Latest / The Antisocial Doctors Podcast / Episode 15: Do Fitness Tracking Watches & Rings Actually Make Us Healthier?

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Episode 15: Do Fitness Tracking Watches & Rings Actually Make Us Healthier? · The Antisocial Doctors Podcast

1:27
Sonia Singh MD: You are listening to the Antisocial Doctors Podcast, hosted by me, Sonia Singh, a board certified internal medicine physician with a Master's in nutrition and a special interest in health anxiety
1:38
Rebecca Berens MD: and me, Rebecca Barons, a board certified family medicine physician with a special interest in disordered eating.
1:43
Sonia Singh MD: We're also a millennial women anxious moms and curious humans navigating social media.
1:48
Sonia Singh MD: We've seen firsthand how these platforms can be powerful tools for education and connection, but can also make us unwell.
1:56
Rebecca Berens MD: This podcast is meant to be the antidote to your doom.
1:58
Rebecca Berens MD: Scrolling, a, solve for the anxiety, stress, guilt, shame, and confusion.
2:02
Rebecca Berens MD: That comes from social media's messaging around health.
2:05
Rebecca Berens MD: In each episode, we discuss a health related talk trending on social media with curiosity, nuance, evidence, humility, and compassion.
2:12
Sonia Singh MD: This is not your average debunking podcast.
2:14
Sonia Singh MD: We wanna explore not just what is trending on social media, but why?
2:18
Sonia Singh MD: Why are so many people drawn to this?
2:20
Sonia Singh MD: What is the nugget of truth here?
2:21
Sonia Singh MD: What are the facts?
2:23
Sonia Singh MD: What can we learn from this as patients and doctors?
2:25
Sonia Singh MD: No shame.
2:26
Sonia Singh MD: No blame, no snark.
2:27
Rebecca Berens MD: We're so glad you're here.
2:42
Sonia Singh MD: Hey, Rebecca.
2:43
Rebecca Berens MD: Hey, Sonya.
2:46
Sonia Singh MD: How's your day going?
2:47
Rebecca Berens MD: It's going,
2:50
Sonia Singh MD: that's us every week basically.
2:51
Sonia Singh MD: Every
2:52
Rebecca Berens MD: week, yes.
2:53
Sonia Singh MD: I'm really eager to hear about this week's topic'cause I have never looked into the data on this and I actually have had several patients ask me about it and I've just been assuming things about these.
3:03
Sonia Singh MD: So I'm excited to actually know the facts and the science.
3:06
Sonia Singh MD: So tell us about the patient story that inspired this episode.
3:10
Rebecca Berens MD: Yeah, so I'm gonna give you two because there's two there's two ways that I've seen this go.
3:15
Rebecca Berens MD: And so I'm gonna give you two stories and then we'll loop back to them at the end.
3:18
Rebecca Berens MD: Okay.
3:18
Rebecca Berens MD: Okay.
3:19
Rebecca Berens MD: So the first one, it was a patient who sent me aura ring data on their sleep.
3:24
Rebecca Berens MD: And they said Hey, my aura ring's been measuring significantly less deep sleep in the last few weeks, and I've been feeling less rested during the day.
3:33
Rebecca Berens MD: What does that mean?
3:34
Rebecca Berens MD: So we'll come back to that at the end.
3:36
Rebecca Berens MD: Okay.
3:36
Rebecca Berens MD: And then another patient who called me about 10 days after, they'd had a upper respiratory infection, had gotten a little bit better, and then about 10 days later they were getting worse again.
3:47
Rebecca Berens MD: And, having more coughing, blowing their nose, thick, green mucus coming up.
3:52
Rebecca Berens MD: And they were concerned they were getting a sinus infection because their aura ring was saying you have mild signs of stress after several days with no alerts.
4:00
Rebecca Berens MD: And at the beginning of the illness it said major signs of stress.
4:04
Rebecca Berens MD: It'd seen major signs of stress and then better, and then now mild signs of stress again.
4:08
Rebecca Berens MD: So these are some aura ring data that was sent to me for my patients that they felt was clinically relevant.
4:13
Rebecca Berens MD: And we can talk about how those played out at the end of this episode.
4:17
Sonia Singh MD: Yeah, I've had similar things happen to me in clinic where most of the time it's somebody's already in clinic because they're feeling sick and then they'll say, and also my AA ring told me that I'm stressed.
4:30
Sonia Singh MD: So yes, I've definitely had similar experiences.
4:32
Sonia Singh MD: So what do you think are the claims being made about AA rings or fitness trackers in general?
4:38
Rebecca Berens MD: Yeah in general, I think one of the biggest things is if we have enough data, we can use that data to optimize our health.
4:46
Rebecca Berens MD: And it's this whole obsession that we all have with optimizing, especially right now.
4:50
Rebecca Berens MD: In wellness culture optimize is a really commonly used word.
4:53
Rebecca Berens MD: And so the idea that the data doesn't lie, we can use this data to help us optimize our health.
4:58
Rebecca Berens MD: And the more that we track, we might be able to predict or catch a disease earlier and prevent it turning into something worse.
5:05
Rebecca Berens MD: I think there's also this move towards more personalized medicine.
5:09
Rebecca Berens MD: So not that one size fits all reactive sick care.
5:13
Rebecca Berens MD: That is the US healthcare system.
5:15
Rebecca Berens MD: Yes.
5:15
Rebecca Berens MD: But personalized, proactive precision medicine.
5:18
Rebecca Berens MD: Precision medicine based on my personal data.
5:21
Sonia Singh MD: Yes.
5:21
Rebecca Berens MD: And then I think the other piece to this is a moralization of health, which is these are all the things I have to do to be a good person.
5:28
Rebecca Berens MD: If I close all my rings, if I took 10,000 steps today, if I got x number of hours of sleep and, all these things, this is this means I did a good job.
5:38
Rebecca Berens MD: I got a, it's very cool.
5:38
Rebecca Berens MD: I got a gold star at the end of the day.
5:40
Rebecca Berens MD: Yeah.
5:40
Rebecca Berens MD: It came from my Apple watch because I closed all my rings, so that was, yeah.
5:44
Sonia Singh MD: And we are millennials that apparently need a trophy for everything.
5:47
Sonia Singh MD: So maybe it feeds into our desire to get the sticker, the gold star or the good grade whatever.
5:56
Rebecca Berens MD: Yes.
5:56
Rebecca Berens MD: So a plus score at the end of the day for closing all your rings.
6:00
Rebecca Berens MD: So yeah, I think those are the claims that I see brought up in marketing and underlying a lot of the posts and ads for these devices.
6:08
Rebecca Berens MD: What are your thoughts about that?
6:10
Sonia Singh MD: Yeah, no, I've definitely heard the same.
6:12
Sonia Singh MD: I feel like I've always been a data gal.
6:14
Sonia Singh MD: So it's weird to me actually that I don't, I'm not that interested in these.
6:19
Sonia Singh MD: I think if I was not a medical professional, I would be very interested in, in, in these.
6:23
Sonia Singh MD: 'cause I just.
6:24
Sonia Singh MD: I like tracking data.
6:26
Sonia Singh MD: I just like seeing numbers.
6:27
Sonia Singh MD: I guess that's why I am in a scientific field.
6:30
Sonia Singh MD: It's I just, I like that concreteness of it.
6:34
Sonia Singh MD: I like the elegance of seeing things change as you're, tinkering with different variables, so yeah.
6:39
Sonia Singh MD: I can see why they would emphasize all of that in their marketing and why they would claim how can you make decisions or take actions or do interventions if you don't have this data?
6:49
Rebecca Berens MD: Yeah.
6:49
Rebecca Berens MD: And it's like giving that clarity and in the face of uncertainty.
6:53
Rebecca Berens MD: Here's some concrete information.
6:54
Rebecca Berens MD: This is facts, so you can rely on this.
6:57
Rebecca Berens MD: And you can make informed decisions based on this factual data, right?
7:01
Sonia Singh MD: Yes.
7:02
Sonia Singh MD: Okay.
7:02
Sonia Singh MD: So why do you think these are so popular?
7:05
Sonia Singh MD: We talked about some of those right now, but at this moment, why do you think wearables have taken off?
7:11
Rebecca Berens MD: Yeah, I think obviously it's in this.
7:13
Rebecca Berens MD: Overlying narrative of wellness, culture and optimization that we've been talking about in pretty much every episode of this podcast.
7:19
Rebecca Berens MD: That is underlying a lot of these health tech developments.
7:23
Rebecca Berens MD: But then I think the virality comes from fomo.
7:25
Rebecca Berens MD: Someone gets one and then they're like, oh, my ring told me this about myself.
7:28
Rebecca Berens MD: And they're like, oh, I wonder what's going on with me.
7:30
Rebecca Berens MD: So it just like spreads really quickly.
7:32
Rebecca Berens MD: So it's something that I don't know about myself, maybe it could help me if I learned this about myself.
7:37
Rebecca Berens MD: And then I think it's also, as we've talked about before, a lot of this, fear of an unexpected health event.
7:43
Rebecca Berens MD: 'cause we are still all seeing the GoFundMe on social media, the horrible, disease that.
7:50
Rebecca Berens MD: Took out a celebrity or a young child or a or some person that's an influencer.
7:55
Rebecca Berens MD: And if only they had known earlier, they could have prevented it.
7:58
Rebecca Berens MD: And so maybe if I get some data about myself, I can prevent that happening to me.
8:02
Rebecca Berens MD: I think that also has fueled a lot of it.
8:04
Sonia Singh MD: Yeah, one thing that I have no studies or data to point to for this.
8:08
Sonia Singh MD: This is just like a general feeling that I have is I think a lot of people are disconnected from their physical bodies or just don't for some reason we seem to be losing some sort of just connection and awareness about our physical beings in some way.
8:23
Sonia Singh MD: Maybe because so much of our lives are digital and online and are not us moving our bodies through space and touching and feeling things.
8:32
Sonia Singh MD: And I think there's some disconnection that's happening between mind and body and I think.
8:37
Sonia Singh MD: These trackers the popularity of them is partially driven by people's deep desire to just understand what is happening in their bodies, and I think these very much give, to, I don't know, to me it's an illusion.
8:51
Sonia Singh MD: I guess we'll find out if it's an illusion, but they give you the illusion that you are connected to your body and that you understand deeply what's going on with it.
