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Saturday, November 2, 2019

Get Regular Eye Exams for Much More Than Your Eyes

What do diabetes, Graves’ eye disease, thyroid problems, cardiovascular disease, rheumatoid arthritis, multiple sclerosis, sickle cell anemia and several other medical conditions have in common?
They can all be detected during a careful eye examination.
Obviously, during an eye exam, your eyes are being checked for vision (farsightedness, nearsightedness, etc.), glaucoma, cataracts and macular degeneration. But other diseases that are located elsewhere in your body can be detected in your eyes, too. That’s because your eye is the only place where a doctor can have an unobstructed view of your blood vessels, nerves and connecting tissue, without any need for surgery.
The eye has the same microscopic tissue as your other major organs and is an important part of your larger nervous system. Abnormalities spotted in the eye may signal the same changes in other parts of your body.

Signs of Possible Problems

What do doctors look for and what might those signs mean?
Elizabeth Klunk, senior vice president of medical management at Versant Health, a managed vision care company, says 20% of people with diabetes learn they are diabetic through an eye exam. If the exam detects traces of blood and other yellowish fluids seeping out of the retinas, it’s a sign of diabetic retinopathy which could lead to blindness. In fact, diabetes is the leading cause of blindness in the United States.
When the doctor asks you to look right, left, up and down, and your eyes can’t do that satisfactorily, it could be a sign of a neurological problem.
The eye has the same microscopic tissue as your other major organs and is an important part of your larger nervous system.
If you have dry and irritated eyes, cloudiness and blurriness, with light sensitivity, the doctor may also see an inflamed retina that might indicate such autoimmune diseases as lupus, rheumatoid arthritis or multiple sclerosis.
Dr. Lisa Mihora, of Peoria, Ariz., says she “takes care of patients with thyroid eye disease, melanomas and eyelids affected by sleep apnea. In my practice, I also diagnose inflammatory conditions (such as lupus and rheumatoid arthritis) and, sadly, I even diagnosed my own mother’s brain tumor through papilledema (optic nerve swelling). The eye truly is a window into systemic conditions.”
Graves’ disease and hyperthyroidism can be detected by bulging and inflamed eyes and excessive tearing.
Thin white or gray rings around the edge of your corneas could indicate high cholesterol and triglycerides. Memphis ophthalmologist, Dr. Ming Wang has several patients who had other diseases diagnosed because of an eye exam.
“I once had a front desk staff member who was convinced her eyes were turning blue,” Wang says. “Due to her African American heritage, the likeliness of this happening was extremely rare. Evaluation of her corneas (normally clear) showed a clear grayish-blue ring around the outer edges.”
That condition is called arcus, where cholesterol buildup in the body can be visible in the eyes. “Over the age of fifty, this is not all uncommon. However, since she was in her twenties, I advised her to get blood work done,” Wang says. “The phlebotomist who drew her blood laughed at the request. But sure enough, her cholesterol levels were sky high and she was put on a medication to control her cholesterol.”

Signs of Alzheimer’s and Cardiovascular Disease

Another example comes from Dr. Faisal Haq, of Key-Whitman Eye Center in Dallas-Fort Worth. “During an annual eye exam last year, one patient complained about seeing flashes of light while shopping,” Haq says. “He described it as ‘a curtain over the left eye.’ The condition worsened. He remembers the curtain seeming to be electrified, with electricity covering two-thirds of his eye. He could only see on the exterior. Ten minutes later, his sight returned to normal.”
Haq immediately sent the patient to his primary care physician. Tests revealed his carotid arteries were almost fully blocked and the man had suffered a transient ischemic attack — a brief stroke. Two weeks later, he had surgery to have his arteries repaired.
The eyes may also provide clues to the development of Alzheimer’s disease, and retinal imaging technology is being studied as an early detector. The technology “would identify Alzheimer’s biomarkers years before symptoms are otherwise presented, says Dr. Howard Fillit, a geriatrician and neuroscientist at the Icahn School of Medicine at Mount Sinai in New York, and chief science officer at the Alzheimer’s Drug Discovery Foundation.

