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Apple has self-declared a revolution in technology with the Apple Watch, promising that the new fitness tracker will "help us all stay fit throughout the day," as Apple chief executive Tim Cook put it when the watch was first unveiled.
The Apple Watch monitors and displays your heart rate, how much activity you've done, and how many calories you've burned. All of this information — and data from your other health apps — feeds into a new Apple platform called HealthKit, which acts like a dashboard of personal health information.
The Apple Watch certainly makes analyzing data easier, and it may even be more precise than other wearable technologies. HealthKit data will also be made available to researchers for analysis through a new platform called ResearchKit.
The tech company is promising this will amount to an Apple-shaped health revolution. "Apple Watch gives us the ability to motivate people to be more active and more healthy," Cook declared last year.
But the claims deserve some scrutiny: the evidence on existing wearables suggests that — as with all other silver-bullet solutions for health — we haven't yet figured out how to make behavior change stick. Scientists are also skeptical about how helpful ResearchKit will actually be in the sea of big data about health.
Will the Apple Watch make people healthier?
Natasha Dow Schüll, an MIT anthropologist who has been studying the science of self-tracking and behavior change for her forthcoming book Keeping Track, told Vox, "Even with the automated devices that just track you, like Jawbone and Fitbit, usually you still have to do something to keep using it — making sure to wear the thing, recharging it — and reports have shown there's a drop-off in use after about two months."
As this study of behavior change and wearables found, the "dirty secret" about these devices is that they "fail to drive long-term sustained engagement for a majority of users." After a few months, the novelty wears off, excitement wanes, and people are back to their old ways — if they ever changed them to begin with.
Those who use the devices religiously over the longer term tend to be health-focused already. Wearables are just another tool in their already well-stacked fitness arsenal.
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Fitbit. (Photo courtesy of Mark Cacovic/Moment Mobil)
When modest changes are recorded as a result of tracking, Schüll added, it's difficult to untangle whether the devices are having an impact or whether it's just the fact that by collecting data, people are paying more attention to what they're doing with their bodies.
Consider a 2013 Pew survey that found that Americans with chronic conditions like diabetes are more likely to track their health indicators (diet, weight) and report that it helps them maintain their health. But they didn't necessarily use gadgetry. Just the act of tracking — even in their heads — was helpful.
"Everyone agrees that the metrics are good and getting better, the algorithms for analyzing the behavior are better," Schüll summed up. "But the sticking point continues to be habit and behavior change, and how you do that."
Everyone is searching for the holy grail of behavior change
Even so, a cottage industry has emerged of "habit pundits" or "behavior design" experts who mix motivational psychology with behavioral wisdom.
They're leading an effort to try to design technologies that respond to specific personality types in the hopes of inspiring lasting change. "Social butterflies will respond if they're in a community where they'll get pressure or kudos," Schüll said. "Others are introverts who find intrinsic satisfaction in looking at their data. People are struggling to come up with the way forward."
In time, these folks may be able to figure out how wearable tracking devices can improve the health of every user. And just because the devices that exist so far haven't been shown to be super helpful doesn't mean they don't have potential, said Schüll. Maybe the new Apple Watch, with its customizable interface and personalized designs, will be a step in the right direction. Maybe Apple will offer more effective prompts and nudges that could do the trick. "But the technology is so new that we just don't know yet what's going to happen with it."
For now, applying common sense is probably useful: for centuries, everyone — not just those who can afford the latest Apple gadgets — has had access to other, less sexy technologies (scales, measuring tapes) that provide extremely accurate and predictive data about your health (weight, the measure of your waist), and those haven't spurred behavior change or reversed the trajectory of the obesity crisis in America.
The promise of ResearchKit
ResearchKit may be more promising for researchers than the HealthKit will be for consumers.
Essentially, ResearchKit includes disease-specific apps that allow patients to track their symptoms and opt to share that data with research partners such as the Dana-Farber Cancer Institute, University of Oxford, and Stanford Medicine.
The open-source platform will also allow researchers to find potential participants for their studies and view the other health data generated by Apple users, such as details about diet and exercise habits, blood pressure, and weight.
"It's part of a larger move toward greater democratization of data," said Dr. Ashish Jha, a researcher and physician at Harvard, "and will allow researchers to much better understand what is actually going on with patients during the 99.9 percent of their lives when they are not interacting with the health-care system."
But Jha also questioned how easy it would be to access the data and what impact, if any, it will have on patient care. "One big question is whether electronic health record systems, which tend to be closed, will allow for providers and patients to link up the patient-generated data with more formal clinical data in ways that will be useful for patient care."
Dr. Ben Goldacre, an author and physician-epidemiologist who has called for the more widespread use of such data to drive health care, noted that Apple's data set is just one of many available right now, and that we're not always great at harnessing the information deluge for health.
"Big data is very much in vogue right now. In medicine, this often means: very large, very noisy datasets, riddled with biases, on unrepresentative populations," he wrote in an email.
"Depending on the research question, that can be useful, and fun, alongside smaller datasets of higher quality, and it'll be interesting to see what Apple collect. But we should remember that bigger isn't always automatically better."
Correction: A previous version of this story incorrectly stated when Apple would begin selling the watch.