8:59
Sonia Singh MD: How my body is stressed.
9:00
Sonia Singh MD: Like now my body is this, but I don't know.
9:01
Sonia Singh MD: I get, I say it's an illusion'cause I feel like every time a patient has been like, yeah I a or ring says I'm stressed, I'm like, yes.
9:07
Sonia Singh MD: Like we both know that, I see it in your face,
9:10
Rebecca Berens MD: I so agree with you on that.
9:12
Rebecca Berens MD: And I actually think, I think part of the reason these have appeal is I think we are used to taking in information through notifications because we are so overwhelmed.
9:23
Sonia Singh MD: Yes.
9:23
Sonia Singh MD: That's so
9:23
Rebecca Berens MD: with constant input.
9:25
Sonia Singh MD: Yes.
9:26
Rebecca Berens MD: There's so much stuff going on.
9:27
Rebecca Berens MD: It's so hard to keep track of everything.
9:29
Rebecca Berens MD: Life moves at a million miles a minute.
9:32
Rebecca Berens MD: There's just constant stuff.
9:33
Rebecca Berens MD: So it's like I need to be reminded of
9:35
Sonia Singh MD: Yeah,
9:35
Rebecca Berens MD: I need to go to the bathroom.
9:36
Sonia Singh MD: Your
9:36
Rebecca Berens MD: wife needs to tell
9:37
Sonia Singh MD: you that you are stressed right
9:39
Rebecca Berens MD: now, the number of people that I, we have to talk about setting alarms to eat meals.
9:43
Rebecca Berens MD: Setting alarms to go to the bathroom.
9:45
Sonia Singh MD: Yes.
9:46
Rebecca Berens MD: Setting alarms to drink water.
9:47
Rebecca Berens MD: We, we are so tied up in the constant input that we're getting that we need notifications.
9:53
Rebecca Berens MD: And so I think people want that data feedback of what's going on with me?
9:56
Rebecca Berens MD: 'cause I haven't felt anything in a while and we are disembodied in Yeah.
10:02
Rebecca Berens MD: In our culture.
10:03
Rebecca Berens MD: Because even even just think about like during the pandemic, that was literal disembodiment, all interaction was happening virtually.
10:10
Rebecca Berens MD: Yeah.
10:10
Rebecca Berens MD: There's no embodied interaction with other people.
10:13
Rebecca Berens MD: And so much of our lives has been moved virtually even post pandemic when we are reintegrated it.
10:19
Rebecca Berens MD: There's just a lot that happens virtually now.
10:21
Rebecca Berens MD: And it does really separate our brain life from our physical life.
10:25
Rebecca Berens MD: And I don't think we actually feel things anymore.
10:28
Sonia Singh MD: Yeah.
10:29
Rebecca Berens MD: And if we do feel them, we don't trust them.
10:31
Rebecca Berens MD: What does this mean?
10:32
Rebecca Berens MD: Is this true?
10:33
Rebecca Berens MD: Is this not true?
10:33
Rebecca Berens MD: Am I really feeling this?
10:34
Rebecca Berens MD: I don't know.
10:35
Rebecca Berens MD: I need some proof.
10:36
Rebecca Berens MD: Prove it to me, proof that I'm sick.
10:38
Sonia Singh MD: Yes.
10:38
Sonia Singh MD: I think we can come back to that because I think there is an element of almost so there is that disembodiment that kind of disconnection from our physical bodies, but then I think there's also a lack of trust in ourselves and in our own knowing and in our own experience, so it's like there's times when somebody will be clearly totally stressed and overwhelmed and sleep deprived, and I'm like, yes, you do not feel well.
11:01
Sonia Singh MD: Not slept more than four hours for three nights.
11:03
Sonia Singh MD: And they're just like.
11:04
Sonia Singh MD: Oh, I like it.
11:05
Sonia Singh MD: It almost feels like they're not even allowing themselves to feel the feeling.
11:09
Sonia Singh MD: And then even if they are feeling the feeling, they don't trust that they know why they're having that feeling.
11:17
Sonia Singh MD: I don't know.
11:17
Sonia Singh MD: There's just a lack of faith in our own, you, there's this desire to see everything as concrete data and objectify and objective.
11:24
Sonia Singh MD: And not, not being able to trust your own experience of it, basically.
11:29
Sonia Singh MD: Yeah, I don't know.
11:30
Sonia Singh MD: I think there's some deeper roots here that, that are making these very popular.
11:33
Rebecca Berens MD: I think a lot of that comes from a societal shift that's happened too, because think of how many patients now who are grown adults who need a note to take a day off of work when they're sick.
11:46
Rebecca Berens MD: Yes,
11:47
Sonia Singh MD: that's true.
11:47
Rebecca Berens MD: Kids, like kids for school.
11:49
Rebecca Berens MD: It's if they're sick, when I was growing up, not that my parents ever kept me home when I was sick, but if they did I didn't need a note.
11:55
Rebecca Berens MD: They just were like, she's sick, she'll come back.
11:57
Rebecca Berens MD: And then I came back and it was fine.
11:58
Rebecca Berens MD: Now it's did they go to the doctor?
11:59
Rebecca Berens MD: What do they have When the can do, they come back we need a note, we need documents.
12:02
Rebecca Berens MD: And it's like that for adults too.
12:04
Rebecca Berens MD: Take a day off of work because you're sick.
12:06
Rebecca Berens MD: You need so many layers of bureaucracy to prove it, that a lot of people, a lot of my patients are just like, I'm just gonna go to work.
12:12
Rebecca Berens MD: It's not worth it.
12:13
Sonia Singh MD: Yeah.
12:14
Rebecca Berens MD: And I think that's, there, there's this cultural thing of we just keep going, hustle, culture, grind through it, it'll be fine.
12:20
Rebecca Berens MD: Yeah.
12:21
Rebecca Berens MD: And so people are ignoring a lot of these signs that they're feeling because it's I have to keep going.
12:25
Rebecca Berens MD: I have to keep going.
12:26
Rebecca Berens MD: Life keeps moving and I have to keep up.
12:28
Sonia Singh MD: Yeah.
12:29
Sonia Singh MD: Yeah.
12:30
Sonia Singh MD: I agree.
12:31
Sonia Singh MD: Okay.
12:31
Sonia Singh MD: So what do you think is the nugget of truth in some of those claims about fitness trackers and wearables?
12:37
Rebecca Berens MD: Yeah, so I think it's definitely true that there are several diseases that have symptoms that may go unnoticed or unrecognized, and earlier intervention is beneficial.
12:47
Rebecca Berens MD: Hypertension for example, there's been a really good public health campaign around hypertension as the silent killer.
12:53
Rebecca Berens MD: 'cause hypertension or high blood pressure often does not have symptoms until a later stage of disease, right?
12:58
Rebecca Berens MD: So people who have high blood pressure often don't feel necessarily anything different.
13:03
Rebecca Berens MD: Yeah.
13:03
Rebecca Berens MD: Or if they do feel anything, they attribute it to other things like, oh, I have a headache.
13:06
Rebecca Berens MD: It could be lots of things.
13:08
Rebecca Berens MD: They're not necessarily thinking it's their blood pressure.
13:10
Rebecca Berens MD: And so I think that there's been successful public health campaigns around the idea of screening in general and the fact that there are conditions that can be intervened on before there are symptoms.
13:20
Rebecca Berens MD: And so that is true.
13:21
Rebecca Berens MD: And I think, so people are looking for ways of what else can I screen for earlier?
13:26
Rebecca Berens MD: Because now I know we have all of this data of these other things that I can screen for I like cancer screenings, blood pressure screenings.
13:32
Rebecca Berens MD: Diabetes screening, how, what else could I screen for that I could catch earlier?
13:36
Rebecca Berens MD: And then I think the other piece is I think a skill that we are all taught as children and that we learn in school is you can't improve what you don't measure.
13:43
Rebecca Berens MD: So you have to, there is this idea of tracking is a helpful tool we can use to improve or like to make a habit stick or to improve a behavior that we wanna work on.
13:52
Rebecca Berens MD: There's good evidence for that.
13:55
Rebecca Berens MD: And also just practice of that in our lives.
13:57
Rebecca Berens MD: It's talked to us I think from childhood.
14:00
Rebecca Berens MD: And so I think that's that underlies the idea of tracking.
14:03
Rebecca Berens MD: But then I think there's also the truth that this can become unhelpful when it's taken to extremes.
14:09
Sonia Singh MD: Yeah.
14:10
Sonia Singh MD: I guess examples that I'm thinking of are of like.
14:15
Sonia Singh MD: Let's say you embark on a new fitness regimen, and a lot of times you may not see anything happen on the scale.
14:20
Sonia Singh MD: You may feel a little bit better, but you may not really know if you're making any difference.
14:25
Sonia Singh MD: And then, maybe you see on your wearable that your resting heart rate has gone down over a certain period of time and you might think, oh okay, that is something, and that might be motivating and encouraging for you to continue.
14:36
Sonia Singh MD: I, I don't know if there's any research on this.
14:38
Sonia Singh MD: My dad is a cardiologist and he's told me that a couple of times.
14:41
Sonia Singh MD: He's had patients come in saying that their Apple watch told them that they had an abnormal heart rhythm and they actually did, and it was asymptomatic and so they wouldn't have known otherwise.
14:50
Sonia Singh MD: And I, again, this is, I don't know if this is a slightly different category than just an aura ring or fitness tracker, but I've also heard of cases where somebody had a bike accident and their fitness tracker alerted, their emergency contact that, they seem to be in distress or something along those lines.
15:06
Sonia Singh MD: And they know they were able to send help very quickly.
15:08
Sonia Singh MD: I don't know.
15:08
Sonia Singh MD: I can think of a few examples and even the case you presented at the top of the episode, where potentially, there can be some benefits or some positive outcomes from'em.
15:18
Rebecca Berens MD: Yeah.
15:18
Rebecca Berens MD: Yeah.
15:18
Rebecca Berens MD: We will come to the Apple Heart study shortly.
15:21
Sonia Singh MD: Oh, okay.
15:22
Rebecca Berens MD: But so when we get into the facts with context and nuance I wanted to point out I just covered some of the common things that people use these trackers for.
15:30
Sonia Singh MD: Okay.
