Apple Is Already Your Fitness Coach. Can It Be Your Cardiologist Too?
The number of Apple stores makes the company an accessible spot for health outreach
“Williamsburg, can you give it up?” Celebrity fitness expert Jeanette Jenkins gives a rallying cry as she leads a throng of approximately 30 Apple Watch users — including a number of Apple store employees — on a brisk walk around Brooklyn’s trendy Williamsburg neighborhood. The group responds with cheers, and Jenkins circles up the group at intervals so that Jay Blahnik, senior director of fitness at Apple, can answer questions about the Apple Watch’s fitness tracking capabilities.
This jaunt around the Brooklyn neighborhood is part of Apple’s heart health panel and fitness event at its Williamsburg-based store on February 21. The event is the latest in a series of health moves by the tech company, including teaming up with Stanford Medicine on the 400,000-participant Apple Heart Study and getting clearance from the U.S. Food and Drug Administration (FDA) to add two heart monitoring features on the Apple Series 4 Watch. Apple CEO Tim Cook has promised to make health the company’s “greatest contribution to mankind.” Add in the tech giant’s vast network of retail stores, and it has the scope to make a major difference for health care and medicine.
“I’m always a little skeptical about the altruism of companies when they have products in the area.”
“I became a doctor to have impact,” said Sumbul Desai, MD, vice president of health at Apple and clinical associate professor at Stanford Medicine. “To be able to do that at scale is such an amazing opportunity.”
But some health experts worry that Apple’s business demands may supersede the company’s interest in advancing public health and promoting evidence-based medicine. “I’m always a little skeptical about the altruism of companies when they have products in the area,” says Venkatesh Murthy, MD, an associate professor of cardiovascular medicine at Michigan Medicine. Apple’s promotion of heart health and fitness is “undeniably a good message,” he adds, “but it’s not without strings.”
Those strings are on display at the Brooklyn event as the group transitions to the meat of the affair: a heart health panel discussion, the second of three such panels Apple is hosting in February. In addition to Jenkins, the Brooklyn panel includes Desai and two cardiologists: Harlan Krumholz, MD, of Yale University, and John Rumsfeld, MD, of the American College of Cardiology and the University of Colorado School of Medicine.
Although neither Krumholz nor Rumsfeld have official financial ties to Apple (Rumsfeld is a member of the Apple Heart Study Steering Committee), both are bullish on the Apple Watch’s potential to change medicine for the better.
“I’m not here to sell you anything,” Krumholz says, “but I’m telling you that things like the Watch and other sensors are going to inform people about their lives and their health in ways we’ve never seen before.”
“The Apple Watch is a breakthrough technology,” Rumsfeld says of the device’s ability to track rapid irregular heartbeats, or atrial fibrillation, a condition that affects at least 3 million Americans and can ultimately lead to heart failure or stroke. “I think we’re right on the cusp of this digital transformation of health care.”
But touting the Apple Watch’s atrial fibrillation alert system has drawn criticism from health experts, who note that it could lead to unnecessary testing and anxiety among Watch users — including young people, who have a low risk for atrial fibrillation. (Per the FDA clearance that Apple won — which is a lesser designation than FDA approval — the heart monitoring features are not intended for individuals younger than 22.)
“We are very concerned regarding the overdetection of heart rhythm issues,” says Eric Topol, MD, executive vice president of the Scripps Research Institute. “I don’t have any question that some people will be helped. My worry is the number of people who may unwittingly be hurt.”
Overdetection among the “worried well” can have adverse consequences. Those individuals may opt for unneeded testing and evaluations, potentially wasting money or undergoing unnecessarily medical interventions. Since atrial fibrillation risk increases with age, people at the highest risk for the condition are in their seventies and eighties, according to Murthy, a very different demographic than the twenty-, thirty- and fortysomethings assembled at the heart health talk in Brooklyn.
For researchers, though, the data collected from the heart rhythms of hundreds of thousands of users over time could hold significant potential, according to John Mandrola, MD, a doctor at Baptist Health Louisville and co-author of a editorial on atrial fibrillation screening published last fall in JAMA Internal Medicine.
“The Apple Watch movement will teach us a lot over the years about the heart rhythm — remember, until now, people have not been monitored in normal daily life,” Mandrola says. “Perhaps it is ‘normal’ to have short periods of arrhythmia? Wearing a research hat, this looks good.”
He warns, however, about the potential short-term effects of tracking heart rhythms. “The end result will be a tsunami of overtesting and overtreatment,” he says. “Increasing the number of rich people who are mostly well and who will seek care will surely exacerbate the vast injustices of our health care system.”
There’s also the risk of sparking anxiety among healthy people. “We don’t want people taking ECGs every day,” says Desai, referring to the Apple Watch’s electrocardiogram function, which users can share with their doctors. “No doctor would recommend that. Most of the time, people are fine. They shouldn’t be in an obsessive mode.”
Suzanne Grant, a spokesperson for the American Heart Association, pushes back on questions about whether the association’s representation on Apple’s panels might create the appearance of a conflict of interest. “The American Heart Association does not endorse specific technology products or brands,” Grant said in an email to OneZero. “We do endorse the concept of technology helping empower people to make better-informed decisions and take control of their health.”
Apple declined to comment on whether the company would be hosting future awareness talks on other health topics, or whether the heart health events were a testing ground for community health outreach initiatives moving forward.
If Apple continues to expand its health outreach strategy, Topol hopes it will evolve from the model on view in Brooklyn. “If this is the first foray of a tech titan into the retail consumer store space, dragging along academics to be co-branded, it is not a good sign.”
