[0:28]I'm Emily O'Ryan, I'm a population health researcher here at the Duke Clinical Research Institute, and I'm delighted to be joined here today by my co-host, head of Cardiology at Duke Med and DCRI faculty member, Dr. Manish Patel. Hey, thanks for the introduction, Emily. Good to work with you again. You know, it's going to be a fun episode. We're joined by a friend and colleague, Dr. Marat Fudem for like a kitchen table style conversation about the potential of wearable technologies from the perspective of just consumers, but health care providers and researchers. Marat is a cardiologist with us at the Duke School of Medicine and part of the Digital Health Solutions leadership team at the DCRI and really an innovator. You know, I would say that Marat more than most at our organizations always pushing us to say, how do we better take care of our patients? How do we learn things and innovate to make sure that we do better? His expertise is in heart failure, but he's really thought a lot about physiology, which I think really ties in nicely when we think about wearables and how wearables do or do not tell us something about that. I should tell the audience like, you know, Marat always pushes the boundaries. I got to know Marat when he was actually interviewing for fellowship where he told me that we've had heart failure all wrong. I sort of said, okay, tell me how we have it all wrong. He goes, well, you know, we we have this concept that we used to tell patients and still do that when you gain fluid weight that you've eaten too much salt and the weight goes up and we have enough fluid in your body that's when you go into heart failure. Marat was like, well, that's sort of right, but really what's happening is there's a redistribution of fluid from the splanknick or the abdominal compartment into the lungs. And I sort of said, well, if you match here at Duke, you know, how would we prove it? You had this crazy idea that we would like, you know, do a study where we measure people's pressure in their heart and then turn them over and inject lidocaine into their back where that nerve is and change the capacitance to the abdominal cavity. The pressures would come down and as the lidocaine wore off, the pressures would go back up. It turns out after he did match here, we did the experiment and he helped us do this. Several patients showed that and there is a physiological probably pathway there. So, you know, it it's part of what I think about when I think about not just Marat, but wearables is that they may teach us about individual personalized physiology that people if we can harness it can respond to. So, without further ado, Marat, thanks for joining us. Thanks for having me. Well, I mean, to kick us off, I wanted to chat a little bit about what defines a wearable and and and what you might say, how do they exist for as a consumer product and in health care? Yeah, you know, I think that's a broad question, but you know, the interesting thing about wearables is that, you know, everybody has a wearable. All of us who have watches or phones or earbuds that all have some form of capability of sensing data. And I think what we experience in in a world of medicine is that we for the first time have population approach us with wearable technology and the insights that wearable technology bring us, but we never prescribed that to patients. Meaning they actually might have insights into their own physiology, and it doesn't have to be cardiovascular, right? It can be brain health, physiology, their excess capacity, and all of these things and they tell us something that we didn't know we didn't prescribe. So there's this friction because we are getting confronted with data by a massive amount of technology that we often not accustomed with. You know, the older new generation of doctors might seeing data now that we just never had an idea of might exist. And then, of course, we have the wearables on our side in the medical side, FDA approved technology, yearlong vetting, clinical trials that gets it to market. And they have their own value, they have their own position, and those are the things we prescribe and increasingly popular in the use specifically in the space of Cardiology. The scary thing, I'll tell you what the scary thing about the wearables is, and in a good way as well, is that care in medicine is actually quite episodic. They come to see you, Dr. Patel, in the office, you do blood pressure measurement, heart rate measurement, and some other vital signs you might do, and then you send them off. And then you see them again in three to six months if they're lucky and can get into your busy schedule, right? Till something bad happens and I might have to get hospitalized, but wearables have now opened the opportunity to get heart rate data every second. Blood pressure data every second, and so now these amount of data are not something we have been accustomed to. So we're actually getting new insights into physiology of patients, because we don't know what the physiology of patients are when they're like free roaming people, right? It's like what happens in wild when patients measure their heart rate every second. We had halter devices that measure heart rate that are medical grade and they can do it to 24 hours, 48 hours, maybe two weeks. But they've been applied in special