15:31
Rebecca Berens MD: And for each one I want us to consider.
15:34
Rebecca Berens MD: Is the data we are getting accurate from the tracker.
15:37
Rebecca Berens MD: Okay.
15:37
Rebecca Berens MD: Because that's the first piece.
15:39
Rebecca Berens MD: Is it even accurate?
15:40
Rebecca Berens MD: And then why does it matter?
15:41
Rebecca Berens MD: Because you can have lots of accurate data.
15:43
Rebecca Berens MD: That means nothing,
15:44
Sonia Singh MD: right?
15:44
Rebecca Berens MD: Doesn't change anything for you.
15:45
Rebecca Berens MD: So both have to be true for this to be a worthwhile endeavor, right?
15:48
Rebecca Berens MD: It has to be accurate and it has to have some sort of meaningful health outcome.
15:52
Rebecca Berens MD: So just wanna preface it with that.
15:54
Sonia Singh MD: Are we covering continuous glucose monitors in this or that's
15:57
Rebecca Berens MD: No, that's gonna have to be its own
15:58
Sonia Singh MD: episode.
15:59
Sonia Singh MD: A whole episode?
16:00
Rebecca Berens MD: Yes.
16:00
Rebecca Berens MD: I did not get into that.
16:01
Rebecca Berens MD: I was like, that's a whole episode.
16:03
Rebecca Berens MD: That's a whole episode.
16:04
Rebecca Berens MD: But this one is just gonna be trackers.
16:07
Rebecca Berens MD: So Ora Ring, apple watch, Fitbit, strap all the various track trackers.
16:12
Sonia Singh MD: Man, I forgot about Fitbit.
16:13
Sonia Singh MD: It's been a minute since I fit Fitbit.
16:15
Sonia Singh MD: There was a year I gave everyone a Fitbit for Christmas.
16:20
Rebecca Berens MD: Oh, I remember my Fitbit days very well.
16:21
Rebecca Berens MD: Okay.
16:22
Rebecca Berens MD: Anyway.
16:23
Rebecca Berens MD: The early OTTs were a fun time.
16:24
Rebecca Berens MD: Alright okay.
16:25
Rebecca Berens MD: So for first thing I'm gonna say, I think this is the most basic type of tracker that everyone knows of, which is the step counter pedometer.
16:32
Rebecca Berens MD: And this is like we said, this is the earliest thing that we think of.
16:35
Rebecca Berens MD: And there there was a study that I found is comparison of consumer grade wearable devices with a research grade instrument for measuring physical activity in a free living setting.
16:45
Rebecca Berens MD: So this is basically taking a medical grade actograph, which is a thing that measures how much you move and is medical grade and making that the gold standard, and then comparing various other types of trackers to it.
16:56
Rebecca Berens MD: Now this is a pretty small study.
16:58
Rebecca Berens MD: It was only 36 office workers.
17:00
Rebecca Berens MD: But they wore an actograph and then, an Apple Watch, Fitbit and Aura ring over a three week period.
17:06
Rebecca Berens MD: And they measured step count, physical activity, energy expenditure, and moderate to vigorous physical activity data from all of the devices.
17:14
Rebecca Berens MD: And then they analyzed them and compared them.
17:16
Rebecca Berens MD: And so the step counts were actually pretty consistent across all of the devices.
17:20
Rebecca Berens MD: So the Apple Watch and Ora Ring were within 10% of the actograph, although I have to mention the Oura ring was only five of these people.
17:27
Rebecca Berens MD: Apple Watch was 21 and the Fitbit was 22.
17:29
Rebecca Berens MD: I don't really understand why that was the case.
17:31
Rebecca Berens MD: It seems like more people could have worn Ora rings, but anyway so this is minimal data that we have here, but they were pretty accurate.
17:36
Rebecca Berens MD: While the Fitbit overestimated step count by about 18%.
17:40
Sonia Singh MD: Ooh, 18 percent's kind of a lot.
17:42
Rebecca Berens MD: Yeah.
17:43
Rebecca Berens MD: So Fitbit's out on step counting, it's not as accurate.
17:46
Rebecca Berens MD: But the AA ring and the Apple watch are actually pretty good.
17:48
Rebecca Berens MD: The, moderate to vigorous physical activity measurement was, has more variability between them.
17:53
Rebecca Berens MD: So Apple and AA ring both underestimated Apple watch by 46% and AA ring by 11%.
18:00
Rebecca Berens MD: Whereas the Fitbit actually showed mean minimal difference.
18:03
Sonia Singh MD: Okay.
18:03
Rebecca Berens MD: So that was interesting.
18:05
Rebecca Berens MD: And then the largest descriptions, these were with physical activity, energy expenditure, which I mean this is like when it tells you how many calories you burned, which there's actually no way that this thing could possibly tell you that there's so many variables that is not accounted for by your movement.
18:17
Rebecca Berens MD: So I don't even know why they bother reporting it.
18:19
Rebecca Berens MD: But anyway based on.
18:21
Rebecca Berens MD: Even the ACTO graph can't accurately provide you with that information.
18:23
Rebecca Berens MD: But
18:24
Sonia Singh MD: I don't, they ask you questions about yourself.
18:26
Sonia Singh MD: I'm pretty sure the Apple Watch and the Fitbit, have you put your, height and
18:29
Rebecca Berens MD: weight.
18:29
Rebecca Berens MD: Yeah, but even that is, but even with your height and weight and stuff there's still other variables involved.
18:34
Rebecca Berens MD: Are you sick right now?
18:35
Rebecca Berens MD: Or, what are the things that there's just a lot of variables that are not being considered.
18:38
Rebecca Berens MD: So anyway, the largest discrepancies were with that calorie counting.
18:41
Rebecca Berens MD: So Apple Watch and Fitbit overestimated apple by 25% and Fitbit by 139%.
18:49
Sonia Singh MD: Fitbit was lying to us in the early on
18:52
Rebecca Berens MD: And Aura ring underestimating by 16%.
18:55
Rebecca Berens MD: So point being the step counter, probably pretty accurate.
18:59
Rebecca Berens MD: The other stuff less
19:01
Sonia Singh MD: okay.
19:01
Rebecca Berens MD: So yeah, so there's that.
19:02
Rebecca Berens MD: Now does any of that matter?
19:04
Rebecca Berens MD: So there is some data from the consumer wearable health and fitness technology in cardiovascular medicine, A-J-A-C-C-J-A-C-C, state-of-the-art review, where they reviewed several studies on on wearables.
19:19
Rebecca Berens MD: And we'll go back to this review several times in this episode.
19:22
Rebecca Berens MD: But there actually is evidence that step counting helps people be more physically active, particularly people who have been recommended to engage in physical activity to manage a health condition like a cardiovascular condition or diabetes or something like that.
19:37
Rebecca Berens MD: So there is actually evidence that step counting does help improve your activity.
19:40
Rebecca Berens MD: So not so bad.
19:42
Rebecca Berens MD: Now when we get into the harms, we'll talk more about this.
19:45
Rebecca Berens MD: But is it accurate and does it matter?
19:48
Rebecca Berens MD: I would say for step counting, yes.
19:50
Rebecca Berens MD: We met those criteria.
19:51
Rebecca Berens MD: So the next one is for cardiovascular health and this is where we come to the Apple Heart study that you alluded to earlier on.
19:59
Rebecca Berens MD: So there was a study funded by Apple which is a large scale assessment of a smartwatch to identify atrial fibrillation.
20:07
Rebecca Berens MD: And this had over 400,000 participants.
20:10
Sonia Singh MD: Wow.
20:11
Rebecca Berens MD: Yes.
20:11
Rebecca Berens MD: This was a really interesting study.
20:13
Rebecca Berens MD: Participants who self-reported no personal history of atrial fibrillation used a smartphone Apple iPhone app to consent to monitoring.
20:22
Rebecca Berens MD: And then they used the apple watch irregular pulse notification algorithm.
20:27
Rebecca Berens MD: And if so they're wearing the watch and it had this algorithm enabled that would notify them of a possible atrial fibrillation.
20:34
Rebecca Berens MD: And if that notification flagged a telemedicine visit was initiated and an EECG patch was mailed to the patient to be worn for up to seven days.
20:43
Rebecca Berens MD: Surveys were administered 90 days after the notification of the irregular pulse, and again, at the end of the study.
20:47
Rebecca Berens MD: And the main objectives were to estimate the proportion of people who received a notification of an irregular heart rate, who did have atrial fibrillation shown on an ECG patch, and the positive predictive value of irregular pulse intervals with a target confidence interval with, of 0.1.
21:02
Rebecca Berens MD: So how predictive was it of actually having an irregular pulse, essentially?
21:05
Rebecca Berens MD: Okay.
21:06
Rebecca Berens MD: So over 400,000 per participants.
21:09
Rebecca Berens MD: And there was 117 days of monitoring, 2,161 participants received a notification.
21:17
Rebecca Berens MD: 450 of those people returned ECG patches, so not a great rate of return containing the data that could be analyzed which had been applied on average 13 days after the notification.
21:27
Rebecca Berens MD: And, atrial fibrillation was present in 34% of those overall, and in 35% of those participants who were 65 or older.
21:36
Rebecca Berens MD: So the positive predictive value of a irregular pulse notification resulting in a diagnosis of atrial fibrillation was 0.84.
21:46
Rebecca Berens MD: So decent.
21:48
Sonia Singh MD: Yeah.
21:49
Rebecca Berens MD: But the interesting thing which we will come back to is of so of 1,376 participants who were notified, and again, not all of these people actually then followed through with the ECG patch for the study.
22:00
Sonia Singh MD: Yeah.
22:01
Rebecca Berens MD: They, when they did the 90 day follow up survey, 57% of them had contacted healthcare providers outside of the study.
22:08
Sonia Singh MD: Okay.
22:09
Rebecca Berens MD: Yeah.
22:09
Rebecca Berens MD: So we'll come back to that later.
22:11
Rebecca Berens MD: But there were no reports of serious app related adverse events.
22:14
Rebecca Berens MD: So serious adverse events, there's none.
22:15
Rebecca Berens MD: But again we could argue that.
22:17
Rebecca Berens MD: Increased healthcare contact may be considered an adverse event of this app potentially.
22:23
Rebecca Berens MD: So the probability overall of receiving an irregular pulse notification was pretty low.
