00:01okay I think one of the probably easiest
00:04places to start with like talking about
00:05tech is the Apple Watch the watch
00:07anytime first of all you see any
00:09messaging from Apple about the watch
00:10there's always something health related
00:12in it and it was fascinating the way it
00:14started because Apple kind of didn't
00:16know what the Apple watch was going to
00:18be it was an iPhone accessory but then I
00:20don't know will you like send a digital
00:22heartbeat to your friend or will you
00:24like answer messages or get
00:25notifications and we threw in some
00:27Fitness features and then the world kind
00:29of figured it out and it just turned
00:30into fitness and notifications yeah and
00:34so every single update to the Apple
00:36watch adds some Fitness or health thing
00:40and they have to find a way to sell it
00:42to the public and it gets increasingly
00:43more and more like if you don't have
00:45this you might miss that heart
00:47irregularity that you have and this has
00:50saved X live so far and here's a letter
00:52somebody wrote from the hospital about
00:54how it saved their life
00:55is this uh okay with you it seems like a
00:59pretty wild uh way to get people to get
01:01something they probably don't need I
01:04isolate the Apple watch in this for sure
01:06I think as the tech industry I think
01:09what's happening is they've seen the
01:11value that Health Data has
01:13and increasingly the healthcare tech
01:16industry is and even the healthcare
01:18industry as a whole is being run as a
01:19hedge fund and to me that's where I draw
01:22the line because for example if I tell
01:27um let's say I'm going to use this water
01:28bottle here let's say I created a grip
01:30for a water bottle that makes it less
01:32likely that it'll slip out of my hands
01:34but I haven't done the research to prove
01:36that that's the case are you going to be
01:38mad about the fact that I'm saying that
01:39it doesn't slip out of your hand
01:41not really right who cares logical but
01:43now what if I say the water that I've
01:45created inside here cures your
01:47depression but I haven't yet tested it
01:50it's kind of a stretch that's the
01:52problem with our current Healthcare Tech
01:54Healthcare hedge fund industry okay no
01:57one is actually going that mile to prove
02:00that something works because that's
02:01really expensive and a lot of times will
02:04backfire because it proves that it
02:05doesn't work and now you've killed your
02:07beautiful product I see yeah I remember
02:09the electrocardiogram coming to the
02:11Apple watch and the entire time I'm
02:14watching this I'm like
02:15I'm gonna have to review this watch and
02:17I'm going to test it and I have no idea
02:19how to tell if the ECG I get from this
02:21watch is good or bad or if it worked or
02:23didn't work but it'll be the first time
02:25I ever do an ECG myself so I guess
02:28I don't know how to well I just don't
02:30know what to do with it to be honest as
02:32a doctor and most doctors don't know
02:34what to do with it because like the most
02:36common use example of the features on
02:38the Apple watch is that it'll tell you
02:39your heart rate's High uh there's a
02:41potential risk that you have atrial
02:43fibrillation right which is when your
02:44heart beats irregularly at an irregular
02:46rate I meant to show you this oh did you
02:48have some I got well I started getting
02:50these PVCs these a couple nights ago
02:54yeah low heart rate and it just this is
02:56an athletic Flex right here
02:59because you're a fitness
03:02so I guess it's weird though because
03:04it's notifying me of some health thing
03:06and I'm like is this good bad I don't
03:08know sometimes you get a high heart rate
03:10notification there's all kinds of things
03:11do people ever go to you saying because
03:13my watch told me something is it ever
03:15used no joke what's today today is
03:17Friday yesterday I was in the office uh
03:20gentleman comes in who has a history of
03:22SVT which is a type of fast heart rhythm
03:25that exists and he said that after that
03:27happened to him once he got an Apple
03:28Watch to start tracking when this
03:30happens but here's the interesting part
03:32he knows when it's happening he can feel
03:35it he can feel the palpitations he has
03:37the skills and the techniques necessary
03:39how to shut it down and it happens very
03:41rarely but he's still got the Apple
03:43watch now the Apple watch started
03:45warning him after he played squash that