How Often to Have a Comprehensive Eye Exam

The American Academy of Ophthalmology advises that every adult, even people without signs or risk factors for eye disease, should have a baseline comprehensive eye evaluation at age 40, when early signs of disease and vision changes may start to occur.
People with an eye disease or a risk factor for developing one, such as diabetes, high blood pressure or a family history of eye disease, should see an ophthalmologist even if younger than 40.
Why is 40 considered the age to start yearly eye exams? “This is when the proteins in your eye’s natural lens begins to break down and clump together, leading to the development of cataracts,” says optometrist Dr. Charissa Lee, director of education at Johnson & Johnson Vision Care in Jacksonville, Fla. “Though this is a natural aging process of the eye, it can worsen in severity over time. So, it’s important to be consistent with your eye exams.”

Finding Coverage for Eye Exams

Due to the lack of eye care coverage in Medicare and other insurance plans, some people are reluctant to have an annual exam or don’t feel the need to unless they’re experiencing a problem.
But, according to the American Academy of Ophthalmology, older adults may be eligible to receive an eye exam at no out-of-pocket cost from the Academy’s EyeCare America program.
Klunk says, “Original Medicare Part A and Part B does not cover routine eye exams, glasses or contact lenses. However, Medicare Part B will cover an annual eye exam once every twelve months if the individual has diabetes or is at high risk for glaucoma.”
An increasing number of Medicare Advantage Plans are offering vision coverage as part of their overall Medicare Advantage benefit, and the extent of coverage varies by managed care organization.
“Individuals who choose to keep original Medicare must purchase a Medicare Supplemental Plan, which can include routine vision services,” Klunk says. “Commercial health plans offer vision benefits, typically as an add-on benefit, which carries its own premium.”
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The Role of Private Equity in Driving Up Health Care Prices

Private investment in U.S. health care has grown significantly over the past decade thanks to investors who have been keen on getting into a large, rapidly growing, and recession-proof market with historically high returns. Private equity and venture capital firms are investing in everything from health technology startups to addiction treatment facilities to physician practices. In 2018, the number of private equity deals alone reached  almost 800, which had a total value of more than $100 billion.
While private capital is bringing innovation to health care through new delivery models, technologies, and operational efficiencies, there is another side to investors entering health care. Their common business model of buying, growing through acquisition or “roll-up,” and selling for above-average returns is cause for concern.
Take the phenomenon of surprise bills: medical invoices that a patient unexpectedly receives because he or she was treated by an out-of-network provider at an in-network facility. These have been getting a lot of attention lately and are driven, at least in part, by investor-backed companies that remain out of network (without contracts with insurers) and can therefore charge high fees for services that are urgently or unexpectedly required by patients. Private equity firms have been buying and growing the specialties that generate a disproportionate share of surprise bills: emergency room physicians, hospitalists, anesthesiologists, and radiologists.
In other sectors of the economy, consumers can find out the price of a good or service and then choose not to buy it if they don’t believe it to be worth the cost. In surprise bill cases, they can’t. Patients are often unaware that they need these particular services in advance and have little choice of physician when they use them.
To blunt growing bi-partisan political support for protecting patients from surprise bills, various groups have lobbied against legislation that would limit the practice. They include Doctor Patient Unity, which has spent more than $28 million on ads and is primarily funded by large private-equity-backed companies that own physician practices and staff emergency rooms around the country. Their work seems to be having an impact: efforts to pass protections have stalled in Congress.
Physician practices have been a popular investment for private equity firms for years. According to an analysis published in Bloomberg Law, 45 physician practice transactions were announced or closed in the first quarter of 2019. At the current pace, the number of deals to buy physician and dental practices will surpass 250 this year, far exceeding 2018 totals. Yes, these investments can provide independent physicians and small practices with an alternative to selling themselves to hospitals and can help them deal with administrative overhead that takes them away from the job they were trained to perform: providing care. But, at least in some cases, the investors’ strategy appears to be to increase revenues by price-gouging patients when they are most vulnerable.
Surprise billing from investor-backed physician practices isn’t the only problem. Private-equity-owned freestanding emerging rooms (ERs) are garnering scrutiny because of their proliferation and high rates. The majority of freestanding ER visits are for non-emergency care, and their treatment can be 22 times more expensive than at a physician’s office.
However lucrative in the short run, private investor-backed companies that hurt consumers are not likely to perform well financially in the long term. Unlike many other markets, health care is both highly regulated and highly sensitive to the reality or appearance of victimizing the sick and vulnerable. Consumer outrage leads quickly to government intervention.
Investors will benefit most by solving the health care system’s legion of problems and by adding true value to our health system — delivering high-quality services at affordable prices and eliminating waste. Those that try to maximize their short-term profits by pushing up prices without adding real healthcare benefits are likely to find that those strategies are unsustainable. Lawmakers and regulators won’t let them get away with such practices for long.
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Truepill’s Dose Of Digital Disruption To The $400 Billion Pharmacy Industry

