Innovative Wearables for Clinical Medicine
Jeff Morris
Health monitoring gadgets were all the rage at this year's Consumer Electronics Show in Las Vegas, and they're not just a fad for consumers. Wearable technology is already making its way into medical offices, with some Age Management Medicine practitioners leading the way.
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In a January 12th U.S. News & World Report article about the health-related technology that abounded at CES, it was noted that information acquired from wearables has seen only limited use by practicing physicians at this point, but that industry experts see many potential benefits to the medical community. These range from cheaper medical costs and more proactive treatment options to more time in doctors' schedules to see more patients. Such benefits are of particular relevance to age management practitioners, who are already in the forefront of prioritizing proactive treatment plans and extended one-on-one time with patients.
AMMG will highlight two such practitioners when Florence Comite, M.D. and George Shapiro, M.D. give presentations that focus on new diagnostic technologies at the 24th Clinical Applications for Age Management Medicine Conference coming up in April in Orlando, Florida.
"Wearables are revolutionizing the way we think about our own health and the health of our patients," said Dr. Comite, an endocrinologist and leader in the field of precision medicine, who is CEO & founder of the Comite Center for Precision Medicine in New York. "They flip the passive practice of receiving lab results on a clip board, into an interactive experience where our body’s evolving and dynamic biomarkers are revealed in real time." Dr. Comite said this is knowledge that, far from being relayed to us by a hurried (and harried) physician as a series of meaningless numbers from a blood draw weeks ago, is embedded—sometimes literally—into our bodies. "In the same way we can monitor the ups and downs of the Dow to gauge the health of the financial market, wearables allow us to monitor the ebb and flow of our body’s cellular processes," she said, "from blood sugar spikes, to circadian rhythm, heart rate, and more. In a sense, putting on a wearable is like giving your body a microphone, or a means to communicate a rich story that, in our conventional system, we otherwise pay little attention to until we’re sick." Wearables then, she said, are integral to revolutionizing the health system at large. "They have the potential to flip a sick-centric, reactive approach to one that is deeply proactive."
One caveat noted by U.S. News is that such technologies may eventually spur concerted pushback from the FDA and HIPPA regulators, citing experts at CES who argued it's going to become increasingly harder to argue a watch or a phone that can track sleep patterns, record heart rates and monitor body temperature is not a health care device that would need to adhere to more stringent regulations. Among possible applications that were cited was a study Samsung recently undertook to see if smartwatches could be used for cardiac rehabilitation in patients who had recently suffered a heart attack. By using a watch to monitor progress, rather than forcing an individual to make an extra trip to the doctor, researchers saw completion rates rise in the testing group from about 40 percent ordinarily to around 80 percent.
In the aesthetics area, cosmetics company L’Oréal unveiled an ultraviolet light sensor smaller than a thumbnail that can help wearers avoid overexposure to the sun's rays, potentially mitigating instances of skin cancer. SmartSleep headgear unveiled by Philips monitors wearers' sleep patterns and works to boost periods of deep sleep, hopefully allowing users to wake up more rested and ready to start the day. Another company displayed an electromagnetic-field wearable and an associated app that together are designed to track and alleviate muscle pain.
Dr. Comite utilizes two types of wearables in her practice: glucose monitors and sleep trackers. "For the majority of our clients, wearables data is something we incorporate strategically in order to track sleep, and, in certain clients, monitor blood sugar levels," she said. Dr. Comite has been fortunate to be on the cutting edge of this technology. "Over the past decade, we have had the luxury of testing the latest wearables on the market, first among our clinical team and then among our self-quantifying clients. There are numerous wearables and digital health tools on the market. We consider the assessment of new health tools, and separating the chaff from the wheat, as part and parcel of our responsibility as clinical practitioners on the forefront of the concierge precision medicine movement."
Tracking sleep patterns, said Dr. Comite, allows her clinical team to assess how a change to a client’s supplement regimen or lifestyle change—a meal habit, or life event—positively or negatively affects an individual’s sleep patterns. "Then we can adjust our recommendations accordingly," she said. "Considering the nuanced differences between sleep stages, it's hard for apps and wearables to accurately track sleep.