03:48he would have high heart rates and he
03:50started getting anxious and then he
03:51started getting worse outcomes with his
03:54heart rhythms so you see how the tech is
03:58fire it works it tracks things but what
04:01we do with that information is really
04:03problematic because until we get some
04:06guidance and we gather enough data to
04:08actually make use of it more data just
04:11means more health anxiety more weird
04:14interventions that we don't even know if
04:16they work or not yeah the magic really
04:18is in when the watch notifies you and
04:21specifically how it sort of gives you
04:24and displays the information in a way
04:26that's useful yeah because it can it can
04:28measure all at once but it's not
04:30necessarily like if you go through the
04:31health app and scroll for a while
04:32there's tons of stuff your breath rate
04:34your like heart rate over time and all
04:36these different things VO2 max somehow
04:38knows and I just don't know what to do
04:40with that information I think it's
04:41entertainment purposes only for now the
04:43the one feature on the Apple watch that
04:45I think is really exciting is the fall
04:47notification feature yes and you have a
04:51story of it going off on a roller
04:52coaster that's one that's happened to a
04:59um but I'll be running around during a
05:00frizzy practice and chasing somebody
05:02around the field long enough you'll like
05:03stumble and you'll get a little
05:05vibration says are you okay did you
05:07follow did you need me to call see
05:09that's the cool feature it's kind of a
05:10flex though because if you made someone
05:11fall hard enough that they get back
05:14I never thought of it you break
05:16someone's ankles hard enough that they
05:17yeah watch is like are you good bro yeah
05:19I'm good yeah I feel like the we keep
05:23saying Apple watch because it's the one
05:24that seems to plug it in the most but
05:26like obviously pixel Garmin Samsung
05:29they're all doing it and it feels like
05:31they all started focusing on like health
05:33and fitness activity tracking first
05:36um and now they seem to have gone into
05:38more of these like afib VO2 max like uh
05:42fall detection more things that feel
05:44like past I'm trying to live in Active
05:46Health style and more like I'm warning
05:49you about your regular Health style
05:51um I kind of wanted to go over like
05:52could we split that into two maybe from
05:55what you said already it seems like a
05:57lot of it seems kind of nonsensical but
05:59if we can uh not nonsensical but I think
06:01it's but less useful okay and every time
06:04we weigh any kind of medical
06:05intervention we weigh risk benefit right
06:07so if I prescribe a surgery and
06:09medication everything has risk benefits
06:11in fact if something doesn't have a risk
06:13that means it probably doesn't even work
06:15anyway because it has to have the
06:17opposite effect if it does something
06:18yeah so with this Apple watch what I
06:21feel like is happening we're getting
06:21data yeah very limited benefit of what
06:24we can do with said data but definite
06:27harms that I'm seeing as a result of
06:29health related anxiety that's being
06:30fueled by all these alarms so that's how
06:32I make my decisions it's very simplified
06:34yeah do you use any type of trackers
06:37yourself so for example I used to wear
06:39an Apple Watch myself and I remember
06:40watching a UFC fight and I guess because
06:43I've been in the ring yeah I got an
06:46alert for the first time that your heart
06:47rate's been elevated for an extended
06:49period of time well sedentary so while
06:51watching it yeah that happened to me in
06:53hockey playoffs this year I was like
06:55getting it was just like just so you
06:56know you're anxious that I guess makes
06:58sense yes exactly you know that's
07:00happening though so it's easy to dismiss
07:01that I guess like for abnormal heart
07:03rate and stuff it's more of the times
07:04where you're not quite feeling it and
07:07you get that um you said you've already
07:09had it do you think it's stuff like that
07:11how much is that affecting you guys in
07:13the medical field of just getting calls
07:15and patients who are like you said
07:16anxiety specifically my watch told me
07:19okay so now we're kind of talking about
07:20the anxiety and the non and health
07:24important I guess vital disease
07:26notifications like random like fast
07:28heart rate all that but now let's talk
07:29about the atrial fibrillation
07:31notification because that's the one that
