Wearables Are Totally Failing the People Who Need Them Most

Then One/WIRED

As the Internet of Things becomes an actual thing, more steps are being counted, more sleep patterns are being logged, more activities are being app-ified. What isn’t appearing in the data is much common sense or ambition. Instead, developers continue flocking to a saturated market filled with hipster pet rocks, devices that gather reams of largely superficial information for young people whose health isn’t in question, or at risk.

It’s a shame because the people who could most benefit from this technology—the old, the chronically ill, the poor—are being ignored. Indeed, companies seem more interested in helping the affluent and tech-savvy sculpt their abs and run 5Ks than navigating the labyrinthine world of the FDA, HIPPA, and the other alphabet soup bureaucracies. This may be their own undoing, as there is a very real—and potentially lucrative—potential to shake up the healthcare system and frack the $2 trillion annual cost of chronic disease.

Bangled with Fitbits and Jawbones and peering through their augmented reality spectacles, the audience at D.C.’s Wearables + Things conference saw the hype cycle of the industry buckle in on itself. Peter Li, a twenty-something inventor who studied biomedical engineering at Johns Hopkins, demonstrated a fitness watch that accurately detected and counted the push-ups and jumping jacks he performed onstage. Nike’s chief scientist pooh-poohed smart watches’ most commonly collected biometrics—steps, temperature, and blood oxygen—as irrelevant to athletic performance, while promoting the importance of smart algorithms for analyzing human performance. Adidas demonstrated a heart rate monitor that clips onto its biometric sports bra. At least someone finally figured out that women already run with a band around their chest.

But then there was Kabir Kasagood, director of business development for Qualcomm Life, which manufactures the semiconductors used in many wearable gadgets. He exhorted developers to stop screwing around in a saturated market for activity trackers and embrace the red-tape and regulatory friction of the healthcare industry. “Go from the children’s table to the grown-up table,” he said. “If you’re serious about this, embrace the FDA. Learn how HIPAA works. Make sure it’s connected to the [electronic medical record] and that all the health laws are observed. There’s a tremendous dearth of innovation here. I would move away from fitness and go hardcore into health. That’s where the money is.”

Dorthy, iStrategyLabs’ shoe clip device. Maggie Winters/iStrategyLabs

The audience response was lukewarm. After all, regulation is yucky. Clinical trials are a drag. Integration with legacy systems is boring. Security requirements and limitations on how user data can be monetized? Meh. As if to prove the point, minutes later, the marketing director of iStrategy Labs demonstrated “Dorothy,” a shoe clip that allows you to click your heels together three times to call Uber. By far the biggest hit of the conference, this hacked-together prototype snowballed into an appearance on Good Morning America.

As of September 30, there were 266 wearable devices on the market (including 118 fitness wearables), with 23 slated for release before the year is out. From Silicon Valley and San Francisco to Austin and MIT, young, healthy, highly educated, mostly male entrepreneurs are developing marginally useful apps and gadgets for people just like themselves. And indeed, most of the information technologies we currently use started this way, from personal computers to the Internet and social media. The alpha geeks home-brew technologies that are taken up by early adopters and spread until your mom is on board. The Silicon Valley assumption is that health and wellness will follow that same path.

But if you follow the money, and you really understand the population with the most to gain from improvements health and wellness, that assumption falls apart. It turns out the wave of wearables adoption isn’t rolling out the same way as the web or smartphones. More than half of US consumers who have owned an activity tracker no longer use it. A third of them took less than six months from unboxing the device to shoving it in a drawer or fobbing it off on a relative.

Test For Diabetes Elderly Person, Everyday life of an independent nurse, Bagnolet, France. Diabetic patient. BSIP/UIG/Getty Images

So who’s made a long-term commitment to measuring and tracking their health? People with two or more chronic diseases. According to a Pew Foundation survey, 45 percent of US adults are dealing with at least one chronic condition. While only 19 percent of people with no chronic conditions track their health indicators, 40 percent of adults with one chronic condition do so, and 62 percent of adults with two chronic conditions do so. So far this year $2.8 billion has been spent on wearable medical devices, and that’s expected to grow to $8.3 billion in the next five years. If you took all the fitness bracelets and smart watches sold in 2014 and multiplied that retail number by six, it still wouldn’t match the $6.3 billion US market for blood glucose test strips.

People with chronic diseases don’t suddenly decide that they’re over it and the novelty has worn off. Tracking and measuring—the quantified self—is what keeps them out of the hospital. And yet there are more developers who’d rather make a splash at a hackathon than create apps and devices for people who can benefit hugely from innovation in this area.

At some point, you’ve got to ask yourself whether it’s just the friction created by health-industry regulation—the HIPAA security rules and FDA approval (or waiver) process and the hassle of integration with legacy systems. Or is it too daunting for a twenty-something engineer to develop technology for people who aren’t like them at all? An obese diabetic on a motorized scooter? Or a frail old lady with memory loss? Or her caregiver? Someone who’s three bus transfers away from a doctor’s office?

Can our innovators rise to the challenge of an aging, chronically ill society whose medical costs are swamping our economy? Or will techies just click their heels together three times, and call Uber?

J.C. Herz is the author of Learning to Breathe Fire .