“I was barely getting any sleep,” Umar Afridi, cofounder and CEO of Truepill, says of the tech-enabled pharmacy company’s early days. From 9 a.m. to 4:30 p.m. each day, he worked at Truepill’s distribution center in Hayward, California. Then he drove to his job as a pharmacy manager at a 24-hour CVS in East San Jose. On the side, he studied for a dozen state pharmacy exams so that Truepill, which at the time had no other pharmacists on staff, could legally ship to those states. “It was a pretty crazy first year,” he says with characteristic understatement.
That craziness has paid off for Afridi, 37, and his cofounder, Sid Viswanathan, 35, who hope to upend the staid, heavily regulated pharmacy business with technology. Truepill, which is based in San Mateo, California, shipped its first prescriptions in 2016. Last year its revenue reached $48 million, helped by the fast growth of direct-to-consumer customers like Nurx, which sells birth control, and Hims, which focuses on remedies for hair loss, erectile dysfunction and acne. This year Truepill could double its revenue to $100 million, as it expands its customer base beyond direct-to-consumer medications to prescriptions that treat more serious illnesses.
Those revenue numbers gained Truepill a spot on Forbes’ Next Billion-Dollar Startups list this year, despite its having raised just $13 million in venture funding led by Initialized Capital at a valuation of $80 million in its last round. That valuation makes Truepill an outlier on the list, as does the fact that Afridi and Viswanathan own the majority of the business and plan to continue to do so after raising the next round of capital, expected before the year’s end.
Afridi and Viswanathan—and their investors—are betting that Truepill will see a big payoff as consumers move away from in-person doctor visits and to a new model of telemedicine. “This is the building block of digital health and the future of healthcare,” says Initialized managing partner Garry Tan.
Pharmacy is a roughly $400 billion business in the United States, yet only recently have entrepreneurs begun tackling the market. In 2013, two young founders launched PillPack, a retail pharmacy startup that was acquired by Amazon last year for around $750 million. Other newcomers followed, including New York City’s Capsule, which grabbed $270 million in funding to do same-day prescription delivery refilled via text.
Truepill’s difference: Its business-to-business model makes it a behind-the-scenes player, invisible to retail customers, who will never have reason to know its name. That’s by design, and it allows Truepill to sign agreements with drugmakers and pharmacy benefit managers, those industry intermediaries that sit between insurers and drugmakers, without directly competing with them. “We’re not a traditional mail-order pharmacy,” Afridi says. “We’re way more than that.”
Afridi was born in Salt Lake City and grew up in Manchester, England, where his mother’s family was from. He studied pharmacy at the University of Manchester and worked as a relief pharmacist, filling in for those who went on vacation, in England. After passing the tests to practice in the United States, he took a job at Fred Meyer near Seattle. Unlike the typical pharmacist, Afridi always had an entrepreneurial side gig. During college, he imported performance cars, like the Mazda RX-7 and the Mitsubishi Evo 5, from Japan and sold them at a profit.
While working as a pharmacist, he taught himself computer programming and began playing around with the idea of an on-demand pharmacy. His goal: to ease customers’ frustrations with waiting in line to pick up medications and to cut back the phone calls and faxes required for pharmacists to do their job. “I’ve always had a passion for technology, and every time I see a problem, I think, ‘How can technology fix this?’” he says.
Viswanathan, an Indian immigrant, had worked at Johnson & Johnson, then cofounded CardMunch, a business-card scanning app. In 2011, LinkedIn bought the startup for a reported $3 million. Viswanathan stayed at the larger company after the deal, and when LinkedIn went public the stock he owned made him wealthy for the first time. “It was fairly life-changing coming from no money to having some,” he recalls. After nearly four years at LinkedIn, he was ready to leave and work on another startup. “My only criterion was what do I want to spend the next 10 years of my life on,” he says.
While he was pondering what to do next, he stumbled upon Afridi’s profile on LinkedIn—where Afridi had changed his header to “startup founder, pharmacist”—and messaged him cold to talk about healthcare. Soon the two were meeting regularly and brainstorming ideas for a business to start together.
By then, other startup pharmacies, like PillPack, were making inroads with retail customers. Rather than compete in what had become a crowded space vying for retail customers, Afridi and Viswanathan figured they could operate in the background, using technology to build an extremely efficient pharmacy distribution center. “Truepill is what you get when you put together a pharmacist and a software engineer,” Viswanathan says.
“This is the building block of digital health and the future of healthcare,” says Initialized Capital’s Garry Tan.
Their idea coincided with the rise of new direct-to-consumer health brands that needed a distributor that could follow all the pharmacy regulations. To consumers, these Instagrammable health products don’t look like drugs, and often their subscription boxes contain a mix of both prescription and over-the-counter products. But if there’s even one vial of prescription pills going out in the mail, the startup sending it needs a pharmacy to fulfill the order. In talking with Nurx, Viswanathan says, “we came to find out they were literally picking up the phone to mom-and-pop pharmacies in different states.” They gained a customer by offering a better way.
In 2017, Andrew Dudum cofounded Hims, the fast-growing direct-to-consumer therapeutics startup for men, and he, too, signed up with Truepill. “We knew from the beginning we were going to grow very fast,” Dudum says. “We expected 30 to 50 orders per day, and that was the scale we communicated to Umar and Sid that we needed to be prepared for. In the first week, we were getting 500 orders per day.” Today, Hims, which is valued at $1.1 billion, does thousands of orders per day and is one of Truepill’s largest customers. “They figured out a way to scale with us,” Dudum says.
At Truepill’s Hayward distribution center, all orders come in electronically. When Hims sends a prescription for finasteride, the male hair-loss treatment, for example, it goes through electronic vetting and then a robotic machine pulls the 1-milligram tablets from custom-made 1,000-count bottles into a small pill vial that gets labeled with Hims branding. That automation allows Truepill to work more efficiently than a traditional retail pharmacy. So, too, does its focus on a small number of medications: Ten medications, including finasteride and the erectile-dysfunction drug sildenafil, represent 80% of its volume. Its scale in those allows Truepill to turn over its inventory every few days and gives it the power to negotiate prices with drug manufacturers and pharmacy benefit managers on those products.
“Truepill is what you get when you put together a pharmacist and a software engineer,” says cofounder Sid Viswanathan.
For Afridi and Viswanathan, direct-to-consumer medications are just the beginning. They are starting to sign agreements with drugmakers and pharmacy benefit managers, though they won’t name those larger partners yet. This shift comes none too soon, as Hims has announced that it would open its own pharmacy in Ohio to shift a portion of its distribution in-house—a move that Viswanathan says will begin to impact Truepill in 2021. “Hims is a large part of the business in quantity, but not in revenue,” he says, noting that medications reimbursed by insurance are higher cost than lifestyle meds that consumers pay for out of pocket. Truepill currently has two distribution centers and is adding another five.
Afridi and Viswanathan’s next step: building a nationwide network of doctors in every state that will enable their pharmacy startup to play a bigger role in the shift to telemedicine. Those doctors will allow it to work directly with makers of specialty medications, say, so that they can distribute their medications to consumers more easily. Over time, Truepill figures its orders could rise from 5,000 to 10,000 per day to 100,000.
“Lifestyle and ED [erectile dysfunction] medications have allowed us to build the infrastructure to all these other areas,” Afridi says. “There is a lot of innovation that needs to happen in the space.”
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Rotavirus vaccine: A potential new role as an anticancer agent