22:27
Rebecca Berens MD: But then those who those who did have an irregular pulse, 34% had atrial fibrillation.
22:32
Rebecca Berens MD: And so 84% of the notifications were concordant with atrial fibrillation.
22:36
Rebecca Berens MD: So positive predict value of 80 84%.
22:39
Rebecca Berens MD: Okay.
22:40
Rebecca Berens MD: And so yeah, so decent study large study and seems that it's a fairly good way of picking up atrial fibrillation.
22:49
Rebecca Berens MD: Now what I'm missing here is the negative predictive value.
22:53
Rebecca Berens MD: I don't actually see that reported.
22:55
Rebecca Berens MD: But, and I don't know how much of that was just based on obviously they weren't doing.
22:59
Rebecca Berens MD: The ECG patches on people who didn't get notifications.
23:03
Sonia Singh MD: I think they just probably had no way to follow up.
23:05
Sonia Singh MD: Yeah.
23:05
Sonia Singh MD: They could have just asked those people at the people who did not have any notifications at a certain time point.
23:10
Sonia Singh MD: Have you been diagnosed with atrial fibrillation?
23:12
Sonia Singh MD: Yeah.
23:12
Sonia Singh MD: Since
23:12
Rebecca Berens MD: the
23:12
Sonia Singh MD: start of the study.
23:13
Rebecca Berens MD: Yeah.
23:13
Rebecca Berens MD: But I guess if the, in theory if what we're looking for is does it miss unrecognized cases?
23:19
Rebecca Berens MD: We don't know that.
23:20
Rebecca Berens MD: Because we don't know what happened with the other people who didn't get the notifications.
23:23
Rebecca Berens MD: So that was interesting.
23:25
Rebecca Berens MD: So yeah, I think again, looking at the smartwatch in terms of the irregular heartbeat notifications, is it accurate?
23:31
Rebecca Berens MD: It's decent, I would say.
23:34
Rebecca Berens MD: Again, I don't know how much it's missing, but at least if it picks something up, it's probably worth getting it checked out if it picks something up.
23:41
Rebecca Berens MD: 'Cause it seems like a decent percentage of the time.
23:43
Sonia Singh MD: I wonder
23:43
Rebecca Berens MD: you may be maybe
23:44
something,
23:45
Sonia Singh MD: I wonder if their positive predictive value is a little bit inflated because if.
23:51
Sonia Singh MD: Over 2000 participants did have an abnormal rhythm.
23:55
Sonia Singh MD: That's true.
23:55
Sonia Singh MD: And got a notification.
23:57
Sonia Singh MD: And even the 57% contacted healthcare providers, even though they might not have all done the follow-up patch that was sent to them.
24:04
Sonia Singh MD: It's probably self-selecting for people who maybe were symptomatic or like some other concern that where they were like, that does happen to me sometimes.
24:12
Sonia Singh MD: Like I've been meaning to get this checked out.
24:14
Sonia Singh MD: And so that is very true.
24:15
Sonia Singh MD: Maybe a lot of the people who ignored the notification or who did not do the follow-up or did not contact a healthcare provider did so because it was like a healthy 25-year-old who was like, I have no reason to have this.
24:24
Sonia Singh MD: This is just, this is nonsense.
24:26
Sonia Singh MD: Yeah.
24:26
Sonia Singh MD: So I don't know.
24:26
Sonia Singh MD: I don't know if we can totally trust the numbers they came up with at the end of this,'cause it
24:31
Rebecca Berens MD: Yeah, very
24:32
Sonia Singh MD: true caveats there.
24:33
Sonia Singh MD: But anyway.
24:33
Sonia Singh MD: Okay.
24:34
Sonia Singh MD: Okay.
24:34
Sonia Singh MD: So what's the next study you wanted to talk about?
24:36
Rebecca Berens MD: So the next thing I wanted share, and this is just coming again from that JA.
24:40
Rebecca Berens MD: A CC review is about heart rate variability.
24:43
Rebecca Berens MD: So this is something that patients have asked me before.
24:46
Rebecca Berens MD: Because they'll get all these notifications about their heart rate variability and they're like, what does this mean?
24:51
Rebecca Berens MD: And I'm like, I don't know.
24:53
Sonia Singh MD: I know this is another example where a patient said it to me the first time and I was like, I don't know what you're talking about.
24:58
Sonia Singh MD: And I just felt so dumb.
25:01
Sonia Singh MD: But even then after I read about it briefly, I was like, I still don't really know what you're talking about, so I'm glad you're gonna tell me about.
25:08
Rebecca Berens MD: Yeah.
25:08
Rebecca Berens MD: So this I just took from the review because it's, again, it's not a clinical measure that we really use.
25:16
Rebecca Berens MD: It's not something that is super relevant to me.
25:19
Rebecca Berens MD: So what I took away from it is it's something that is used to indicate how well you're recovering from stress.
25:25
Rebecca Berens MD: So if you have lower heart rate variability, it's an indicator that you are more stressed because your autonomic nervous system regulation is being affected.
25:33
Sonia Singh MD: Okay, so low heart rate variability is bad and high heart rate variability is good?
25:38
Sonia Singh MD: Yes.
25:38
Sonia Singh MD: Okay.
25:41
Rebecca Berens MD: Yes.
25:41
Rebecca Berens MD: So basically, so high baseline heart rate, vari heart rate variability or increased heart rate variability over time indicates cardio, respiratory, fitness, sleep quality decreased stress, being younger and then being male also.
25:54
Rebecca Berens MD: It was on that list.
25:55
Rebecca Berens MD: And then low heart rate variability is associated with less cardio, respiratory, fitness, lower sleep quality, inadequate exercise recovery, chronic exercise over training, increased stress, systemic illness or infection, aging and being female.
26:10
Rebecca Berens MD: Which, oh yeah, that
26:11
Sonia Singh MD: all sounds
26:11
Rebecca Berens MD: bad.
26:11
Rebecca Berens MD: That was fascinating to me.
26:13
Rebecca Berens MD: I don't know, I don't know why the male and female thing, if that's actually hormonally related or if it's just stress related.
26:18
Rebecca Berens MD: I don't know.
26:19
Rebecca Berens MD: But but they were different for some reason.
26:21
Rebecca Berens MD: And so that's essentially the meaning behind it.
26:22
Rebecca Berens MD: But again, this is not something that we have clinical norms for this is something that, it's like a, in an individual's trend over time is maybe relevant for how that person, how, like how stressed are you relative to how stressed you were yesterday.
26:39
Rebecca Berens MD: But there's not a, there's not a like good number and a bad number, if that makes sense.
26:44
Rebecca Berens MD: It's not like a, it's not like you your heart rate availability should be this and it's not.
26:48
Rebecca Berens MD: So now you're sick basically.
26:50
Sonia Singh MD: Yeah.
26:51
Sonia Singh MD: I'm also curious what interval they use to calculate this number.
26:54
Sonia Singh MD: Is it minutes or hours or days or
26:57
Rebecca Berens MD: So that is actually very interesting.
26:58
Rebecca Berens MD: There's a number, there's actually multiple different ways it can be calculated.
27:02
Rebecca Berens MD: And I didn't get all into the weeds of this because frankly it was very confusing.
27:05
Rebecca Berens MD: And the upshot of what I got from it was They have variable accuracy, and the point is that there's not a clinical norm for a given person.
27:14
Rebecca Berens MD: And these these monitors the wearables compared to like medical grade, like ECG monitoring of the same thing.
27:23
Rebecca Berens MD: There were absolute errors ranging from 29 to 31%.
27:27
Rebecca Berens MD: And they were less accurate during waking activities when you're moving around, which makes sense.
27:32
Rebecca Berens MD: Okay.
27:32
Rebecca Berens MD: Versus when you're sleeping when you're not moving around, which again makes sense to me.
27:36
Rebecca Berens MD: So they're not super accurate when you're awake.
27:39
Rebecca Berens MD: They're not absolutely accurate either.
27:42
Rebecca Berens MD: But the trend for one person over time likely has some relevance.
27:48
Rebecca Berens MD: But again, like in terms of.
27:50
Rebecca Berens MD: What does this mean that we don't already know?
27:53
Rebecca Berens MD: As you alluded to, if someone comes in and they're like, yeah, I've been sleeping terribly and I feel sick and blah yeah, they're probably gonna get a flag on their ring or their watch that you're stressed.
28:02
Rebecca Berens MD: It's okay, we know.
28:04
Rebecca Berens MD: I believe you.
28:05
Rebecca Berens MD: But it's going back to what you said I think people they don't believe that they feel sick until it's proven to them.
28:12
Rebecca Berens MD: It gives them validation because they're like, I shouldn't feel this way, but now that my watch or ring has validated it, I'm allowed to feel this way.
28:20
Sonia Singh MD: Yeah, that's an interesting concept.
28:21
Sonia Singh MD: Like it almost gives you permission.
28:23
Sonia Singh MD: Yeah.
28:23
Sonia Singh MD: You're like no.
28:24
Sonia Singh MD: But my watch says that I slept very poorly.
28:27
Sonia Singh MD: Yeah.
28:27
Sonia Singh MD: So I can be cranky and tired today.
28:30
Sonia Singh MD: I slept.
28:30
Rebecca Berens MD: And it's or you could just be allowed to be cranky and
28:33
Sonia Singh MD: tired.
28:33
Sonia Singh MD: You're allowed to be cranky.
28:34
Sonia Singh MD: Yes.
28:35
Rebecca Berens MD: Like, why do you need permission from a, from an electronic device to be crank?
28:39
Sonia Singh MD: So if people ask what,'cause I think I've had somebody ask me before what is the ideal heart rate variability?
28:44
Sonia Singh MD: And I was like, I don't know what that is.
28:45
Sonia Singh MD: And I feel very, we don't have
28:46
Rebecca Berens MD: norms for that.
28:47
Rebecca Berens MD: We do not have norms for that.
28:48
Sonia Singh MD: I feel very validated that you said you were confused by it.
28:51
Sonia Singh MD: 'cause every time I've tried to read about this topic, I get a little bit in and then I'm like, I, my head is spinning and I'm like, I don't know.
28:57
Sonia Singh MD: I'm not, I don't think this is that helpful.
28:59
Rebecca Berens MD: It's not.