situations, when patients apply them, they're often very much aware of the technology being applied. They actually change behavior when patients wear blood pressure monitors, heart rate monitors, they change behavior. Not when you wear your watch, you know, the Apple Watch, I don't change my behavior because I've been doing it all day every day. So I think that has provided us a lot of scary amount of data, we don't know what to do quite yet with. Is there a lot of variation in how the data are used and what should people be thinking about? You know, data is probably where the majority of value is rather than technology itself, not that piece of plastic, but really the data that you feed into the system. That tells a lot about you, I think you have to assume to prove otherwise that that data is going to be shared. Well, obviously the company has the data access that they have to, but who within the company has access is going to be a little nebulous. You obviously signing all of these consents and disclosures right in the beginning when you sign up for any technology. That's lifestyle devices, God knows where that goes and what purpose it will be used for, and I think that's for every company. I think to be honest, it's okay to assume the worst, but on the medical side, I can tell there's a lot of data protection because health care data typically is very well protected. Having said that it's never immune to breaches by bad actors and that the data might come out. I would argue there's not much you can do with your heart rate data. You can have my heart rate data, there's nothing fancy about it, but, you know, that verbal data will affect many, many, many other things. So I do think that until proven otherwise, lifestyle data at risk for misuse in the health care setting, a lot less at risk. That's why we have so many barriers to even getting that data into the health care system, but the more data streams we add, the more susceptibility for the data to leak. So I do think that focus on that and having people think about it proactively, having rules and regulations about it will be very, very important, particularly for the medical market where the data you're getting out of patients might be more sensitive. And by the way, also bidirectional, many of the device we have today, I can talk to the device and advice talks back to me, as opposed to if you buy that Fitbit, it's a one way street. The Fitbit fits the data and that's all you got. So, so use at your own risk and maybe even read the terms and conditions before, before you sign. Yeah, before that consent, yeah. I'd love to hear your perspective. I mean, you're an associate professor now, you've been in practice a few years, you've been doing research for a while. Um, I think you were here for the initial hype train in like the Fitbit era of the, you know, 2011, 12, 13 and then there was that study where the headlines said Fitbits will make you gain weight and everybody got all up in arms about that at at academic conferences and maybe nowhere else. But we were all talking about it for a while. Can you like give us kind of the the overview of like how you've seen this space evolve and like are people when they come into your clinic, are they still excited about wearables? Are they asking you about? Are you asking them about? Like what's the general temperature and how is that changed? Yeah, I think the world will not get around to be fully lined up with wearables. I mean, that's a trend, everybody has some form of a watch and certainly a a mobile phone that is connected to the internet. I mean, even ten years ago, that was a very different landscape that it is now. Think of your parents, maybe grandparents that have access to technology, I mean, I'm pretty sure that my mom uses her iPhone more often than me, even then that's hard to imagine. You know, there might be a different different engagement with wearables, but there certainly it's it's getting increasingly common. Patients are often having them, the the discussion about wearable and wearable data is more and more common. I mean, every year we'll talk more about this, not infrequently patients ask what can I do to monitor my X vital. Whatever that might be and that might be activity, heart rate, blood pressure, I deal a little bit also with the autonomian my clinic. There's a lot of heart rate related questions with the answer. So, I think that patients bring it up more and more often, patients are willing to also spend money because they know they can get wearables and know they can get data to us using things that they can get off the shelf, doesn't require medical grade technology that, you know, need insurance pre-approval. I mean, wearables are not that expensive these days. And I think from our end, from a physician end, we actually haven't had that many wearables come to the market from a medical grade standpoint because the lifestyle device that just out pacing us like, you know, ten hundredfold, right? What they bring on the market. So, it actually been more interesting to keep up with the side of lifestyle device and what people can get at Walmart compared to what we can offer patients, but there, of course, is pre equal technology and also very much to founder in science because when we prescribe a device that's a thousand dollars, twenty thousand