When we think about smart clothing – the types you can buy and wear today – it's okay to feel torn. Smart bikinis and jackets for controlling our music can seem superfluous at best, and while there is a health and fitness thread running though some of these garments, they're rarely more insightful than any other wearable.
For Venk Varadan, this approach is all wrong. His company Nanowear has invented a medical-grade textile that can capture millions of signals on the skin, with the potential to unlock the types of biometric insights that would make your Fitbit green with envy. But it's probably not for you. At least not yet.
All of the metrics
Nanowear's smart fabric is called SimpleSense and can collect a host of different metrics: ECG, heart rate variability, respiratory rate, actigraphy, impedance cardiography, thoracic impedance and cardio-phonography. While that makes for an impressive cocktail of biometric insights, Nanowear is first focusing on monitoring congestive heart failure, using its FDA-approved undergarment as a way for doctors to remotely monitor patients and hopefully keep them out of hospital. For the patients, it would mean a comfortable, discreet way to stay on top of the condition.
Tech companies… very rarely make products for poor people
Around 5.7 million people in the US have heart failure, about half of whom will die within five years of being diagnosed. It's a heavy burden on the patients and on the US's Medicare program. A 2017 study concluded that the costs associated with hospitalisation of Medicare beneficiaries with heart failure was "substantial" and "compounded by readmission". It also found that 22.3% of these patients were readmitted within 30 days.
"[Hospitals] are getting hemorrhaged over these CHF admissions," says Varadan. "Unfortunately I think tech companies, and particularly Silicon Valley companies – I think we're all at fault for this – very rarely make products for poor people, and in healthcare the biggest drivers of cost are the Medicare and Medicaid patients that show up to the emergency room."
Nanowear is about to embark on a clinical trial, three years in the making, that will observe 400 patients to prove its technology can effectively diagnose and monitor congestive heart failure. It's building off of a previous study conducted by Boston Scientific, which proved that its implantables had a 70% success rate in identifying decompensating heart failure three weeks before an event. Nanowear is taking the same thesis but using a technology that would be a fraction of the cost and reach a larger number of patients.
"If you're not talking about something that's going to get out to a billion people, you're in the wrong space with wearables in my opinion," he says.
The problem with smart clothes
Wearable X's Nadi X pants
Venk's biggest problem with smart clothes – and by some extension, wearables as a whole right now – is that they're health devices for healthy people. "I don't need something to tell me I'm healthy, I can look at myself in the mirror, I'm young enough that I'm confident that I don't have a murmur or something like that," he says. "But there are patients who… forget getting a nice-to-have Christmas toy… they're patients with sick hearts or sick lungs. They need a monitor. They're walking around with these bulky things, that's no way to live your life. All these patients still have to work. They're poor, they're not allowed to retire."
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Nanowear did take a swing at more typical garments in 2016 when it got clearance for its first products, a smart bra and tank top that collected some of the metrics mentioned earlier like ECG, heart rate and respiratory rate data. "We were very romantic with the idea of clothing," says Varadan. "We realised after talking to hospitals they had no idea how many 6 foot 5, 300 pound patients they had and how many 36C cup sizes, and they weren't going to store inventory in their hospital – they're not a retail store."
We were very romantic with the idea of clothing
That's why Nanowear's product is now a shoulder sash – adjustable, gender neutral and unaffected by breast tissue. In January the company announced it had entered a supply-chain partnership agreement with The Secant Group to manufacture its cloth technology worldwide, and Varadan tells us that, should the trials prove successful, the plan is to get the product rolled out to hospitals by mid-2019.
For Varadan, the merging relationship of health and wearables depends on data – and being a data company means having "clean pipes", something he believes the consumer gen-1 companies have failed at, and why smart clothing will find better use in the medical domain before reaching those smart jackets and bikinis.
We can capture more… lactic acid, sweat composition, hydration
"It's not going to start in the consumer world, it's going to start in the healthcare world and then come our way," he says. "Don't start with the consumer, because it's going to be impossible. It's not in our DNA. Let's try to climb the highest mountain first. I realise investors hate that and the market hates that, but we'll be sliding downhill after that. If we're solving the sickest of sick patients, why would a pharma company entertain using the Apple Watch as a companion device, which is giving them basic metrics at best?
"We're not against clothing by any means at all, but what could we do that could hit volume first in healthcare?"
Looking to the future
Beyond congestive heart failure, there are all sorts of potential chronic conditions Nanowear's technology could be used to track. Varadan says he's excited to comb through all of the health data that Nanowear harvests in its trials – we're going to find correlations we have no idea about – which could unravel all sorts of other findings. "We can capture more," says Varadan. "Lactic acid, sweat composition, hydration, those are the big things we'd want to add to future devices. But again think about a visionary thing: an ICU bed has like four different vendors of sensor wired up and you walk around with a tower – what if all of that is replaced with a bed sheet or a hospital garment?
"This should replace every wired electrode on the planet, and that's just in healthcare. This should be on every one of our soldiers, every one of our firefighters, every one of our cops, every one of our babies' cribs – that's the vision we built this company on."
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