Numerous vaccines, from flu shots to those those that help thwart chickenpox and measles, are widely used to guard against contagion, but researchers in France are proposing a breakthrough role for rotavirus vaccines: deploying them in cancer treatment.
So far, their investigation suggests the question about repurposing can be answered with a resounding “yes.”
“We have found that rotavirus vaccines, Rotateq and Rotarix, have both immunostimulatory and oncolytic properties,” Dr. Tala Shekarian of Centre de Recherche en Cancérologie de Lyon told Medical Xpress.
“Moreover, they can directly kill cancer cells with features of immunogenic cell death. In vivo, intra-tumoral rotavirus therapy has anti-tumor effects, which are mainly immune-mediated,” she said.
To date, the research has been conducted in  and animal models with results that have surprised seasoned scientists.
“Interestingly, in several immunocompetent murine tumor models, intra-tumoral rotavirus overcame resistance to and synergized with immune checkpoint-targeted therapy,” Shekarian said.
Checkpoint blockade immunotherapy is an innovative form of treatment that relies on medications known as  to address multiple forms of cancer. These medications engage the body’s immune system to recognize and attack . Keytruda, a medication that helped revolutionize the treatment of non-small-cell lung cancer is a checkpoint inhibitor drug.
All checkpoint inhibitors are based on a deceptively simple principle: Cancer cells possess a protein dubbed PD-L1. T cells, key soldiers in the immune system’s army, have a surface protein called PD1. Tricky cancer cells use their PD-L1 proteins to help them elude T cells, to get past the guards—the checkpoints—activities that allow them to proliferate and spread. Checkpoint inhibitor medications prevent  cells from eluding and hiding.
A problem with these drugs, which are used to treat multiple cancers ranging from Hodgkins lymphoma to lung, bladder, ovarian and kidney cancers, is that they simply stop working. Cancer cells develop resistance to them in a way that is vaguely similar to the stubborn resistance of superbugs to antibiotics. Once resistance emerges, tumor cells can resume exploiting the vast armies of “good guys,” the T cells, which are again unable to keep lethal, malignant invaders at bay.
Enter the rotavirus vaccines.
They are already approved, possess a high safety profile and complement checkpoint inhibitor treatments, scientists in France say.
Reporting in Science Translational Medicine, Shekarian is the first author in an investigation that demonstrates how off-the-shelf rotavirus vaccines can double as anticancer agents. The discovery suggests that viruses, but not just rotavirus, possess potent anticancer properties. The pathogens can deactivate properties of  whether they are live agents or attenuated—weakened—as vaccines.
The oncolytic properties of common viruses can be exploited to prime antitumor immunity, the team wrote in the journal.
Shekarian and her colleagues underscored in their report that while many “viruses are currently in active clinical development in combination with immune checkpoint–targeted therapies … the implementation of these therapies is limited by their manufacturing constraints [and] the risk of exposure of clinical staff.”
A more expeditious approach, the French team reported in the journal, was to test already approved agents.
“Rotavirus vaccines are pediatric and adult clinical grade products. Therefore, in situ immunization strategies with intra-tumoral attenuated rotavirus could be implemented quickly in the clinic,” Shekarian told Medical Xpress.
The research was led by Dr. Aurélien Marabelle of Centre de Lutte contre le Cancer Léon Bérard in Lyon. Marabelle, who is traveling and unable to comment on the team’s laboratory investigations, is also associated with INSERM, or Institut national de la santé et de la recherche médicale. INSERM is the French national institute of health and research, the only public health research institution in France.
The researchers tested several vaccines in vitro and found that rotavirus vaccines activated NF-κB, which stands for nuclear factor kappa light chain enhancer of activated B . This is a family of transcription factors that regulate important cellular activities such inflammatory responses, cell growth and apoptosis, or programmed cell death.
In a human cell line, NF-κB was protective in a tumor model that was resistant to an immune checkpoint blockade, Shekarian, Marabelle and the team found.
Additional research involving live or inactivated rotavirus vaccines in multiple tumor models showed durable immunity, especially when combined with other immunotherapies.
These studies indicate that rotavirus vaccines already in production and circulation could double as anticancer agents, the scientists said.
“The development in clinic of such approaches was the driver of the work, using commercially available vaccines,” Shekarian said, noting that they are safe for children, they’re inexpensive and easily available worldwide, including underdeveloped countries.
Explore further
More information: Tala Shekarian, et al. Repurposing rotavirus vaccines for intratumoral immunotherapy can overcome resistance to immune checkpoint blockade, Science Translational Medicine (2019) DOI: 10.1126/scitranslmed.aat5025
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Brain stimulation headset for treating depression at home now for sale in U.K.

