Apple’s privacy-friendly image, combined with its focus on hardware and innovations rather than on monetising customer data, has earned the company something that’s rare to come by in the tech world — trust. When the Apple Watch entered our lives in 2015, people were not aware of the breadth of what the device was capable of doing. And then they started using it.
Over the years, the Apple Watch has quietly become a part of the relationship shared by doctors and patients because of the way data is presented — in an easily digestible fashion for everyone.
Think of it this way. Earlier we used to think of healthcare and ailment in the same breath. Apple and the Apple Watch have changed our perspective towards health.
Helping that change come about is Dr Sumbul Desai, MD, who serves as vice-president of Health at Apple, overseeing health initiatives including clinical product development, medical research, and innovative clinical partnerships. She also leads the regulatory and quality teams at Apple.
“As a physician, I’m trained to take care of being sick. You often get involved with the healthcare side of things. However, as a physician, we’re also always taught that prevention is key to being healthy. I think what we’re really focused on at Apple is how we empower individuals to take ownership of their health. Think about health as a part of your everyday life. Take those small steps to walk a little bit more because those things actually have a significant impact over time. And you do that by providing actionable insights that are grounded in wellunderstood evidence and science,” says Dr Desai. We recently met on the sidelines of BioAsia 2023 in Hyderabad. “Then, obviously, we want to make sure that the user feels that all of the data is incredibly private and secure. We want people to raise… kind of elevate the thinking around health... where health is really about keeping well. And it’s not scary or intimidating, it’s approachable,” she says.
ATTENTION AND FOCUS ON PRIVACY
Apple, of course, is known for the high standards it has set in matters related to privacy, be it the iPhone, the iPad, Mac or the Watch. The idea is to highlight that privacy is a fundamental human right and every user should have the option to choose who they share their data with and what they share. Keeping privacy in mind while working on health metrics is not easy but it’s the only way Dr Desai and her team know how to go about things.
“It’s the fabric of everything we do. It’s such a part of how we think. Honestly, I don’t know any other way. We take privacy so seriously that from the beginning, when we’re designing, how we are going to build the science or the study to build the features that we do, we think about privacy from day one. So do we have to take extra steps? We do. We feel so strongly about privacy that we don’t want to sacrifice privacy for speed. We’d rather be slower and be private, science-based and accurate. The truth is, these things take quite a bit of time. And it’s because of our attention and our focus on how we handle data.”
Dr Desai maintains a hectic schedule. She recently served as vice-chair of Strategy and Innovation in the Department of Medicine at Stanford Medicine, as well as Associate Chief Medical Officer at Stanford Healthcare. She also serves as Clinical Associate Professor in the Department of Medicine at Stanford School of Medicine. She has an important take when it comes to things one can learn from India. “I think there is a lot that I think can be learned from the Indian population, namely, the fact that this is a younger population largely. You have a little bit of a different situation than the rest of the world where a lot of countries are dealing with ageing populations. You obviously have an ageing population, but you also have a very large cohort of younger individuals. And I think we’re really interested to see how you focus on prevention in a younger group. I think there (is an) opportunity to focus on proactive empowerment around health in a group where you can really have an impact because it’s still earlier in their lifespan. And so we’re excited to see what we learn here from our customers,” she says. There’s another issue one may think is India-centric but it’s not. There are some doctors who are not technologically savvy. Getting them on board to believe in some of the metrics that are coming from the Apple Watch can be a challenge. “It’s a similar issue, actually, in the West too. And I think that’s where the science behind what we do is so important. We spend a lot of time testing against gold standards, we test against things, tests that physicians know. And then you look at the performance compared to the gold standard. And then we publish on that. One thing that’s very different is we actually publish or contribute to papers because we want the physician community to understand the work we’re doing. And so we’re hoping by speaking their language through the science, they’ll have a better understanding of what we do. We’re very early, there’s a lot more we can do in that process but that’s something that we really spend a lot of time thinking about… outreach to the physicians.”
‘ENHANCING A RELATIONSHIP’
Since the beginning of Apple’s journey in the health category, the idea has been to break down barriers between users and their own everyday health data and also between healthcare providers and patients. The relationship between doctors and patients has changed considerably since the arrival of the device.
“We want to enhance and enrich that relationship. We’re never looking to replace the doctor. What we’re looking to do is augment the relationship between the patient and the physician. For a lot of our features, like ECG, the electrocardiogram, we enable the PDF that you can share with the doctor. With cycle tracking, we enable a PDF that you can share with your doctor. What you’re noticing is that with every product that we build, we create a way to make sure that you can communicate this information with your doctor. And the one interesting fact that I don’t know if everybody realises is that we actually design those PDFs that you can share with the doctor, with the doctor in mind. We design it in a way that it’s easily glanceable, easy to understand, and doesn’t take a lot of time for the physician. So we use our physicians to actually design what that looks like. What I’m getting at is that our focus is on enhancing that relationship, we want to make sure it’s convenient and easy for the patient, but also convenient and easy for the physician and how we create those features and really contribute to that relationship,” she says Dr Desai goes on to offer a simple analogy to highlight what the Watch can do. “If you think about what we do with the Watch, it’s almost like imagining yourself taking pictures of your life with your phone. These are little snapshots of your life that happen outside of the clinic. The fact is that we can give the physician additional information so that they have a better understanding of what’s going on with their patient. We’re hopeful that it will also be beneficial to the patient-physician relationship.”