And it's important to note that none of them are certified medical devices, so we can’t consider the data without context, or diagnose a sleep disorder from wearables data alone,"
noted Dr. Comite, reinforcing the point made by U.S. News that such devices have not yet received—or even been considered for—FDA approval.
The particular technology Dr. Comite utilizes includes Sleep Cycle, a sleep app that tracks movement both when you're awake and when you're asleep. "Most sleep apps do this," she said, "and Sleep Cycle is one of the apps that uses this technology that I recommend to many of my patients." However, she said, motion alone can't get you a full picture of how well you sleep. "If you're a naturally restless sleeper, movement data isn’t necessarily indicative of poor quality rest," Dr. Comite pointed out. "In addition to movement, some wearables look at heart rate and heart rate variability to estimate sleep stages. The Fitbit Alta HR uses this technology." She said her practice is starting to experiment with other tools. "Nokia Health and Apple’s Beddit use thin mattress-like pads to look at additional metrics like temperature information and whether you snore while you sleep," she said.
Dr. George Shapiro, founding partner of Cenegenics New York City, is also enthusiastic about wearable, or semi-wearable, technologies. He has been investigating products from Biomobie, a company based in China, that have been the subject of clinical trials at Harvard University and the Mayo Clinic. The devices in this case are primarily therapeutic rather than diagnostic; they use integral wave micromagnetic fields for therapeutic effects on migraine, insomnia and stroke. The technology, says Dr. Shapiro, can be held in the hand. The Bioboosti mobile device integrates diagnosis, treatment and curative efficacy management, and is said to do so with no side effects. One Brigham & Women's Hospital study at Harvard concluded that based on preliminary findings, Bioboosti "appears to be an effective and well-tolerated device for the treatment of insomnia."
In another pilot study, student middle-distance runners held the Bioboosti device for 16 minutes after running. Preliminary results showed beneficial changes in blood pressure and blood lactic acid that could indicate an increase in athletic ability. In 2016 clinical trials of Bioboosti at Harvard University and the Mayo Clinic demonstrated curative effects in the treatment of insomnia and the recovery of heart and lung function. In April, Dr. Shapiro intends to report on results using the device and its effectiveness in raising sleep quality.
In addition to sleep issues, Dr. Comite utilizes wearables for glucose monitoring. She says continuous glucose monitors are becoming more mainstream as the pre-diabetes epidemic puts pressure on the industry to become more proactive at detecting and predicting suboptimal carbohydrate metabolism in an individual. "The Abbott FreeStyle Libre Pro is a great clinical tool that’s easy for patients to use," she said. "The wearable consists of a small disk that adheres to a patient’s upper arm and tracks data for up to 14 days. I wear it myself. Unlike direct-to-consumer monitors, the Abbott Pro is, in the United States, currently a professional system intended for use by health practitioners that requires a prescription." Dr. Comite notes that with this version of the Abbott, the data is blind to the patient, so clients know they are being monitored but can’t obsess over the results. "This is particularly helpful when we are getting a baseline and want a true picture of a client’s 'normal' day-to-day metabolism," she said. "I know when my carb-loving client is sitting down to a pizza dinner, though he swears, 'It’s salad tonight, doc!'"
Dr. Comite also said a DTC device such as a Dexcom "can be a wonderful precision health tool for all patients—nondiabetics included" because it reveals how a certain food or stressor can trigger a blood sugar spike. "It gamifies healthy living and can be hugely revealing to an individual’s personal metabolic makeup," she said. "It can show individual glycemic response, influenced by genetic makeup, microbiome, lifestyle, family history, and more. This is true for everybody—prediabetic or not."
"Wearables can provide insightful data about a client’s individual health profile," said Dr. Comite, "and can also be an integral component of a personalized program to optimize healthy longevity. Personalized dietary and lifestyle recommendations, not universal guidelines, are essential for optimal health. By integrating, analyzing, and tracking wearables data into an individual’s health record, we can generate a precise understanding of current and future health at the cellular level; and create a customized plan to guide a client toward his or her optimal health sweet spot. Wearables data can help us provide such precision medicine guidance."
Drs. Comite and Shapiro are expected to present on Friday, April 27. For the latest information on the 24th Clinical Applications for Age Management Medicine Conference in Orlando as it becomes available, visit www.agemed.org.
Return to January 2018 e-Journal 