**Brain stimulation headset for treating depression at home now for sale in U.K.
Representatives for Flow Neuroscience have announced on the company’s website that a headset device that they call simply Flow is now available for sale—they claim the device can reduce chronic depression symptoms. The British government recently gave the go-ahead to such devices (as did the EU), citing research showing such devices can be useful for treating long-term, chronic depression. The device is now available to purchase for £399, and includes an app the company claims was created by a team of psychologists. They also note that they are offering a 30-day trial period.
The device sits mostly on the top of the forehead and sends a small jolt of electricity through the skull into the  (the part of the brain responsible for personality, decision-making and regulating emotions). The technology, known as , has been the subject of numerous tests, most of which have found that it provides some degree of relief from depression symptoms. Many have concluded that it is at least as effective as antidepressants, but without the side effects. Thus far, none of the trials have found any adverse effects of such treatment other than reddened skin where the electrodes are placed and the occasional headache. Such treatments have been found to change the potential of neurons—in some cases, making them fire more often, and in others less often. People with chronic depression typically experience less  in the left side of their prefrontal cortex—the mild shocks are meant to increase such activity to match that in the right side. Some of the trial results have even shown that in some cases, mild electrical stimulation can encourage the growth of new neural connections, perhaps reducing depression symptoms permanently.
Upon purchase of the  (after consulting with their own health care professional) users are directed to wear the headset for a half-hour approximately every three days over the course of six weeks. While doing so, they are encouraged to use the app, which provides useful tips, such as reminders to get enough sleep, eat right, and exercise.
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ADHD rates doubled among U.S. adults over 10 years