dollars, we need to make the case to insurance to patients and the potential risk associated with that, why that might be, you know, reasonable to do so. So it sounds like certainly increasing interest from the patient perspective, but had not quite yet made that connection between what a provider can recommend or prescribe is sort of what people are using in day-to-day life. The choices are so large and vast, both on lifestyle market and medical market that increasing in both ends. That actually, I think, one of the problems is that we actually not keeping up, we don't have a common language, we don't have common dictionaries. And you might experience something in one practice where, you know, a doctor says, yeah, go use this patch that you can get in Walmart or get off the internet. And other doctors would not recommend it because they don't have the same familiarity with this. So I think you will see more and more guidance documents by maybe the government and societies, like the American Heart Association, American Heart of Cardiology, that's specific now to cardiology, that will be recommending use of data and use of the technology. It's it's a little bit of slippery situation to be in because these are not devices regulated by the medical market or the government.
[12:15]Well, I'd be interested and Emily can speak to this, too, but I'd be interested what level of evidence we should require for at least from the medical side, right? Like, I I get it that on the consumer side, people are going to do consumerism, but on the medical side, in addition to the FDA guidance, if it's used to be a diagnostic tool, and very few things are, they're often informative but not to be diagnostic. What kind of evidence do we need to say, okay, your Aura ring that's telling you you're sleeping X number of hours a night is valuable and this is what you should do with it, because these behavior changes, I think are part of what people are starting to think about. Well, I will actually take it a step back. You know, I think we need to be careful. I mean, I love when metal and plastic touch the human body. I love when I get excited about technology, but we got to be very careful that not always does that technology tells you accurate data. I mean, even in personal experience as a consumer and non-expert, you will be very easily fooled if, you know, a good example is the peak VO2, right? I mean, there are the watches that tell you what your peak exertion capacity is. Sounds cool. It's an objective metric that you should be able to get, but the way to get to it is an absolute garbage. It's an estimate, but if you don't know that, you will take that as a face value and you think, oh, look, I'm healthy, or quite the opposite, or look at I'm not as healthy because this watch tells me that. I think knowing if the data is even reliable is going to be one thing that the FDA and study sites like ours will hopefully determine whether it's accurate. And then where in the diagnostic pathway or treatment pathway, those technologies could fit, that's going to be to some degree even harder. It's easy to define objective metrics and says accurate or not, it's going to be harder to say that's a diagnostic pathway to fit in, that's when to prescribe, that's how much you should be worth. That's going to be the the exciting part of the next ten, twenty years. I find this so interesting because I think there's some cories even with like the supplement market, right? Where like there's some evidence for some supplements and you know, it's stronger in certain areas than others, but it certainly doesn't have the same integrated systematic approval framework. That is used in drugs and and devices and even within the marketing of devices, you see the term, you know, FDA cleared, for example. And because it has the FDA term, the acronym there, people assume this is something that's maybe been through the same process that a new cholesterol lowering medication has been tested for safety and effectiveness and been approved. What do you think is really needed for people to understand how these devices may or may not be held to certain standards of evidence? Do you give warnings to patients about this? Do you do you feel like because these are just used to capture data that maybe there's no real potential harm? I mean, I'd be sort of curious like, do you, do you feel like the consumer education piece here is a need, a strong need. Yeah, so I think you're making actually a very good point because, you know, those coming back to the original questions, you know, do you see that uptech increasing? Absolutely. Do I ever tell a patient don't buy this tool or please don't tell me about this data? No, I do tell them, you know, more data certainly going to be good, particularly if you use it for your own biofeedback. And by that, I mean, listen, you get data and you learn about your own feelings, your own symptoms, and then you correlate with vital signs. If you see correlation, great. If you don't, well, that may be the wrong vital sign for you to track. Then I'm honestly also telling them at the same time for certain technologies that they acquire, not us prescribe. But if they acquire, we might not have the capability to track and integrate into our health care system onto electronic medical record. It's a true problem because the