. And then, when those stories are the display for, like… whether or not you should get the thing, it makes it feel like this is something everyone should be looking out for.
Yeah, it’s a very… manipulative marketing tool. Because look, I can say right now, let me give you a CAT scan every day for the next 20 years, and I might be able to catch a cancer. And we might be able to intervene. But what I’m not telling you is that I’m also gonna be radiating your body, probably producing all sorts of cancers at the same time. So there’s… A healthy balance that has to exist when it comes to healthcare tech: we tell people what’s possible, but we also have to be honest about the drawbacks. Otherwise, it gets into shady territory. Yeah. Do you think there’s any type of, and if, like, the doctor community has discussed this before, but there are some people who say, like, obviously, all these numbers aren’t very accurate.
But if you follow trends based on the numbers you’re getting, is there a best practice for using these not just to improve a healthy lifestyle but also to see health improvements, as the health app does? Still, even just you reading things yourself, like ‘Yeah, I mean, I get a heart rate variance every morning when I wake up, and like that’s something when I first saw it, I researched it, and then I’m scared. As you said, I’m exactly who you’re talking about with health anxiety, looking stuff up online. Sometimes this really helps me. Sometimes I think this sends me into a bit of a spiral, and I don’t love it—for example, resting heart rate.
The lower a person’s resting heart rate, the healthier they are. Because that usually means they’re in great shape. This is why this guy over here sits at a 40 heart rate going to sleep. If you are at a resting heart rate of 75, that’s considered normal; you’re healthy. And let’s say you start exercising and you start lowering that. The Apple Watch will show that trend over the course of the month. But you tracking that number is purely for entertainment. Because if I, as a doctor, encourage you to work out and you start working out, I don’t need the Apple Watch to tell me that your resting heart rate’s gonna go down. Yeah. The only time that’s really important is if you’re a professional athlete and you’re trying to go from the 99th percentile of success to 99.
5. The huge majority of the general public does not need these tools. But again, for entertainment, for motivation, fine, I’m with it. Especially, this tech can evolve and will really become good. The future is bright. I don’t want to poo-poo the whole industry. I think the way that they’re selling it now is premature. It reminds me of, like, when we were talking to the CEO of Rivian, where. A lot of people will get a truck and will never benever come anywhere near the capabilities of the e-tech, and the capabilities are so good that it’s like once in a while, someone maximizes its use, it’s amazing.
It reminds me of, like, yeah, most people aren’t trying to get from the 99th to the 99.5th percentile, but the people who are might find this watch amazing. Exactly, the new ultra has got this like trail climbing mode and all these other super useful things, but generally for most of us, we’re just like, ‘Oh, neat. I should probably be okay.’ Well, it’s the same thing with, like, protein and creatine supplements. Like, you could take these, but if you’re an average person—and I mean ordinary, even to a higher degree—if you fall within 90% of people who exercise, if you focus on a healthy diet and the routines you’re doing. The supplements may add about 5% improvement.
And again, that’s for people who are competing. The average person, people who go to GNC and vitamin shops and all these, and get these things, you’re doing it for fun. You’re not changing much, that’s fair, isn’t it? Yeah, that’s super fair. I do like. I like. I use the term entertainment. We haven’t thought about it much. But like, entertainment doesn’t necessarily mean bad. Things like no entertainment are motivators as well. And like, I—I used to play frisbee with Marquez. I had four knee surgeries and then had to quit that eventually. And found my activity—way, way down. Like, some minor things. And then I borrowed an Apple Watch here once. Those competitions they do are like— one of the most things ever. Gamifying fitness. Yes. It’s like that.
It helped me get into a way, way more active lifestyle. And that is amazing. Yes, on the other hand, like, what you’re saying, like, if you’re not in that. Professional athlete aspect of things. Like, these things are just like. You can look and be like, ‘Okay, cool. I did it today.’ I knew that already. But it’s nice to see it on my wrist. It’s the same way I’m addicted to checking the checkbox. Closing the ring is like that’s a satisfying thing. Look, that’s the strong part of this app and these tools. And the motivation behind it is exciting, and I want people to make use of it. In fact, one of my first YouTube videos was about getting fit for summer.
It was like, get some new workout gear as a kickstarter to your motivation. thatI’m again very research-based when you look at research, and you see these initial boosts of motivation by getting new gear, by getting a tracker, long-term, they don’t make a difference. You’ve got to have a routine and get into something. It’s a lifestyle change. Or you need to keep buying things, which I’ve fallen into that hole way too many times. New hobby, new shit. Shoes, everything, yeah. All right, I asked ChachiBT for a joke about a doctor named Mike. So this is what it wrote. Oh, no. Why did everyone at the hospital want to hang out with Dr. Mike? Because they were sick. I don’t know.
Because whenever he was around, they knew there was always a microscope. That is so bad. I can’t believe you had that ready to go on the board. Yes. That is so bad. So this is why humans will still own comedy for a little while. ChatGPT, not so great at that one. But hey, if you enjoyed this clip, leave a like or a thumbs up. You should leave a thumbs down for that joke. No, not for the comedy. Why don’t skeletons fight each other? Why don’t skeletons fight each other? Why? Because they don’t have the guts. End it. End it now.
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