Over a 10-year period, ADHD rates more than doubled among American adults, new research shows.
However, the rate among  remains much higher than in adults.
“While we can’t pinpoint the source of the increase in ADHD rates in adults, we can surmise that it has to do with growing recognition of ADHD in the adult populations by doctors and service providers, as well as increased public awareness of ADHD overall,” said study co-author Dr. Michael Milham. He is vice president of research at the Child Mind Institute, in New York City.
For the study, researchers analyzed data from more than 5 million Kaiser Permanente Northern California patients, and found that the percentage of adults with a diagnosis of ADHD rose from 0.43% in 2007 to 0.96% in 2016.
White adults showed a larger increase—0.67% to 1.42%—than those in other racial/.
Adults with other —such as depression, and bipolar, anxiety or eating disorders—were more likely to have ADHD. The researchers also found that adults with ADHD had higher rates of health care use and sexually transmitted infections.
Meanwhile, ADHD diagnoses among children aged 5 to 11 rose from 2.96% in 2007 to 3.74% in 2016, a 26% increase.
The study was published online Nov. 1 in JAMA Network Open.
“More work needs to be done to better understand why rates are higher in white adults, particularly whether there are deficiencies in detection and diagnoses among non-white adults,” Milham said in a journal news release.
“And,” he added, “we must develop more effective diagnostic tools and standards for adults, who, in general, remain more challenging to diagnose than children.”
Study lead author Dr. Winston Chung, a psychiatrist with Kaiser Permanente in San Francisco, noted that people in some cultures are less likely to regard certain behaviors as a disorder or to seek help for them.
“It’s always been just understood that  and races might vary in meaningful ways in how they cope with stress or expressing emotions,” Chung said.
However, “this is something we don’t actually have definitive answers to,” and more research is needed, he added.
Explore further
More information: Winston Chung et al. Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups, JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.14344
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Here’s how Fitbit can help fix Wear OS

Now that Google’s acquisition of Fitbit is official, the question is what the search giant will do with it. When the news broke on Friday, Google’s Rick Osterloh said the company sees the deal as an “opportunity to invest even more in Wear OS, as well as introduce Made by Google wearable devices.” For the time being, then, it looks like Google plans to leverage Fitbit’s expertise to another push into wearables.
Earlier this week, we speculated on some of the ways in which Google’s purchase of Fitbit would be bad for wearables. However, there are a lot of things Google could learn from Fitbit to make Wear OS a compelling platform. The important thing here is that Google doesn’t do what it has seemingly done in every other situation like this, which is to change its mind after only a short while.