fanciest watch they buy, they still have to send me screenshots of the PDF that they have on their computer, so I can upload it into the EMR, because if we don't have the integration for all of these tools at this standpoint, and this is for some of the market leaders, you assume if you have not a market leading device and there's no way we get that data any system anytime soon. So, I think honest discussion of have that data, learn from that data, feel free to discuss it with me during your next appointment, but too much data sometimes can be a problem. True thing that happened in in a clinical study where patients had blood pressure recorded with their watches. You know, the next generation Apple Watches at least are considering through the light signal, the PPG signals we refer to it, to actually measure blood pressure. And the problem becomes now that can measure blood pressure every second. And what happens is if people exercise, well, nobody measures pressures during exercise unless it's done in a very specific setting in a hospital. Your blood pressure goes to two hundred, I have patients to three hundred systolic blood pressure. That is okay in certain settings during exercise. But if you at home measured and you see something like that or in a study setting, you start panicking. Well, Dr. Google told me blood pressure is supposed to be 120 over 80, why is my blood pressure 190 right now? Well, because the context matters and we never told patients to measure in that setting. But what happens is now that data gets sent our way. Just today, I was given data, somebody pointing out that there was a scary finding on the report that heart rate was 170. Well, what happened when you were having heart rate of 170? Well, I was running. Well, but that's normal, you know, like just because Dr. Google doesn't tell you that that's normal exercise heart rate, does not mean that we have a problem. So, I think putting things in context, interpreting, that's what doctors will be there for. The only problem is if that happens now every day with every patient multiple times, that's going to be insurmountable of a problem. So up front coaching them, that data that they have, you know, need to be interpreted carefully, use it for biofeedback, that's how I use it. And then we on our medical side needs to learn, need to learn very quickly what's out there with sensors, because they're going to they're going to own their body with multiple sensors very, very, very soon and going to know a lot about it. A lot more than we do, because we don't have those biosensors on them. It's important for people to realize that a lot of the wearable science or claims, they're not causal, they're often associated. Meaning that people who can afford a wearable, get a wearable, get data, they may change their behavior. So they're driven by multiple things. The biofeedback you're describing, I think is right. I do think performance is the place that will also be really transformed. I think people who really want to be at the highest level of human physical performance are already putting all kinds of things on themselves. Because this is kind of a a performance test if you will. One thing you mentioned is quite interesting, the extremes of human physiology is where you will test these things first and then they will go into the mainstream. Extreme sports, they've been using, testing all day every day for a while. Astronauts, if you look at the Apollo 13 mission that didn't go well, they are back then fully lined up with heart rate sensors 24/7. If you in space, you're fully monitored all day every day. That's in the sixties and seventies. And then slowly moves into the general population, but the extreme on the other side of health and extreme performance heart failure, right? And I'm a heart failure doctor, you and, you know, interventional cardiologists, that's another extreme, where if you, of course, have heart failure, your pump is at the end of his life cycle. So here again, you want to watch it very closely and all the surrogates of and derivatives of heart failure that result in, you know, changes in cardiac physiology. So I think that is why cardiology deals with all of this and the extreme sports and physiology deal with this. But again, we demystified these sensors, they got smaller, faster, and that's why we're using it now in general populations as well.
[22:21]This has been beyond the endpoint, a podcast where we bring personal and expert perspectives on health care and clinical research to the casual listener. Stay tuned after the interview for a breakdown with the hosts. They'll talk through key takeaways and what this week's topic means for you. Maybe the bigger question for us is how do we feel about it today and what would be our recommendations for it going forward? And I'll say at least in my clinical practice, I have to admit, heart rate monitoring, despite the fact that it's so much more data and so many more things that people are individually bringing to me. There are a number of patients that probably had atrial fibrillation or dysrhythmia is happening at night. As you said, free range adults walking around in in life without us checking all their heart rates. But they now notice it. They may not have felt it. They come in and we go, oh, you know what, your Apple Watch told you this