KEEPING THINGS ‘SCIENTIFICALLY ACCURATE’
What has made the Apple Watch a success in various markets is how it takes into account health metrics from around the world. What works in the US may not work in India or, say, in China or Japan. By subjecting the Watch to rigorous scientific validation processes in various markets, Apple has managed to come out on top. “When we design our features, we have a global perspective. So we don’t just design with the Western mindset; we design understanding that our features and products come to each region. And we take that into account, when we design our features, thinking about the language we use, the colors we use, localisation elements, all of that come into the design process. “The other thing is, we sometimes actually even go as far to create kind of like subcommittees that are focused on how these features are going to translate globally. Some of the features that are available, like irregular heart rhythm notification, which is the AFib notification feature, and the electrocardiogram feature, are regulated features. So we actually have to go to each government and regulatory body. A lot of times through those conversations we incorporate some of the feedback to make it appropriate for each region,” Dr Desai tells The Telegraph.
Perhaps a bigger challenge for her team is to cope with demands. There are user demands for bigger and better features but, at the same time, there is a need to improve and dial up the elements that are already available.
“It’s funny actually, to be honest, the science automatically balances that out for us… and the privacy element because there’s a timeline we can hit based upon the studies that we need to run to make sure that the metrics are accurate. So we definitely take into account customer feedback. And we hear from customers about what they want, the things that we can implement sooner. But also, we’re often driven by what our schedule is for completing the studies, making sure that the information we’re going to provide is actionable and scientifically accurate. Interestingly, it just falls into a roadmap that ends up balancing out the time. Some of it is almost beyond our control because of the length of time it takes to do some of this work.”
And it’s not just the Watch that her team has to work on; there is the Health app on the iPhone. This means, the company is planning three-four years in advance. She takes us through the process: “We do a number of things. We work cross-functionally across a number of teams. So I work with the engineering and design teams. We sit down every year and we go through a planning cycle and we think about what are we hearing from customers. What do we think we can deliver? And where are we at with our longer-term roadmap, and then kind of focus on those things accordingly. It’s a balance between what you can execute well and having an impact. And what you can actually deliver from a science and regulatory standpoint.”
Apple Watch Ultra and Apple Watch Series 8
APPLE WATCH HELPS YOU TO...
■ Stay active: Activity rings show your daily activity. Make it your goal to close them every day.
■ Finish a number of workouts: From strength training and HIIT to Pilates and yoga, Apple Watch tracks all your favourite ways to work out — with the metrics you most want to see.
■ Keep heart in mind: Unusually high or low heart rates and irregular heart rhythms (known as arrhythmias) could be signs of a serious condition. Notifications in the Heart Rate app will alert you to these irregularities so you can take action and consult your doctor.
■ Be safe: Apple Watch is able to detect if you’re in a severe car crash and automatically connect you with emergency services, provide your location and notify your emergency contacts.
Apple Watch has changed the relationship between the medical community and patients without compromising on privacy Pictures: The Telegraph
‘IT’S A NICE MARRIAGE’
When the Watch arrived in 2015, most talks were about how a big tech company was trying to enter the health segment. Further, Dr Desai being a physician had to think of how her priorities aligned with that of Apple when she joined the company in 2017. It was like a marriage and both needed to work at it.
“I’m actually pretty lucky because I think at Apple, one of the things that’s really phenomenal is our focus on values is really very aligned. How do you make the most impact in improving someone’s health? And that was very aligned with my values of making an impact and empowering. There are obviously trade-offs. There are so many opportunities in health and you’re not going to be able to tackle all of them. But I think as long as you know that the features that you’re working on are impactful, it really makes that marriage process quite easy,” she says. Keeping her motivated are the letters the company CEO Tim Cook receives every day, about how the Watch and the Health app are helping people. “There’s a great example of a dentist in Haryana, who had an irregular heart rhythm notification and ended up with a blockage. And had they not been notified, the outcome would have been significantly poorer. The letters we get every single day are read and those things motivate us to do more. So it’s a nice marriage because we’re ultimately trying to give back to the world. And that’s something that company is very aligned on.”
‘GIVE YOURSELF A BREAK AND GIVE YOURSELF SPACE’
Being at the thick of developments in the health sector, she uses the Apple Watch all the time. And that means, there are a few features that are close to her. “The cycle tracking feature is incredibly impactful and I’ll tell you why. Just the fact that I can log (details) on my Watch makes it much easier for me. And we included symptom tracking. I actually learned about myself this many years later, as a physician and a woman who’s been menstruating for so many years, that I get chills right before my periods. I used to think, especially with Covid, that I was getting sick. It turned out it was actually related to my period. The fact that it gave me an insight was really empowering.” The other two features that are special to her are cardio fitness (VO2 max) and ECG. “ECG was one of the first features that I worked onat Apple and I am incredibly proud of us putting out a feature that is used worldwide and having an impact in the way it has.” What many don’t talk about is how the Apple Watch is attracting young users, who value preventive healthcare. Many are using the Apple Watch SE, which is packed with health features. Her message to this crowd is the same as she would give adults. “Use it as a tool to empower you to focus on health. But using technology appropriately is always important. We want to make sure that you’re using this as an additive aspect to your life and use technology where it can help you but you also need to put technology away when you need to focus on other things. I have children of my own and I definitely give them that message that these are things to help you move more, help you breathe, be a little bit more mindful, use it as those tools but also know that there’s a time to maybe give yourself a breakand give yourself space.” The next edition of the Apple Watch is months away but what is always close to her heart is what Tim Cook said a few years ago — Apple’s greatest legacy would be in health. Dr Desai’s team remains laser-focused on making an impact on the individual’s health and empowering people to live healthier.“We’re excited about the impact we can make,” she rounds of