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10 May 2019

What happens first – implantable ‘wearables’ or self-driving cars?

In a week where Abbott Laboratories unveiled the first smartphone compatible implantable heart monitor, we wondered what was likely to become commonplace first – such implantable ‘wearables’ or self-driving cars. Both exist in highly regulated marketplaces, but consumer wellness as and commercial healthcare might have a primary benefit – a lower end-cost to the consumer.

Consumer wearables proved that there is strong demand for the ‘quantified self,’ that is, devices that provide users with data about their bodies. Initially, this was step count and sleep tracking, but in time, as the technology improved, this has evolved to heart rate tracking, blood-oxygen levels, and soon even blood-sugar levels. Fertility tracking is also a quickly growing market.

While the wearables themselves might have been commoditized in record time, there is still a market for the more expensive devices, sold to fitness enthusiasts. Some healthcare and insurance providers are experimenting with the benefits of providing these sorts of devices to people, to see if being made aware of their habits can help improve their overall care quality.

The next step for these more sophisticated devices is that the healthcare provider can gather better diagnostic data, and intervene early when the cost of providing healthcare is lower than a trip to an emergency department. Effectively predictive maintenance for the body, these devices also have their uses in spotting cases where emergency intervention is needed.

These applications are still early-days, but the logical extension from wrist-mounted wearables would be to devices that could be incorporated into the body itself. Of course, that would require the issue of power-supply to be solved, but it could open the door for much richer data gathering – as the process isn’t limited to the time when a user is wearing the device. This would be a way to monitor the condition of a patient continuously, when they are going about their normal life, and once you add in the possibility of an implantable way to administer medication, the technology could be truly revolutionary.

In a more dystopian view, an implantable heart monitor might become a mandated procedure for certain healthcare providers or insurers, but this might be the only time we’ll be grateful for the resurgence of anti-vaxxers into public discourse, as their outrage might be as contagious as a few of the diseases they are so averse to inoculation for.

To be clear, there will be a huge backlash in both the courts of public opinion and the legal ones, to the first initiative that would mandate such devices. It is far from clear that, should enough time pass, such devices would be seen to be as routine as a course of childhood vaccinations, or your annual checkup – but it is certainly possible that they would be.

Such a process though would take decades, but this brings it in line with many projections for self-driving vehicles. The current capabilities of autonomous vehicles are probably sufficient to deploy them at scale without bringing about societal collapse, but the issue of the acceptable number of civilian casualties remains perhaps the biggest barrier to adoption for these vehicles.

In time, government regulators will be persuaded of the capabilities of these vehicles, but this doesn’t solve the other main barrier – that of the business model. These ‘data centers on wheels,’ as some like to term them, are going to be expensive, and there remains the lingering question of how consumers are actually going to purchase them.

Private ownership is the current paradigm, but if these are exorbitantly expensive, it could take a very long time for the automakers to reach the volumes needed to enjoy the appropriate economies of scale. Ride-sharing is at the other end of the scale, where the very high price of such a vehicle can be accommodated by a transit service, using one vehicle to service the needs of many consumers per day, rather than just one.

There is also the immense societal change that needs to take place to accommodate these new vehicles, with legislation, contracts, business models, and insurance and financial systems needed to either be rewritten or completely reinvented, depending on the pace of change.

But then, much the same can be said about a future containing implanted ‘wearables,’ and so we’re left to conclude that both technologies are going to take at least ten years before they could be said to be commonplace in the market. There are so many things to be settled before they can be launched at scale that trying to put firm dates on arrival is a fairly fruitless endeavor.

The Abbott Laboratories device itself, the Confirm Rx ICM, has been cleared by regulators in the US and Europe, is implanted in the chest, just above the heart, in what Abbott calls a minimally invasive outpatient procedure. It uses Bluetooth to connect to the phone, which can then transport data back to the care providers.

Its main draw is that it will be always-on, as it doesn’t have to (or rather, can’t be) removed for charging. This should ensure 24/7 monitoring, and in more forgetful patients, it should also have more operation uptime, as one can’t exactly forget to put it on in the morning.

There are some early adopters, of sorts, for implants like Abbott’s. Biohackers is usually the term used to describe people who decide to ‘hack’ their bodies using technology, with implanted RFID chips being perhaps the most common example of this desire. For some, it’s a desire to move away from having to carry an ID badge around all the time, where scanning a hand on the required doors is a burden and the small initial discomfort of an implant is not particularly onerous.

For others, it’s more a desire to be on the bleeding-edge, inhabiting the weird space outside or ahead of cultural acceptance and technological progress, where leather trench coats and a penchant for industrial music are almost mandatory, and the ability to drop Matrix quotes on cue is prerequisite.