and it's not always correct. We do have to confirm it, we have to do a variety of other things. But there are patients I've had that were having a fair burden of atrial fibrillation, they weren't feeling it intermittently, that their watch identified, that we then identified as a risk factor for stroke and actually, you know, motivate them to change some of the things they're doing and potentially even treat them with different therapies. So I don't want to make it sound like the wild Wild West doesn't have some upside. It's just how do you define the right use cases and put it into medical therapy in my mind, but I'd be interested Marat and your thoughts about this, because I am struggling in the sea of data. How do we start to get people to identify the kinds of things that we're looking for in addition to just the heart rates that we've highlighted? I think the unique opportunity is that as we get more data and we accessing patient's physiology during times we never had access to, sleep, home environment when they're not monitored, during exercise where they typically would have not exercise with us. We now have to create reference values. Medicine's very good at creating what is a normal value, what's an abnormal value for any physiological test we can do with them, when any lab value we can do with them. But we just have to do that now for the free range environment if that sensor is going home with them. That's un-censored data we understand. I'm going to give you an example, heart rate, blood pressure. We have been knowing that for hundreds of years what that is, so we're pretty good at creating boundaries, but these sensor data are getting now so complicated, they're actually start putting them together, they're putting them into clusters. So they are telling now a multitude of components. For example, stress factor. You know, there's a number of companies wearables that tell you your stress level and give you one to ten. Well, that's an arbitrary value. Having said that, it incorporates heart rate, sleep pattern, activity level and now it comes on and on and on. Well, now creating reference values for that is going to be more complicated and it's going to get a lot more complicated the fancy the sensors get. I think that is where I see the FDA having some struggles. I think that's where clinicians will have some struggle in in interpreting of and creating reference values for the new stuff that's going to come on the market. And to that point, just putting my outcomes researcher hat on. The sea of data does make me pretty nervous when I think about the potential for data mining and multiple testing that doesn't have, you know, appropriate statistical corrections. Do you think that from a research perspective, let's say all of those data are generated, they're, you know, dumped in the EHR, we're able to see what happens to people over time. Are we going to learn a lot from that, from the outcomes studies we do there? And are we going to find out anything new at a population level or or do you think it's just going to be reinforcing what we already know? I think you will you will see a lot more studies, you know, dumping, you know, very high resolution data from wearables. We have already now a number of NIH and non-NIH supported studies, like the Apple Watch study where there's longitudinal heart rate track data that now have a massive data. For of course, now if you have large data sets that are obtained in a quote unquote free world, you have a lot more noise that you introduced, but because you have a lot more data, you can get, of course, novel signal patterns out of it. So I do think in general that you have more noise, you have to go through, you have to actually discover new capabilities. You have to think differently about how to actually curate the data, not just analyze it and do statistical test, but like who's going to actually clean the data for you? That tends to be a bigger problem and takes you more time than the actual analytical tests you have to run on the computer later. But that's what people like you will need to start sorting out pretty quickly because I I don't think there's a way around that we're going to be dumping data on on us that's going to be looking like that. But you will, I think, get richer data outputs and hopefully, phenotypes. I mean, you will understand things, you know, it's one thing, my blood pressure is 120 over 80 in office today, or you give them a 24-hour blood pressure readings. You there's a daytime blood pressure, there's a nighttime. There's a very broad range of things you can get out of high resolution data than from a single or even two, three data points throughout the day. And I think that's what we'll find out. We'll just learn new things. Just the problem or not not it's not a problem, it's an opportunity is that it's going to come at a much faster pace than we were used to over the last 50 years, I think in the space of medicine because the amount of technology coming our way. There's no limitations anymore in technology development, right? It it's the limitations now human brain processing the data and making sense out of it fast enough. That's what we are dealing with right now. Engineering is not a limitation. Well, and I'd like to talk about one more limitation that Manash touched on, which is again, kind