28:59
Rebecca Berens MD: It's not.
29:00
Rebecca Berens MD: Okay.
29:00
Rebecca Berens MD: Okay.
29:01
Rebecca Berens MD: Alright.
29:01
Rebecca Berens MD: And then big picture for cardiovascular health in general, do these things actually help?
29:05
Rebecca Berens MD: Like I said.
29:06
Rebecca Berens MD: There are benefits in increasing physical activity and increasing key health metrics associated with cardiometabolic conditions.
29:15
Rebecca Berens MD: So blood pressure, waist circumference, LDL cholesterol, but there are also significant disparities.
29:20
Rebecca Berens MD: So people who actually use these devices are often not the people who would actually benefit most from using these devices.
29:27
Rebecca Berens MD: Which, surprising to no one, I'm sure.
29:29
Rebecca Berens MD: So it says about 30% of US adults use wearable devices, and this is again from the JCC review.
29:35
Rebecca Berens MD: Adoption is concentrated among younger and wealthier and more educated individuals who are already healthier at baseline and already are engaged in exercise.
29:44
Rebecca Berens MD: So the people who would most benefit maybe from having some additional tracking to help them with motivation to be physically active and to monitor for things like atrial fibrillation, if they're maybe someone who's at risk are not probably wearing these things.
29:59
Rebecca Berens MD: And the other key thing that they said was that the face-to-face delivery of wearable interventions, so like using the wearable and then discussing it with your doctor in a visit was much more effective than just doing it on your own.
30:14
Rebecca Berens MD: And I think that's because, as we could expect having a synchronous conversation about this is what matters, this is what doesn't, this is, the things I care about would allow someone to focus on what's important and understand the nuances.
30:26
Sonia Singh MD: Yeah.
30:27
Sonia Singh MD: It's interesting that's what the data shows.
30:28
Sonia Singh MD: 'cause when I think about, I've had two or three patients that ask me about heart rate variability and they're among the healthiest patients in my practice, like people who are exercising regularly and really conscious of what they're eating.
30:39
Sonia Singh MD: And especially for them, I was just like, I don't think this adds anything for you.
30:43
Sonia Singh MD: Like I, there, there's nothing that I think you should be doing differently.
30:46
Sonia Singh MD: Yeah.
30:47
Sonia Singh MD: But I think their frustration was I feel like I'm doing everything right.
30:50
Sonia Singh MD: So like why is this thing still telling me that my heart rate variability is too low?
30:57
Sonia Singh MD: Too low?
30:57
Sonia Singh MD: Yeah.
30:58
Sonia Singh MD: So yeah.
30:59
Sonia Singh MD: Okay.
31:00
Rebecca Berens MD: Yeah, and so that's the thing, like I, I think my answer to that would be the absolute number does not matter.
31:05
Rebecca Berens MD: Your trend personally over time may indicate increased or decreased stress for you.
31:10
Sonia Singh MD: Yeah.
31:10
Rebecca Berens MD: But the absolute number is not accurate and there's no actual norm for it anyway, because we don't use that number clinically so
31:18
Sonia Singh MD: That's helpful.
31:18
Sonia Singh MD: I gotta keep that explanation in my back pocket.
31:20
Rebecca Berens MD: Yeah.
31:21
Rebecca Berens MD: Yeah, so I think when it comes to cardiovascular health, there are some benefits in terms of increasing physical activity.
31:28
Rebecca Berens MD: Again, that sort of like accountability piece maybe.
31:31
Rebecca Berens MD: And maybe if you're someone who's at risk for atrial fibrillation, maybe wearing this watch is a reasonable thing to consider doing.
31:39
Rebecca Berens MD: I don't know that everyone should just be wearing one, because I don't think it's likely that every random person's gonna be at risk for atrial fibrillation.
31:45
Rebecca Berens MD: But I think that the piece of 57% of people who got notifications reaching out to a healthcare provider is very relevant because how helpful was it to get that notification and then have to reach out to a healthcare provider?
31:57
Rebecca Berens MD: Did it actually add anything to you, or did it just add more anxiety to your day?
32:01
Rebecca Berens MD: All right.
32:02
Rebecca Berens MD: So the next thing I wanna cover is sleep.
32:04
Rebecca Berens MD: So for sleep disorders this is another common reason that people use these devices.
32:08
Rebecca Berens MD: So this study was called The Accuracy of three Commercial Wearable Devices for Sleep Tracking in Healthy Adults.
32:14
Rebecca Berens MD: So in this one, they compared the AA ring Gen three, the Fitbit Sense two and the Apple Watch Series eight to a gold standard sleep assessment with polysomnography.
32:25
Rebecca Berens MD: Again, very small study, 35 participants.
32:28
Sonia Singh MD: Yeah.
32:28
Rebecca Berens MD: And they wore these devices and were monitored with a polysomnography.
32:33
Rebecca Berens MD: And the sensitivity for detecting a sleep versus a awake was greater than 95% for all of the devices.
32:40
Rebecca Berens MD: And so that's in, in comparison to the polysomnography for discriminating between sleep changes.
32:46
Rebecca Berens MD: The sensitivity varied so aura Ring was better able to distinguish between different stages of sleep and be correct versus the Fitbit and Apple.
32:56
Rebecca Berens MD: And aura Ring was not different from Polysomnography in terms of wake, like light sleep or deep sleep or REM sleep.
33:04
Rebecca Berens MD: Fitbit overestimated light sleep and underestimated deep sleep.
33:08
Rebecca Berens MD: Apple underestimated the duration of wake and deep sleep and overestimated light sleep.
33:13
Rebecca Berens MD: So in, in all of them, the devices were similar to polysomnography in the estimate estimation of total sleep duration.
33:20
Rebecca Berens MD: So basically they're okay, or a ring seems to be a little bit better than the others.
33:25
Rebecca Berens MD: None of them are perfect but they're okay.
33:28
Rebecca Berens MD: But again, this is just light sleep.
33:32
Rebecca Berens MD: Deep sleep, awake, asleep.
33:33
Sonia Singh MD: Not,
33:33
Rebecca Berens MD: this is not anything to do with sleep apnea in terms of like your.
33:40
Rebecca Berens MD: Oxygen level is dipping.
33:41
Rebecca Berens MD: Now it is also measuring heart rate, which again, we may see a person who has sleep apnea may experience an apnic episode and have a big heart rate fluctuation associated with that.
33:52
Rebecca Berens MD: But but that is not what this study was looking for.
33:54
Rebecca Berens MD: They were just looking for concordance in terms of estimating the types of sleep.
33:57
Sonia Singh MD: Okay.
33:58
Rebecca Berens MD: But interestingly, there is actually a the Samsung smartwatch feature was FDA authorized in 2023 for detecting signs of moderate to severe sleep apnea.
34:08
Rebecca Berens MD: And so they, it detected that this device it's an app on the Samsung.
34:14
Rebecca Berens MD: Phone, I guess that syncs with the Samsung smartwatch and you can opt into this feature to detect signs of sleep apnea.
34:20
Rebecca Berens MD: And it's doing similar things to what these other trackers are doing in terms of monitoring sleep, but it, the patterns that it was able to identify compared with polysomnography, they determined were accurate enough to pick up moderate to severe sleep apnea.
34:34
Rebecca Berens MD: Now, not for diagnosis right, it's enough just to say, you may have this
34:38
Sonia Singh MD: like a screening tool for
34:40
Rebecca Berens MD: Yeah.
34:40
Rebecca Berens MD: But but it cannot it cannot give you a diagnosis.
34:43
Rebecca Berens MD: It does not diagnose or treat anything.
34:45
Rebecca Berens MD: It is not to be used as an apnea monitor.
34:47
Rebecca Berens MD: It's just, using a software algorithm to analyze the sensor input and give an overall risk assessment for sleep apnea.
34:53
Rebecca Berens MD: And it can show only in cases of moderate to severe sleep apnea, not for mild sleep apnea.
34:59
Sonia Singh MD: But do we know how good it is at that?
35:02
Rebecca Berens MD: The Samsung sleep apnea sensitivity was 82.7%.
35:08
Rebecca Berens MD: And specificity was 91%.
35:12
Sonia Singh MD: Oh, that's not bad.
35:13
Sonia Singh MD: If we apply your two questions, is it accurate and does it matter?
35:17
Sonia Singh MD: So is it accurate?
35:18
Sonia Singh MD: It sounds like it's decent, it's not perfect, but it's decent.
35:21
Sonia Singh MD: And then does it matter?
35:23
Sonia Singh MD: Like it certainly matters if you have sleep apnea or not, but I guess the part to remember is this does not make the diagnosis.
35:30
Sonia Singh MD: Yes.
35:30
Sonia Singh MD: So now you still have to go to an actual doctor and get a referral for a sleep study, go do the sleep study, get your cpep titrated if you have it.
35:39
Sonia Singh MD: And I guess what I would imagine for people who are in the moderate to severe category, if they had just gone to the doctor and said.
35:47
Sonia Singh MD: I think I'm concerned that I have sleep apnea.
35:50
Sonia Singh MD: If you snore, if are above a certain BMI, if you are tired during the day, I mean there's a zillion ways to get to a sleep study.
35:57
Sonia Singh MD: I guess my question would really be to put this in clinical context and say was this thing even necessary or was there a much more direct route to getting diagnosed with sleep apnea if that was, a concern?
36:07
Rebecca Berens MD: Yeah.
36:08
Rebecca Berens MD: So I'm gonna go back to my patient case because Okay.
36:10
Rebecca Berens MD: I think it's very relevant.
36:11
Rebecca Berens MD: So this patient that I talked about at the beginning, again, this was a patient who sent me oring data, but they were worried about lack of deep sleep and they were feeling less rested during the day, so had a symptom.
36:21
Rebecca Berens MD: They did snore and had done so for years and their wife had told them that they should get a sleep study.
36:28
Rebecca Berens MD: They denied any witnessed apnea or waking up in the middle of the night coughing, gasping for air.
36:33
Rebecca Berens MD: They denied morning headaches.
36:35
Rebecca Berens MD: They'd had a recent blood pressure check that was normal.
36:37
Rebecca Berens MD: They had some symptoms of sleep apnea, but not all of them.
36:40
Rebecca Berens MD: I think it's very possible that this person, especially if they had not had the AA ring data, would not have brought this up to their doctor.