07:32could actually have Healthcare
07:33implications we have no idea what to do
07:35with it in the healthcare setting when
07:37you get a random alert like that yes we
07:40can put on a halter monitor monitor you
07:42for seven days which is a little thing
07:43you wear on your chest it monitors it if
07:45you have symptoms like palpitations you
07:47could notify it so when we re read it
07:49back we can go back to the time where
07:51you press it yet symptoms because a lot
07:53of times patients will have some sort of
07:55electrical irregularity in their heart
07:57feel it but then we didn't do the EKG
07:59when that was going on so we don't know
08:01what's going on so the halter allows us
08:02to do that but in general when we have
08:04atrial fibrillation we have rules of how
08:07we decide to treat it how often is it
08:10happening we have scoring systems that
08:12we use based on the patient's age there
08:15are other medical history like little
08:17factors but if it happens very very
08:20rarely and the person's otherwise
08:21healthy with no medical history which is
08:23most of the time what happens when we
08:25get these calls yeah what we do with it
08:27we don't have good evidence to decide
08:29maybe we put the halter monitor on but
08:32then it doesn't catch anything then the
08:33Apple watch Two Weeks Later catches
08:35something again we still don't know what
08:36to do yeah I feel like there's the in
08:38the keynote there's a classic example of
08:40like I got this notification I thought
08:42it was kind of weird I went to a doctor
08:43the doctor confirmed it this thing saved
08:45my life yeah and the the the fitness
08:48things that we wear have such scale
08:50there's so many of them out there that
08:51inevitably there's a couple of those
08:53stories that are real and then when
08:55those stories are the display for like
08:58whether or not you should get the thing
09:00it makes it feel like this is something
09:02everyone should be looking for it's it's
09:05manipulative marketing tool because look
09:08I can say right now let me give you a
09:11CAT scan every day for the next 20 years
09:15and I might be able to catch a Cancer
09:17and we might be able to intervene but
09:20what I'm not telling you is that I'm
09:21also going to be radiating your body
09:23probably producing all sorts of cancers
09:25at the same time yeah so there's there's
09:27a healthy balance that has to exist when
09:30it comes to healthcare Tech where it's
09:32like we tell people what it's possible
09:34to accomplish but then we have to be
09:37honest with the drawbacks otherwise it
09:40gets into Shady territory yeah do you
09:43think there's any type of
09:44and if like the doctor Community has
09:47discussed this before but
09:49there's some people who say like
09:50obviously all these numbers aren't very
09:52accurate but if you follow Trends based
09:54on numbers that you're getting on things
09:55is there like a a best practice of
09:58potentially using these two actually not
10:00just increase healthy lifestyle but also
10:04some sort of Health the health app does
10:06show Trends Trends but even just you
10:08reading things yourself like yeah I mean
10:10I get a heart rate variance every
10:12morning when I wake up and like that's
10:14something when I first saw it I research
10:16it and then I'm scared like you said I
10:18I'm exactly who you're talking about
10:19with health anxiety looking stuff up
10:21online sometimes I think this really
10:23helps me sometimes I think this sends me
10:25into a bit of a spiral and I don't know
10:27like for example resting heart rate the
10:31lower the resting heart rate generally
10:33speaking the healthier a person is right
10:35because that usually means they're in
10:36great shape this is why this guy over
10:38here sits at a 40 heart rate going to
10:43if you are at a resting heart rate of 75
10:46that's considered normal you're healthy
10:47and let's say you start exercising and
10:50you start lowering that the Apple watch
10:51will show that Trend over the course of
10:53the month yeah but you tracking that
10:55number is purely for it's purely for
10:58entertainment okay because if I as a
11:01doctor encourage you to work out and you
11:02start working out I don't need the Apple
11:03watch to tell me that your resting heart
11:04rate's going to go down yeah that that's
11:07the only time that's really important is
11:09if you're an athlete professionally and
11:11you're trying to go from 99th percentile
