Apple Inc. is working diligently on multiple fronts to partner with some of the nation’s leading universities and other groups like Biogen and UCLA to assist with depression and cognitive decline diagnosis, with the goal of expanding the scope of its growing health portfolio. Apple wants to tease out digital biomarkers associated with the conditions using an array of sensor data that includes mobility, physical activity, sleep patterns, typing behavior, and more so that algorithms can detect them reliably. Apple hopes that this will serve as the foundation for unique features on its devices.
Why Does Apple Believe Digital Biomarkers Are a Modern-Day Necessity?
In recent years, health care workers and technologists have been investigating how digital biomarkers could aid in monitoring patients who are suffering from physical and mental illnesses. Digital biomarkers are defined as quantifiable, objective, physiological, and behavioral data that are digitally collected through portable devices such as mobile phones, wearables such as rings, jewelry, wristbands with sensors, implantables that can be embedded in tattoos, or digestibles which can be swallowed.
The data collected are typically used to explain, influence, and/or predict health-related outcomes. For instance, depression is reported by 4.7% of adults over the age of 18 living in the US, according to the Centers for Disease Control and Prevention (CDC). By evidence-based tracking of select symptoms of depression with biomarkers, individuals and their clinicians can work with more accurate data than the existing self-report or other assessment methods that have dominated the field to date. The ultimate hope is that digital tracking can not only assist in diagnosing, but also in measuring outcomes over time. Of course, privacy concerns are paramount and complex.
With the assistance of some of the brightest and most advanced researchers nationwide at leading universities and other groups, Amazon is making notable gains on the digital biomarker frontier. Some of the most recently reported news is offered in the article below for your review and comment.
Apple’s Smartwatch Collaboration with Harvard & University of Michigan
Much of Apple’s previous health work has been focused on smartwatch features. The Apple Watch is now capable of more than just counting steps and monitoring your heart rate. The company made headlines in 2018 when it received de novo approval for its ECG feature on the Apple Watch. In addition, Apple has begun to include more health-related features in its iPhones. In June, it announced a new health sharing feature and a walking stability feature, allowing patients to share their health data with doctors and family members. It is steadily increasing its collaborations with notable partners to increase its healthcare footprint.
Apple announced a smartwatch collaboration with Harvard’s T.H. Chan School of Public Health in March 2021 to study women’s health across demographics and lifestyles. Apple has also conducted a study on hearing health in collaboration with the University of Michigan and the World Health Organization (WHO). A collaboration between Apple and Stanford University demonstrated that its smartwatch and iPhone could detect an irregular heart rhythm known as atrial fibrillation.
Apple’s Smartphone Collaboration with UCLA
Apple is now shifting to more of a smartphone focus, building on evidence that people with some behavioral conditions use their digital devices differently than others. In some cases, data from both an Apple smartphone (iPhone) and smartwatch (Apple Watch) will be used. Apple has announced a three-year collaboration with the University of California, Los Angeles (UCLA) to gather more data to explore the link between sleep, physical activity, heart rate, and daily routines with depression and anxiety.
UCLA researchers now aim to track data from the iPhone’s video camera, keyboard, and audio sensors, as well as data from the Apple Watch for movement, vital signs, and sleep to develop a product. Analysis of participants’ facial expressions, how they speak, the pace and frequency of their walks, sleep patterns, and heart and respiration rates are all being evaluated. They may also measure the user’s typing speed, the frequency of their typos, and the content of what they type, among other data points. Apple’s code name for the UCLA project is “Seabreeze,” while Biogen’s code name is “Pi.” They believe that developing reliable algorithms can help in the early detection of mental health conditions.
Each data could provide researchers with information about Apple users’ emotions, concentration, energy level, state of mind, and more. The UCLA researchers have participants complete questionnaires about how they feel to compare this data with other measures of stress, anxiety, or depression. The researchers are also looking at the amount of the stress hormone cortisol in the follicles of participants’ hair. If the study discovers that any data correlate with relevant mental-health conditions, those signals or features can be used in-app to alert people that they may be at risk and stimulate them to seek care.
Apple & Biogen Collaborate to Develop Mild Cognitive Impairment Technology
In January 2021, Biogen and Apple announced a 2-year partnership to study the cognitive functions of 20,000 participants using the Apple Watch and iPhone. They hope this can be used to identify mild cognitive impairment (MCI), a condition that often leads to Alzheimer’s. The data will be compared to traditional brain health tests, such as traditional cognitive assessments and scans that track plaque buildup in the brain. Biogen’s interest in cognitive decline is well known. As of June 2021, the company received FDA approval for its contentious Alzheimer’s drug Aduhelm. In the 2021 article published by Biogen, Apple Chief Operating Officer Jeff Williams said:
“Working in collaboration with Biogen, we hope this study can help the medical community better understand a person’s cognitive performance by simply having them engage with their Apple Watch and iPhone.”
Apple & Duke University Collaborate to Develop Autism Technology
Apple is also working with Duke University on a research project to develop an algorithm for detecting childhood autism, which will include using the iPhone’s camera to observe how young children concentrate. None of these projects are new, as seen in this Apple Newsroom press release, dated October 2015. For more information about this early collaboration, see ResearchKit.
This much development by Apple warrants at least a mention of Apple’s notable competitor, Google. In addition to the health services app, Google is also making great strides toward developing new health features, particularly on the latest smartwatch Wear OS version in many unique styles and added features. The Wear OS smartwatch connects to multiple sensors to collect better health data related to workouts and provide metrics such as heart rate, step count, calories, distance, etc.
The extent to which sensitive and personal information may be involved will raise privacy concerns for Apple users as well as the healthcare community. To address these pivotal issues, Apple aims for algorithms that work on users’ devices and don’t send the data to Apple servers. The promise so far is that Apple’s digital biomarker initiatives will avoid the involvement of telehealth processes, along with their many legal, regulatory, and ethical complications. Decades of work have gone into developing these tools, and many other companies are developing similar biomarker technologies for healthcare. However, to date, Apple seems to have partnered with more companies than any other, according to our Telehealth.org research.
When queried, Apple has explained that its first and foremost priority is users’ privacy. However, if any evidence of child pornography is found, they are bound to report it to the authorities. In watching how these developments impact the professional community and the people it serves, it is apparent that today’s technology will only continue evolving, quickly become ubiquitous, and that in many cases, professionals will be forced to adapt their services to include digital interventions to sustain their viability. See last week’s Telehealth.org article, Amazon, Walmart, and Dollar General Continue their Advance into Delivering Telehealth Services to see how other companies are moving into the healthcare area as both competitors and employers.
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