36:49
Sonia Singh MD: Yeah.
36:49
Rebecca Berens MD: Without the data.
36:50
Rebecca Berens MD: Now their wife might have.
36:53
Sonia Singh MD: The evidence was there.
36:55
Rebecca Berens MD: The evidence was there, like to, to your point, there was evidence it could have been brought up, but I don't know that it would've been, and again, this is, this comes to the question of do we not take our symptoms seriously until we have some sort of data proving it?
37:11
Rebecca Berens MD: And so I think if this is something that helps someone take their symptoms more seriously and actually bring them up to their doctor,
37:18
Sonia Singh MD: yeah,
37:19
Rebecca Berens MD: that is potentially beneficial.
37:21
Rebecca Berens MD: Could this person have been diagnosed with a sleep apnea without it?
37:23
Rebecca Berens MD: Yes, absolutely.
37:24
Rebecca Berens MD: But they were not.
37:27
Sonia Singh MD: I can understand why maybe when you're just hearing it from your spouse who's complaining about your snoring, you discount that.
37:32
Sonia Singh MD: And when you're tired during the day, there's a million other explanations for it.
37:36
Sonia Singh MD: I can see how this thing still would have therapeutic value for somebody, even though you know it like you, and I said, this is not the most direct path to getting this diagnosis is not required to make this diagnosis.
37:48
Sonia Singh MD: But in the same vein as like us talking about doing a few additional labs in certain cases that are maybe not indicated from a medical perspective, but help the patient, understand what's happening in their body.
38:00
Sonia Singh MD: Yeah.
38:00
Sonia Singh MD: And get to the point of accepting a certain diagnosis or not having a diagnosis.
38:04
Sonia Singh MD: So yeah, I think it falls into that category, so that's interesting.
38:07
Rebecca Berens MD: Yeah.
38:07
Rebecca Berens MD: Yeah.
38:08
Rebecca Berens MD: I think this is the one area where I'm like, if I have a patient who I'm concerned about this, they're at high risk, they don't wanna go get a sleep study.
38:17
Rebecca Berens MD: Maybe this would be a way To convince them to get a sleep study
38:20
Sonia Singh MD: that it's worth the time.
38:21
Sonia Singh MD: Yeah.
38:22
Rebecca Berens MD: But yeah, I think I, to your point, like I think that they may not be taking their own symptoms seriously, or the concerns of their spouse seriously
38:30
Sonia Singh MD: but if, or the concerns of their doctor, yeah.
38:31
Sonia Singh MD: Or the
38:31
Rebecca Berens MD: concerns
38:32
Sonia Singh MD: of their doctor.
38:33
Sonia Singh MD: Doctor just wants to make some money off of the sleep study.
38:35
Sonia Singh MD: So
38:35
Rebecca Berens MD: but if the, unbiased third party
38:38
Sonia Singh MD: device
38:39
Rebecca Berens MD: Yeah.
38:39
Rebecca Berens MD: Device that is, when I say unbiased, it is still a for-profit company making this device.
38:43
Rebecca Berens MD: But there's, it, there's some useful data there potentially.
38:47
Sonia Singh MD: Yeah.
38:47
Rebecca Berens MD: So I think it's interesting.
38:48
Sonia Singh MD: Okay.
38:49
Sonia Singh MD: Let's move on so we've reviewed all of these potential benefits.
38:52
Sonia Singh MD: So let's talk a little bit about potential harms.
38:55
Rebecca Berens MD: Yeah.
38:55
Rebecca Berens MD: So I think the biggest one as we have alluded to is just the impact psychologically that this information has on a person.
39:03
Rebecca Berens MD: And unsurprisingly, this has not been studied very much so in that JACC scientific statement article about consumer wearables.
39:11
Rebecca Berens MD: They said inadvertent psychological effects from the use or prescription of consumer wearables are under-recognized.
39:18
Rebecca Berens MD: Some individuals may be incentivized to adopt healthy behaviors and enhance their cardiovascular self-management.
39:23
Rebecca Berens MD: This desirable effect, contrast with others who may react negatively.
39:26
Rebecca Berens MD: Eg.
39:27
Rebecca Berens MD: Obsessive symptom control monitoring by the worried well negative reactions to notifications, serving as reminders of disease or inclu inclusive results.
39:35
Rebecca Berens MD: And these responses may undermine relations with healthcare providers satisfaction with care and mutual trust.
39:41
Rebecca Berens MD: These factors are important, but a little studied, so there's just not been a lot of study on this.
39:45
Sonia Singh MD: Okay.
39:45
Sonia Singh MD: Can I also just get on my soapbox about worried well I hate the phrase worried well doctors use it all of the time, and it just makes me cringe because really most of these people have some health anxiety.
39:57
Sonia Singh MD: Maybe it's mild, but they have some health anxiety, and that is pathology.
40:01
Sonia Singh MD: Just like any other pathology, they're anxious about their health, they're concerned about something.
40:06
Sonia Singh MD: And I think when it's phrased as worried well it just sounds like they're just.
40:11
Sonia Singh MD: Annoying, yes.
40:12
Sonia Singh MD: It's oh, these people are just coming and asking you stuff and taking up resources and filling up appointments and they're fine.
40:18
Sonia Singh MD: And it's if they are worried they are not fine, by definition they're not fine, so anyway, I really hate that phrase of worried.
40:25
Sonia Singh MD: And just the treating of it as oh yes.
40:28
Sonia Singh MD: People can become obsessive or they can get worried about these numbers.
40:31
Sonia Singh MD: It's no, they can develop true pathology.
40:34
Sonia Singh MD: Yes.
40:35
Sonia Singh MD: Related to this data, so I and I just think.
40:39
Sonia Singh MD: This also shifts as time goes on because we already take in so much data all the time.
40:46
Sonia Singh MD: Everybody is constantly being flooded with data.
40:49
Sonia Singh MD: So I guess one of my biggest gut, repulsions to this whole category of things is just I don't want more data.
40:56
Sonia Singh MD: I have too much, I had a fellow physician ask me the other day like, oh, are there any medical record systems that interface with Aura so that you can get that data from patients?
41:04
Sonia Singh MD: And I was like, I don't know how you're gonna deal with that.
41:06
Sonia Singh MD: 'cause that is so much data for every person that you're then trying to process and review.
41:11
Sonia Singh MD: And again, you just have to ask yourself how much is this adding to versus me sitting down and really talking to this patient, so anyway, yeah, I don't think those psychological side effects can be.
41:23
Sonia Singh MD: I'm sure they are minimized in a lot of these studies and
41:26
Rebecca Berens MD: They're just not even asked about.
41:27
Rebecca Berens MD: I think that's the problem.
41:29
Rebecca Berens MD: And I totally agree with you.
41:30
Rebecca Berens MD: I hate the words worried well as well.
41:31
Rebecca Berens MD: And I think, you know what the, what I see happening is, the idea of oh yeah.
41:37
Rebecca Berens MD: How all this data can help people, be more proactive and make changes about their health.
41:40
Rebecca Berens MD: I see it going the opposite direction where it's like a gamification gone too far.
41:45
Rebecca Berens MD: Yes.
41:45
Rebecca Berens MD: And it becomes a competition with yourself to get more and more steps every day and to close your rings every day, even if you're sick.
41:50
Rebecca Berens MD: And I see patients who have OCD or have eating disorders and it becomes so distressing if they can't.
41:58
Rebecca Berens MD: If they can't do that day, they're like, they're outside febrile with the flu and they're still getting their steps in because they have to get it in that day, it's just, it's it's not helpful.
42:07
Rebecca Berens MD: And it is actually harmful and I think that's the problem.
42:09
Rebecca Berens MD: These things are framed as really benign and no problem at all.
42:13
Rebecca Berens MD: And that's clearly not the case.
42:15
Rebecca Berens MD: There are clearly people who this really negatively affects them.
42:19
Rebecca Berens MD: And I'm not sure that it always outweighs the potential benefits, especially as we said.
42:23
Rebecca Berens MD: 'cause most of the people who are using these are not the people who would benefit from them the most potentially in terms of metabolic health.
42:30
Sonia Singh MD: I think that people who are drawn to these things are people who are already very achievement driven, accomplishment driven, productivity driven, already a little bit obsessional about data and numbers.
42:42
Sonia Singh MD: And those are the people who I think are attracted to these devices.
42:45
Sonia Singh MD: And then they get them and they just lean further and further into that.
42:48
Sonia Singh MD: And I always try to tell people okay, so let's zoom out.
42:51
Sonia Singh MD: What was even the goal of getting this thing?
42:52
Sonia Singh MD: It's probably to improve your overall quality of life by helping you be healthier and more fit, and maybe live longer and be healthier and all.
43:01
Sonia Singh MD: But if on a day-to-day basis it is draining you of mental energy and you are becoming emotionally tied to what is happening with your data isn't really doing that, and I think there's very few patients that I can think of that I've interacted with, in which I think.
43:19
Sonia Singh MD: Any of these wearables have made.
43:22
Sonia Singh MD: A really positive difference in the big picture of their health.
43:25
Sonia Singh MD: I'm certainly not anti I'm not like, no, you should not have, actually, in a couple of cases, I have told patients that they should not.
43:31
Sonia Singh MD: I have a few patients that are already extremely anxious and hypervigilant about every physical symptom in their body, and I had one of them reach out to me and say.
43:41
Sonia Singh MD: My husband's thinking about getting me an AA ring for my birthday, but I was thinking about it and I talked to my therapist and I wanted to talk to you, and I was like, I'm not sure if this is the right move for me.
43:50
Sonia Singh MD: And I was just so grateful that she asked me and she asked the therapist and we were both on the same page of no.
43:56
Sonia Singh MD: You were already so aware of everything in your body.
43:58
Sonia Singh MD: You already have so much data coming in from so many different specialists and so many different people.
44:03
Sonia Singh MD: This is just going to add to the pile of things that need to do.
44:07
Sonia Singh MD: I was actually thinking about this and I think it's relevant to a few of our episodes.
44:11
Sonia Singh MD: The full body MRIs, like the blood tests for cancer.
44:14
Sonia Singh MD: Several of the other ones, but there's a certain amount of healthcare that I think is preventive and proactive and helps people live healthier lives and live longer.