of at the population level. I mean, if we think about, you know, taking away the technological barriers and sort of making data more available for analysis. If you think about, you know, where those data are generated and who they come from, and there's I think a lot of concern about the digital divide in health care where we're looking at data from this narrow segment of the population that tends to be more educated, more wealthy. Do you worry about long-term inequalities that might come from that and and what can we what can we do to proactively address that? Yeah, you know, even the Fitbit problem in the past was costing hundreds of dollars, where it costs now, you know, several dozen only. So I think certainly technology in itself introduced divides. Even if medically prescribed, you know, certain insurance pay for it, certain insurance don't pay for it. So I I'm not sure that I have a perfect solution for that besides that I don't think we're quite there yet, because I don't think that we're using wearable technology broadly enough to say there's an equity. Because I think we just don't use it quite yet and it's actually patient-driven. When it's patient-driven, that's inequity. Patients that can't afford it, that's the inequity coming our way. But at least it's not some responsibility that I feel I bear, because they come to me. Having said that, it will be unavoidable to start thinking about that, so that it's a good point.
[31:25]I think that some of this to your point, Emily, could be driven again by what's the population needs. The biggest thing, you know, in clinic, even before the wearables, data matters to people and people personalize data. You know, some of the things I tell my patients all the time is just the act of weighing yourself every day and putting it on a calendar or something. Low tech as that sounds, makes you get more engaged with your own health and your weight. And if I said what are the the largest things we could do for for health in general in the world, blood pressure is certainly one of them and a weight is another big one. So anyway in which we can start to democratize the digital divide by finding wearables that are low cost, that give people back that information so we can get better at hopefully finding these different phenotypes, as as Marat said, or different sort of personalized physiologic markers. There are people that have their blood pressure go up at night, there are people who don't have it go up at night, and that may change how we should be thinking about how we treat their blood pressure. There are people who have nighttime jobs that that affects their blood pressure in a significant way, and if we knew how to help them with the different dosing or scheduling of their blood pressure, why it matters. So the idea that some wearable in the future or now could be potentially prescribed to manage large conditions like blood pressure and weight, should force us to say how do we democratize some of those low cost solutions because they're going to be really big opportunities on public health to individualize how we care for our patients. And to be provocative, I would say that certain wearable devices, let's say like Fitbits, I actually I can see a future where you actually going to give them away for free and you actually going to capitalize as industry on the data, because really the health data is going to be what's the valuable component of these technologies to industry, to maybe even health care system rather than the technology itself, because at some point they're going to be so cheap, it's it's going to be a matter of few dollars, believe it or not. I think there are places where that might happen, although we do it for heart failure where we try to give patients scales to weigh themselves at home. Exactly. We try to do things like that so we can measure their blood pressure, but I mean, get their weight for their fluid and then we might even start to give them, you know, cuffs, Omron cuffs or other cuffs where they can do it. So let me ask a couple questions as we round it out. Marat, how many wearables do you have on right now? And how many do you have on an average day? Yeah, well, just my watch, I took it off. But I mean, I use a special scale at home that I have that actually also, you know, give to patients. It's a scale that measure also water content. I mean, I think per day and I have my phone that never leaves my body. You know, that's in personal life and clinical practice, it Duke, we are seeing, there we have a lot of wearables we're handing out to patients, you know, the scales, the patches. Yeah, things to understand, to test, to capture. Yep. I'm I'm on the low end of the spectrum. I come from a long and proud line of hypochondriacs, so, um, I'm like one of those people who would get the sleep monitoring device and then not be able to sleep, because I would be worried about it knowing that I wasn't able to sleep. So I definitely think that there's some element of the utility can vary. Yeah, I think it's good to know. I come from a long line of people who get data and ignore the data, so it's a it's another of of behaving. Uh, but I do have uh, I do have the watch, I do have the Aura ring and I obviously have the phone. So those are different pieces of data at any given time that people can have. My sense of