Apple Watch ECG
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Apple's health hiccups

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Good morning! Over the last five years, smartwatches have become both phone replacements and pint-sized medical devices. But the health-tracking advancements we’ve seen from wearables may be stalling out due to technical difficulties. Turns out that putting something akin to clinical diagnostic equipment in a watch is really, really difficult! I’m Caitlin McGarry, and this year I plan to learn to play the cello. (Screenshot this and hold me accountable, please.)

Paging Dr. Apple

Once Apple figured out that the Apple Watch wasn’t just an iPhone accessory but a full-blown health and fitness tracker, the company made huge strides in developing medical-grade features for its flagship wearable. The turning point was FDA clearance for the Apple Watch Series 4’s electrocardiogram feature, which could diagnose a user with atrial fibrillation (a common heart condition that can lead to stroke or heart attack). From there, the company was on a roll, adding features like fall detection to the Series 5 and blood oxygen-monitoring to the Series 6.

But last year’s Apple Watch Series 7 offered little in the way of marquee health features, and Apple has had some hiccups developing what would be an absolute game-changer for a smartwatch: the ability to accurately measure blood pressure.

Apple’s ambitious health roadmap may have hit some speed bumps. The company has been working on advanced sensors that can monitor blood pressure and blood glucose (an important metric for diabetics) directly on the wrist. If this sounds too good to be true, well, it just might be. The blood pressure-monitoring feature won’t be ready until 2024 or possibly even 2025 (as many as four generations of watches from now), Bloomberg reported. That’s a big setback for the company, which has become accustomed to pushing wearable devices forward pretty rapidly.

  • Apple has long been rumored to be working on an Apple Watch blood pressure-monitoring feature, and according to Bloomberg, teams have been working on sensors and software for four years. But measuring blood pressure from the wrist is challenging, and internal testing has revealed issues with accuracy.
  • Users wouldn’t be able to take systolic and diastolic readings (i.e. 120/70) like with a traditional blood pressure cuff, according to Bloomberg, but the watch would be able to diagnose hypertension and recommend users seek medical treatment, similar to how the atrial fibrillation alerts work.
  • Other smartwatch makers have attempted to offer blood pressure tracking to varying degrees of success. Omron makes a $500 FDA-approved watch that literally puts an inflatable blood pressure cuff in the watch band itself, and it feels weird as hell to wear. Samsung offers a blood pressure-monitoring feature on some of its Galaxy watches, but it requires you to enter blood pressure readings from a traditional cuff to calibrate and also isn’t available in the U.S. (due to, you guessed it, the FDA).

Offering blood glucose would be the holy grail for a wearable device, health tech experts have told me. Blood pressure measurements would certainly be useful for heart health but if Apple gave diabetics the ability to track glucose without pricking the skin it would be quite literally life-changing. Sadly it doesn’t sound like Apple has pulled it off — or will anytime soon.

  • Apple has teams dedicated to developing technology to measure blood glucose without, well, actual blood, but Bloomberg reports that the feature is “several years” away and that the company hasn’t even set a target date.
  • Tech companies have been working for literal decades to figure out how to measure blood glucose without sampling blood or tissue fluid, but no one has successfully done it — yet. Back in 2001, the FDA approved the GlucoWatch Biographer to take non-invasive blood glucose measurements, but the device failed to catch on — not because it was a bad watch, but because it measured glucose by sending electrical currents through the skin. Turns out people didn’t really enjoy that experience, and the readings were inaccurate.
  • Diabetics can now wear sensors like those made by Dexcom under the skin to take continuous glucose readings, but that doesn’t seem like a very Apple approach to this problem.

So what's next for Apple's health plans? It does have some more feasible health features in the works: The Series 8 watch, due out this fall, may include a body temperature sensor, which is expected to be used as part of a fertility-planning feature. Oura, which makes a health-tracking ring, is working on a similar feature.

Bloomberg noted that Apple employees are reportedly frustrated by the slow rate of health feature development, and while people are still buying up Apple Watches, last year’s model was underwhelming in terms of feature improvements. If the company can succeed where so many others have failed, it might be worth the wait. But for now, that still looks like a big if.

Caitlin McGarry (email | twitter)

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Correction: In yesterday's newsletter, we meant to write that Sonos bought Mayht Holding BV. Sorry for any confusion.

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