Make fitness fun and easy

It’s fair to say that Wear OS is already a competent smartwatch platform. What it lacks is a strong fitness component. There’s a lot Google could learn from Fitbit here. To start, the most important lesson is to make the experience fun. For a lot of people, working out is a chore. What Fitbit has always done well is add a sense of whimsy to something as mundane as walking 10,000 steps a day. Anytime you finish your step goal or walk after a long period of sitting, Fitbit makes it a cause for celebration with splashy graphics and words of encouragement.

Robust heart rate tracking is a must

If the first new wearable Google releases doesn’t feature Fitbit’s PurePulse heart rate tracking technology, then the acquisition will have been a missed opportunity. More so than any other hardware feature, PurePulse is the reason to buy a Fitbit wearable. After some initial foibles, the feature feels both consistent and accurate. Moreover, one of the smartest things Fitbit has done in the last few years is make the tech more affordable. What used to be a feature limited to the company’s more expensive trackers is now something you can get on the $100 Inspire HR. Reliable heart rate tracking should be a standard feature on Wear OS devices, not a nice add-on.
There’s a lot of ways in which Fitbit’s PurePulse heart rate tracking could make Wear OS a more compelling platform. One example is Fitbit’s Cardio Fitness Score feature, which leverages the company’s heart rate tracking to provide you with an easy to understand way to improve your fitness level. Heart rate tracking should be at the center of any attempt Google makes to try and create a compelling fitness platform because it would allow the company to most directly match the Apple Watch’s more advanced fitness features.

Fitbit is more than just Fitbit

In 2016, Fitbit purchased smartwatch startup Pebble’s talent and intellectual property. It’s hard to say what came out of that purchase other than the Fitbit App Gallery, which was created with help from some of the talent Fitbit acquired in the deal. The fact Fitbit seemingly never did more with Pebble’s tech seemed a missed opportunity. Pebble had a lot of interesting ideas about how smartwatches could complement a smartphone, particularly as it relates to notifications and user interface.
In addition to Pebble, through Fitbit, Google has also acquired talent and technology from Vector, Coin, Fitstar and Twine Health. Between Friday’s acquisition and its Fossil purchase earlier this year, the company now has a wealth of talent in the field. It should leverage that talent in a way that allows the company to improve the ecosystem with better software, hardware and features.

Battery life and Bluetooth performance need to go hand-in-hand

One area where Fitbit trackers have always excelled is battery life. Even taking advantage of features like heart rate and sleep tracking, you can still get close to a week of battery life on most Fitbits. And battery life is an obvious area where Wear OS can improve.
But Google shouldn’t only focus on the battery life of its smartwatches. If you’ve used a Fitbit in conjunction with an Android phone — particularly one of Google’s Pixel smartphones — you’ll know that they absolutely destroy your phone’s battery. The same is not true with iOS devices. If wearables are going to be a major aspect of Google’s Android strategy moving forward, then Bluetooth performance needs to be as good or better than it is on iOS. Likewise, Bluetooth performance and battery life can’t be an afterthought on Pixel smartphones. Part of the problem with a lot of wearables is that they’re a burden on the most important device in people’s lives, that’s something Fitbit has, for the most part, been able to avoid.

Make it social

One of the underestimated strengths of Fitbit’s platform is its social hooks. If you’ve ever bought one of the company’s trackers for a family member, then you’ll know how much your parent or sibling seeing your daily stats can motivate them to reach their own goals. Fitbit wisely built a lot of functionality that encourages people to engage in healthy competition.
For example, one of the things you can do in the Fitbit app is take part in something called Adventure Races. These essentially see you doing the digital equivalent of a tough mountain hike. Along the way, you can see how you’re doing against your friends and family members. They can be easy to overlook, but more so than any feature Fitbit offers on its trackers, it’s the social ones that keep people hooked. Studies have found that fitness trackers can help people with their physical health, but the main issue is that most people stop using their devices a couple of months after buying them. By making the experience social, Fitbit has been able to turn some users into dedicated fans. That’s something Google shouldn’t underestimate.
More than anything, what Google needs to learn from Fitbit is that Wear OS doesn’t need to be everything to everyone. The reason so many people love their Fitbits is that they do one thing and they do it exceptionally well. Apple eventually came to the same realization with watchOS. It was only after the company stopped trying to create the “next big thing” and focused on how the platform could help people with their health and fitness goals that the Apple Watch became more compelling. A similar focus is essential for Wear OS if it’s to have any chance at denting Apple’s hold on the wearables market.
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