44:23
Sonia Singh MD: And then there's like a point after which more healthcare, begets more healthcare, where like the more stuff you're doing, the more stuff it ends up leading you to.
44:33
Sonia Singh MD: And I think these fitness trackers are beyond what I would consider the high return on investment, necessary for you healthcare and like into the realm of more healthcare begets more healthcare.
44:46
Sonia Singh MD: Where like you, you'll do it and then you'll find something and then you'll do more and then, and it just goes on and on.
44:52
Sonia Singh MD: Yeah.
44:53
Rebecca Berens MD: Yeah.
44:53
Rebecca Berens MD: And I totally agree with you.
44:54
Rebecca Berens MD: And that was my next risk that I thought up was the.
44:58
Rebecca Berens MD: Associated increase in healthcare usage and follow up testing and the associated risks and costs that come with that, because like I said, so 57% of the participants who got notified of the Apple heart study did reach out to their healthcare provider.
45:12
Rebecca Berens MD: Outside of the study.
45:13
Rebecca Berens MD: And I am sure every PCP who is listening to this podcast has received a portal message with a screenshot of a health tracker.
45:22
Sonia Singh MD: Yeah.
45:22
Rebecca Berens MD: Something.
45:23
Rebecca Berens MD: And they're like, what does this mean?
45:25
Rebecca Berens MD: And, you and I have time to look at that.
45:28
Rebecca Berens MD: And generally I know what I do is I'm like, let's talk about this in a visit so we can like, really, I can look at everything and we can really talk about it.
45:34
Rebecca Berens MD: Most PCPs do not have time for that.
45:36
Sonia Singh MD: Yeah.
45:36
Rebecca Berens MD: They're already getting so many portal messages in a day.
45:40
Rebecca Berens MD: And so
45:40
Sonia Singh MD: many lab results and so many imaging results and so many cons.
45:43
Sonia Singh MD: So many things like real data that needs to be acted upon and Yeah.
45:48
Rebecca Berens MD: And it's be
45:48
Sonia Singh MD: urgent.
45:49
Rebecca Berens MD: You're getting this.
45:49
Rebecca Berens MD: And you can't dismiss it, because you don't wanna miss something.
45:52
Rebecca Berens MD: And what if it is something serious?
45:54
Rebecca Berens MD: But it's, it requires an appointment really to like really assess what's going on and is it necessary to have that appointment?
46:00
Rebecca Berens MD: Or are we taking that appointment from someone else who needs it?
46:03
Rebecca Berens MD: There's limited healthcare resources, and so I think it, there's a lot of both personal risk and population risk of increased uptake of this because it increases healthcare usage in a way that is not necessarily likely helping anyone.
46:16
Rebecca Berens MD: Yeah.
46:16
Rebecca Berens MD: And is creating more anxiety, is creating more cost and more testing.
46:20
Rebecca Berens MD: And another thing that I just wanted to plug in here was for all the PCPs who are listening,'cause we understand you I'm sure you've heard of that study where they they estimated the time it would take for A-P-C-T-P to provide Yep.
46:32
Rebecca Berens MD: Adult primary care.
46:33
Rebecca Berens MD: I know it was estimated as 26.7 hours per day.
46:36
Sonia Singh MD: 27 hours.
46:37
Sonia Singh MD: Yeah.
46:37
Rebecca Berens MD: Okay.
46:38
Rebecca Berens MD: So we don't have time
46:40
Yeah.
46:40
Rebecca Berens MD: To review more data.
46:41
Rebecca Berens MD: And that was assuming a panel of 2,500 patients.
46:44
Rebecca Berens MD: Yeah.
46:44
Rebecca Berens MD: I don't know how many patients were on your panel when you were employed, but I had over 3000
46:48
Sonia Singh MD: No, I never got there.
46:49
Quit.
46:49
Rebecca Berens MD: Oh that's that was nice of them.
46:50
Rebecca Berens MD: Yeah.
46:51
Rebecca Berens MD: I started and I got, so someone else who just left panel transferred to me and then they just kept adding new patients and I was like, what?
46:58
Sonia Singh MD: Yeah.
46:59
Sonia Singh MD: There are not enough hours in the day to provide high quality, adequate care to a typical primary care panel.
47:05
Sonia Singh MD: So to add more data to that for them to review is presenting a challenge?
47:10
Rebecca Berens MD: Yes.
47:11
Rebecca Berens MD: Yes.
47:12
Rebecca Berens MD: And I think the other flip side of that is, if you have a person, which I mean is unlikely a person who's wearing a health tracker, but say a person who really does have something going on and is ignoring it and the device is maybe not picking it up.
47:26
Rebecca Berens MD: 'cause again, we don't know the negative predictive value, for example of of the devices picking up atrial fibrillation.
47:31
Rebecca Berens MD: Or if it's, or if there is sleep apnea that's not picked up some for some reason by the device, they're thinking they're fine And they're being falsely reassured and therefore not going for needed healthcare to the healthcare system.
47:42
Rebecca Berens MD: 'Cause they're replacing healthcare with this system.
47:44
Rebecca Berens MD: Again, we've talked about this many times where the more direct to consumer health tech that has become available and the more people who are losing healthcare coverage.
47:52
Rebecca Berens MD: They're just taking it into their own hands of I can't do it that way.
47:55
Rebecca Berens MD: That's too expensive and complicated and I'm just gonna handle it myself.
47:58
Rebecca Berens MD: I'll do these things, these tests, and now I'm, I know I'm good.
48:01
Rebecca Berens MD: But are you really good?
48:01
Rebecca Berens MD: You might not be.
48:03
Rebecca Berens MD: And so that's another flip side from that.
48:06
Rebecca Berens MD: And I think the big thing too is the as we both have mentioned several times in this episode the disconnection of our mind from our body and not actually experiencing our physical sensations and relying more on data to tell us how we feel than how the symptoms we're having.
48:24
Rebecca Berens MD: For example, if we go back to my sinus infection patient at the beginning of the episode so that patient had classic symptoms of a sinus infection.
48:32
Rebecca Berens MD: Yeah.
48:32
Rebecca Berens MD: The classic
48:32
Sonia Singh MD: sinus symptom, sinus.
48:34
Sonia Singh MD: Sinus.
48:34
Rebecca Berens MD: I don't know if they would've reached out to me if.
48:37
Rebecca Berens MD: The heart rate thing hadn't triggered.
48:40
Rebecca Berens MD: And I'm like, why don't you trust that you feel sick?
48:42
Sonia Singh MD: Yes.
48:43
Sonia Singh MD: Maybe we're part of that problem, is that we make it hard to get in.
48:47
Sonia Singh MD: We can be dismissive.
48:50
Sonia Singh MD: I think people have been trained to do this whole grin and bear it or deal with it.
48:54
Sonia Singh MD: Suck it up or deal with it myself.
48:56
Sonia Singh MD: And maybe sometimes they need the ding of a notification to push them to take the next step of messaging the doctor and saying, I'm not better, so yeah.
49:05
Sonia Singh MD: I think there's a lot of factors that play in that.
49:08
Rebecca Berens MD: I think it's an interesting concept to think about and I think it is just something we all should be thinking about if we're going to be interacting with these devices is if we wanna talk about what we can learn from this as doctors and humans How are we integrating this into our life and our care?
49:23
Rebecca Berens MD: How is it benefiting us?
49:25
Rebecca Berens MD: How might it be harming us?
49:26
Rebecca Berens MD: How can we ba balance those things?
49:29
Rebecca Berens MD: And I think there, there are some clinical situations like my patient with sleep apnea.
49:34
Rebecca Berens MD: I really don't think that person would've come to me about that.
49:37
Rebecca Berens MD: Sleep apnea.
49:38
Sonia Singh MD: Yeah.
49:38
Rebecca Berens MD: Any other way.
49:39
Rebecca Berens MD: And they got diagnosed and it was, and they're, now they're treated and I'm, I fully believe that was very beneficial for that patient.
49:44
Rebecca Berens MD: But I think there's a larger number of people who are getting a lot of information and data overload and a lot of anxiety coming from that.
49:54
Rebecca Berens MD: And it's really difficult to balance those things.
49:57
Sonia Singh MD: Yeah, I think I would just say the same thing that we have said for social media generally in one of the early episodes, which is just frequently check in with yourself about how this thing is making you feel.
50:08
Sonia Singh MD: If this thing is adding to your life in some way or benefiting you in some way, then great, continue using it.
50:14
Sonia Singh MD: But if you're noticing that it's not adding anything and all it does is like it's another thing for you to look at, another app for you to check, or it's becoming obsessive or it's.
50:23
Sonia Singh MD: Leading to I can imagine looking at my watch or my, I don't have an Oura ring, but I can imagine looking at my Oura Ring app and it's saying I didn't sleep well and then just being annoyed and feeling like, yeah, I know I should have gone to bed earlier.
50:36
Sonia Singh MD: I have that talk with myself even without the ordering, but it would be worse.
50:40
Sonia Singh MD: It's like an app was also shaming me for how I did not sleep enough.
50:44
Sonia Singh MD: I think you just have to this is such an individual thing.
50:47
Sonia Singh MD: You have to really look at what it's adding and what it's taking from you and make the decision from that.
50:51
Sonia Singh MD: One thing that you didn't mention, because I'm sure there's no data on it, but I had a patient who was wearing all of the wearables and he was just like, sometimes I worry about like the I'm gonna use the wrong physics term, like the electromagnetic radiation or like the wi the fact
51:04
that
51:04
Rebecca Berens MD: all of these, yes, I did not look at that, but that
51:06
is
51:06
Sonia Singh MD: good.
51:06
Sonia Singh MD: The fact that all of these things are pinging wifi, what's gonna happen years from now from us wearing all of these things, and I was like, I don't know.
51:13
Sonia Singh MD: I told him I don't know the data on that.
51:15
Sonia Singh MD: I have not looked it up.
51:16
Sonia Singh MD: I still have not looked it up.
51:17
Sonia Singh MD: But my question to you would be there are some things in our life that are just like necessary parts of modern life, and there may be some really low level risk associated with them, but if it's a necessary thing that you have to do or something that's an integral to your functioning, then you just gotta swallow it and do it, and keep an eye out for any actual data that tells you one way or another.