11:13of success to 99.5 which the huge
11:17majority of the general public is not
11:19needing these tools but again for
11:21entertainment for motivation fine I'm
11:23with it especially this Tech can evolve
11:25and really will become good I think the
11:28future is bright I don't want to like
11:29poo poo the whole industry I just think
11:31the way that they're selling it now is
11:34premature yeah it kind of reminds me of
11:36uh like we were talking to the CEO of
11:39Riven where a lot of people will get
11:41like this hundred thousand dollar truck
11:43and will never use anywhere near the
11:45capabilities of the truck but the tech
11:47and the capabilities are so good that
11:49it's like once in a while when someone
11:51maximizes its use it's kind of amazing
11:53uh kind of reminds me of like yeah most
11:56people aren't trying to get from the 99
11:57to 99.5 percentile but the people who
12:00are might find this watch Amazing
12:02exactly the new ultra's got this like
12:04Trail climbing mode and all these other
12:06things that are like super super useful
12:08but generally for most of us we're just
12:10kind of like oh neat I should probably
12:12be okay well it's the same thing with
12:15like protein creatine supplements like
12:17you could take these but if you're an
12:20average person and I mean average even
12:22to like a higher degree yeah if you fall
12:24within 90 of people who exercise if you
12:27just focus on a healthy diet and focus
12:29on the routines you're doing
12:31the supplements are going to maybe add
12:34five percent of improvement and again
12:36that's for people who are competing the
12:38average person people who go to GNC and
12:41Vitamin Shoppe and all these and get
12:42these things you're doing it for fun
12:43yeah you're not really changing much
12:46that's fair yeah that's super fair I do
12:48like I I like how you use the term
12:49entertainment I guess it's not something
12:51we've thought about much but like
12:53entertainment doesn't necessarily mean
12:55bad thing like no entertainment is a
12:58motivator as well and like I I pers I
13:00used to play Frisbee with Marquez I had
13:02four knee surgeries and then I had to
13:04quit that eventually and found my
13:05activities like way way down like some
13:08minor things and then I borrowed an
13:09Apple Watch here once and those
13:11competitions they do are like
13:12one of the most things ever identifying
13:15Fitness yes it's like that has super
13:17helped me get into like a way way more
13:20active lifestyle and and that is amazing
13:23but yes on the other hand like what
13:25you're saying like if you're not in that
13:27potentially professional athlete aspect
13:29of things like these things are just
13:31like you can look and be like okay cool
13:32I did it today I knew that already but
13:35it's nice to just see it on my wrist
13:36there's the same way I'm like addicted
13:39to like checking the checkbox like
13:41closing the ring is like yes that's a
13:43satisfying thing look that's the strong
13:45part of this app and these tools and the
13:48motivation of it is exciting and I want
13:50people to make use of it in fact when I
13:52made like one of my first videos on
13:54YouTube it was about how to get fit for
13:56summer it was like get some new workout
13:57gears a Kickstarter to your motivation
13:59the one thing that I'll say is because
14:01I'm again very research based when you
14:03look at research and you see these
14:05initial boosts of Motivation by getting
14:07new gear by getting a Tracker long term
14:09they don't make a difference right you
14:11gotta have a routine and get into
14:13something it's a lifestyle change or you
14:15just need to keep buying things which is
14:16I've fallen into that whole way too many
14:19times yeah new hobby new shoes new
14:22everything yeah all right I asked uh
14:23Chachi BT uh for a joke about a doctor
14:27so this is what it wrote oh no why did
14:31everyone at the hospital want to hang
14:36because they were sick
14:38I don't know because whenever he was
14:39around they knew there was always a
14:44that is so bad I can't believe you had
14:46that ready to go on the board yes so bad
14:49so this is why uh humans are still gonna
14:51own comedy for a little while chechi BT
14:53not so great at that one but hey if you
14:55enjoyed this uh clip maybe uh leave a
14:57like or a thumbs up or uh you should
15:01not for the for the cop why don't
15:04skeletons fight each other why don't
15:07skeletons fight each other why because
15:10they don't have the guts