it is that, like we said, there's a huge behavioral component. Just by having it or forcing yourself to look at it or to engage with it, there may be things that do or don't change your behavior in a good, hopefully or sometimes not so good way. But those are all things that I think just like healthy behaviors and nudges that occur, whether they're food nudges, economic nudges or health nudges with wearables are all important. And I guess, you know, we started by saying what are these wearables that we think about from your phone, to your pedometer, to your Fitbit, to your patches and things that people have. Maybe as we round out the thing, Marat, what are the some of the unique wearables that we haven't thought about or people might not be thinking about yet? Yeah, so I, maybe one comment before I tell you sort of the the playyard of what we're dealing with out there, already on the ground, is that I think the key part about wearables that it democratized the commodity of health. We live in the Amazon prime era where what people want to have their own data, immediately, and not have to wait to see the doctor in six months. And that's how long it takes to see a doctor from scratch these days. So I think the reality becomes that you want to have the data now, so you just going to get it yourself and and and wearables can get you that data faster. So that democratized the data. So I think that's the exciting part about what wearables brings to the table. Here's what the wearables allows you to do is that really today there's not a one sphere of the human body or privacy has not been invaded by these devices. I mean, we're talking from head to toe, you could imagine a device that I mean, we started with headbands. We have in air wearables that we actually already have marketed and it's all out there. One device called Lume Health goes into the ear, right above the hole where you put the earbuds in above it, and it's supported by sunlight. So it's uh it's a four energy, so it's a little solar cell and you have to never take it out of your ear, and it only weighs a couple grams, so you actually don't notice it's in there. It might grow into your ear, who knows. That's used to track your heart rate, your blood pressure, your cardiac output and it's done for it's market right now for the patients. Then you go into actual necklaces, vests. You see I'm working my way down to my favorite, which I haven't prescribed yet is a toilet seat. There are a number of companies that even have built in sensors in the toilet seats with the intent to measure, you know, urine output, stool output, to crazy stuff like heart rate and blood pressure, you know, and that's where context matters. Why would you want to measure blood pressure and heart rate in the context of a restaurant visit? So I think sometimes it makes sense, sometimes they don't make sense, but I can tell you that the modern house, think of the house in the past you walk in, you turn the light on, that was all you do. That you use electricity. Now, the fridge is smart, the TV is smart, Aura is listening to you, voice recognition. We have heart failure devices with voice recognition. They let you speak three sentences every day into that device and it will tell you if you have heart failure decomposition that's impending weeks ahead of decompensation. So things will listen to you, they'll watch you. We underestimate how many devices are already embedded in our lifestyle. Yeah, it's a brave new world and, you know, with it comes the promise and the scaringness of it, right? Because I think about all the ways that information and data can sometimes be malused or disinformation can happen because you don't really know what's happening. But that's our that's our burden to make sure we do the science around it and I think is probably the biggest opportunity for us, as you said, if we can democratize giving people their health information faster, then hopefully we can lead to people avoiding unhealthy events and that would be really an important step.
[40:21]Yeah, I mean closing thoughts, I think is that wearables are here to stay. I think they will be changing their appearance and the way we define wearables will be different. I don't think you need to wear a wearable. Uh there's a lot of camera technology and sensor technology that doesn't actually have to touch your body. So I think our definition will change, access will change, costs will change, and I hope we'll all change to the greater, but the biggest obstacle and challenge we'll have is actually what you do with the data. So I'm actually truly not worry about technology, uh, engineering capabilities are excellent and will only grow, but it's just it's just going to be the data handling and communication, what you do with the data becomes key. And that's what we already experienced right now in the health care space. It's we don't worry about the new technology, we worry about the data comes out of technology. And I think people that be able to solve that will rule the world and help the world the most.
[41:48]This has been beyond the endpoint. Resources related to this episode are available on dcri.org/bte. If you have any burning questions about clinical research or health care, drop us a line at beyondtheendpoint@duke.edu. We'd love to address your questions in a future episode.