51:39
Sonia Singh MD: And so for him, I was just like, I want you to really think about whether all those things you're wearing is really doing anything for you.
51:45
Sonia Singh MD: Because if you at all have that fear in your mind, if that is an anxiety that he's walking around with of oh, putting in this thing on every day what might it be doing to me?
51:52
Sonia Singh MD: Then get rid of it if it's not adding anything to your life, because I'm certainly not telling you it's necessary.
51:57
Sonia Singh MD: I don't need any of that data.
51:59
Sonia Singh MD: Yeah, I don't know if I, I don't know if there's any
52:01
Rebecca Berens MD: Yeah.
52:02
Rebecca Berens MD: I didn't look that up, but that's a really good point.
52:03
Rebecca Berens MD: Maybe we can do that for a future episode because actually I've heard concerns about that from patients before.
52:08
Rebecca Berens MD: And I have looked it up a handful of times, but I didn't look it up as it relates to, these trackers specifically.
52:13
Rebecca Berens MD: When I looked at that before, it's mostly been around wifi routers is what people have been concerned about.
52:18
Rebecca Berens MD: Yes.
52:18
Rebecca Berens MD: And it seems like you said, very low level, if any risk and distance from it and all of that matters.
52:25
Rebecca Berens MD: And so yeah, I mean if there is any coming from these things, they are touching you.
52:28
Rebecca Berens MD: Yeah.
52:28
Rebecca Berens MD: If you're wearing multiple of them, then yeah.
52:30
Rebecca Berens MD: I think it's a cumulative effect.
52:32
Rebecca Berens MD: Probably.
52:32
Rebecca Berens MD: We talked about this in clean beauty.
52:33
Rebecca Berens MD: It's the same sort of thing.
52:34
Rebecca Berens MD: Yes.
52:34
Rebecca Berens MD: It's like
52:35
Sonia Singh MD: same
52:35
Rebecca Berens MD: concept, low level environmental risk.
52:36
Rebecca Berens MD: Yes.
52:36
Rebecca Berens MD: You are not gonna be able to avoid wifi routers.
52:38
Rebecca Berens MD: You're just not, those are gonna be in your life everywhere you go.
52:42
Rebecca Berens MD: But you could avoid,
52:43
Sonia Singh MD: Easily avoid an aura ring.
52:45
Sonia Singh MD: Yes.
52:45
Rebecca Berens MD: So if it's a concern and we don't really maybe know how much of a concern, do you actually need that thing?
52:50
Rebecca Berens MD: Probably not.
52:51
Rebecca Berens MD: I think the other thing is at the end of the day, these are all for-profit businesses, and they are gonna come out with the next big model.
52:58
Rebecca Berens MD: The next new thing you're gonna be replacing this device.
53:02
Rebecca Berens MD: Regularly if you wanna have the most up-to-date data, which is what they're selling to you.
53:07
Rebecca Berens MD: Yeah.
53:07
Rebecca Berens MD: So is the cost of that worth the benefit?
53:11
Rebecca Berens MD: Because they're not cheap.
53:12
Rebecca Berens MD: A lot of them also have with subscriptions associated with them.
53:14
Rebecca Berens MD: So you pay for the actual device and then you also have the monthly subscription.
53:18
Rebecca Berens MD: And I've had a couple patients who, again, they, I'm a little bit worried about sleep apnea and I'm like, maybe we should do a sleep study.
53:26
Rebecca Berens MD: And they're like, ah, I don't wanna do that.
53:28
Rebecca Berens MD: And I'm like but they'll get an NOA ring.
53:30
Rebecca Berens MD: And I'm like okay, maybe it's something.
53:31
Rebecca Berens MD: It won't, I don't know if they'll tell us everything we need to know, but, but maybe if it flags, then you'll go get the actual sleep study done.
53:38
Rebecca Berens MD: But then I'm like, did you save yourself any money by doing that?
53:41
Sonia Singh MD: I can see the argument for sure, like the convenience of it, yeah.
53:45
Sonia Singh MD: And just the ease of it.
53:46
Sonia Singh MD: I can actually imagine my husband making that decision.
53:49
Sonia Singh MD: Yeah.
53:49
Sonia Singh MD: And just being like, I'm just gonna get this thing.
53:50
Sonia Singh MD: And then if it says that I'm not sleeping well I will go get it.
53:55
Sonia Singh MD: And I don't necessarily think there's anything wrong with that as long as you have the resources to do that.
54:00
Sonia Singh MD: But if you're using your limited resources for this and for going something else, that is where the real harm I think
54:07
Rebecca Berens MD: happens.
54:07
Sonia Singh MD: Yeah.
54:08
Sonia Singh MD: Okay.
54:08
Sonia Singh MD: So how do you talk about wearables and trackers to your patients?
54:12
Sonia Singh MD: What are some tips you would have for that?
54:14
Rebecca Berens MD: Yeah, so most of the time people already have them.
54:17
Sonia Singh MD: That's
54:17
Rebecca Berens MD: true.
54:18
Rebecca Berens MD: I have rarely, I've rarely had anyone ask me if they should get one, but most of the time they already have them.
54:22
Rebecca Berens MD: And it comes up as this is what this thing said.
54:24
Rebecca Berens MD: What I generally will ask is what we talked about, what, how are you using this device?
54:30
Rebecca Berens MD: What are, what is it helping you with and how disruptive is it to your life in terms of notifications?
54:37
Rebecca Berens MD: Notification burden we all have at baseline.
54:39
Sonia Singh MD: Yeah.
54:40
Rebecca Berens MD: But particularly for my patients who have, eating disorder history, OCD, perfectionistic traits, they're compulsive about closing rings.
54:47
Rebecca Berens MD: I have a much more serious conversation about the harms of this are maybe outweighing the benefits for you Versus someone else who's maybe, yeah, maybe it's helping me, meet my exercise goals for the day.
54:56
Rebecca Berens MD: And I'm not, but I'm not compulsive about it.
54:58
Rebecca Berens MD: I'm not gonna go exercise when I'm sick.
55:00
Rebecca Berens MD: Yeah.
55:00
Rebecca Berens MD: And, I'm not gonna worry about it if I didn't close my rings one day.
55:03
Rebecca Berens MD: It's a balance.
55:04
Rebecca Berens MD: So I think that's the thing is how is it helping you?
55:06
Rebecca Berens MD: How much is it disrupting you?
55:08
Rebecca Berens MD: Is the, is it affordable to you?
55:10
Rebecca Berens MD: Yeah.
55:10
Rebecca Berens MD: Or are you foregoing, like you said, something more necessary to pay for this device.
55:15
Rebecca Berens MD: And particularly when it comes to getting a real sleep study done.
55:18
Rebecca Berens MD: You're still gonna have to get the real sleep study done if it flags.
55:21
Rebecca Berens MD: So you're not really saving any money and it could falsely reassure you.
55:25
Rebecca Berens MD: So I think there's there's that piece as well.
55:28
Sonia Singh MD: Yeah, no, I totally agree.
55:30
Sonia Singh MD: And like you said most people are not gonna come to us to have a conversation about whether to get one of these, which is a shame because I do think that you should do a little bit of a screening before deciding if one of these is right for you.
55:41
Rebecca Berens MD: But I think for the doctors who are listening I think it's very important for us to be having these conversations with patients.
55:49
Rebecca Berens MD: And not to be dismissive of the data that is produced.
55:53
Rebecca Berens MD: Because I can imagine if I'm someone who has 10 minute visits back to back and someone's scrolling through pages of data in my office, like I don't have time to review it.
56:02
Rebecca Berens MD: I think it's important to have a conversation with them about it doesn't mean you have to look at every single piece of data in there.
56:07
Rebecca Berens MD: Some of this stuff that we've talked about in this episode people are gonna be using this stuff, it's going to affect their health one way or another.
56:13
Rebecca Berens MD: So it's good for us to be having an open conversation with them about it.
56:17
Sonia Singh MD: Yeah.
56:17
Sonia Singh MD: Or just to be able to say these are some of the evidence backed benefits of it.
56:22
Sonia Singh MD: If you were trying to reach a certain steps goal if you were, trying to increase your physical activity.
56:26
Sonia Singh MD: If you're trying to establish a habit, it's understandable.
56:28
Sonia Singh MD: I can pick up some cases of sleep apnea, I can pick up some cases of atrial.
56:32
Sonia Singh MD: But, a lot of the metrics it's giving you are probably not actionable or anything that, is super relevant for our work together.
56:41
Sonia Singh MD: And I would just keep checking in with yourself about how this data is making you feel and how much it's really benefiting you.
56:47
Sonia Singh MD: And the vast majority of patients that will come in with these trackers are already very proactive about their health.
56:52
Sonia Singh MD: So it, it typically, it's not adding a ton.
56:56
Rebecca Berens MD: Yeah.
56:56
Rebecca Berens MD: It's, and it, the people who it would add more to are usually the people that don't have them.
57:01
Sonia Singh MD: And a lot of the benefits you talked about could be achieved from a simple pedometer I bought my son one for$10 on Amazon,
57:07
Rebecca Berens MD: yeah.
57:08
Sonia Singh MD: So those things can often be achieved without a fancy aura ring and a subscription and all of those other, bells and whistles.
57:15
Rebecca Berens MD: Yeah, absolutely.
57:17
Sonia Singh MD: All right.
57:17
Sonia Singh MD: This was a great episode.
57:19
Sonia Singh MD: So we will have additional resources.
57:22
Sonia Singh MD: All of our references for this episode.
57:25
Sonia Singh MD: Other experts you can potentially follow on our substack.
57:28
Sonia Singh MD: The substack also has our antidote, which is for patients.
57:32
Sonia Singh MD: We have little affirmations and reminders you can tell yourself, and you're maybe tempted to by a wearable or you're trying to interpret data from your invariable, or you're getting anxious from something that your wearable is telling you.
57:42
Sonia Singh MD: And then we also have scripting for clinicians that they can, tweak or borrow and use in clinic to talk to patients about some of these devices.
57:50
Sonia Singh MD: So hope that's helpful for you, and we'll see you next time.
57:53
Sonia Singh MD: Bye, Rebecca.
57:54
Rebecca Berens MD: Bye, Sonya.
57:57
Sonia Singh MD: Hey guys.
57:58
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Sonia Singh MD: Thanks again for joining us.