LIFTS Episode 91 - Apple vs. Samsung vs. Oura – Who Wins in Health Tech? | with ROOK Co-Founder Marco Benitez

0:00He spent more than 20 years in the industry. He's obsessed with the bold idea that your smartwatch might already know more about you and more about your health than your doctor. Information, it's everything. It's the new oil. Apple is going to have a more meaningful impact on the health of the U.S. than our government can do. Everyone will be using a wearable. Probably it's going to be a pill. probably something that you will have in your body and trying to check all time, 24-7 information about your health. Wearables are the next medical device and everyone should be wearing a wearable.

0:41Matthew Januszek:We're live and welcome to this week's episode of Lifts. I'm Matthew Januzek and I'm here with my co-host Mo Iqbal. Mo, how are you doing today? I'm doing great and today we're joined by Marco Benitez, a serial entrepreneur and the CEO of Rook, a health tech company that turns wearable data into real-world health insights. Marco's journey is really a fascinating one. I've known Marco now for a couple of years, I think maybe three or four years, maybe a bit longer. But he went from being a national Taekwondo champion to a biomedical engineer, and now leading a company that bridges the two worlds that really talk to each other.

1:19And this is something that we're going talk about today, fitness and healthcare. How do we get these two worlds more integrated? He spent more than 20 years in the industry. He's obsessed with the bold idea that your smart watch might already know more about you and more about your health than your doctor. And that's something that Matthew, both you and I are incredibly passionate about. Thank you so much. I'm super, super excited to be here and more with these two guys that I really admire and they know everything about this industry. So I'm super excited to be here. Thank you so much for the opportunity.

1:48Matthew Januszek:Well, Marco, just to start off, Mo's statement that you made, which is your smartwatch may already know more than your health doctor. Bold statement. Why don't you kick us off by expanding on that a little bit more? I'm pretty sure you know that the FDA approved to use some devices as they have FDA clearance, which is amazing. I mean, it's the first time that we can see this type of trends. I started to use wearables when I was like probably in the early 2000s or even at the end of the 90s. I was using the polar ones and I was using for the Taekwondo. So trying to identify patterns with my heart rate beat and all these type of things that helped me to improve myself.

2:34So I do believe that these devices are improving so much and during pandemics even more because they starting, you start to receive 24, seven hours information and more accurate because now the hardware, it's even better. I mean, Apple Watch is doing really great, but Garmin, the hardware of Garmin, it's amazing. It's like it become more accurate. And because at the very beginning, wearables were in the gray area. Now they are moving towards, you know, health and being more like doctors are starting to receive this information. Some of them are starting to use this information. During COVID, I remember, because we have a different business model before, we start to see these type of patterns on our own platform and see when people started to have COVID and we saw the temperature increasing, we saw the heart rate changing, the HRV changing.

3:34So information, it's everything. It's the new oil. I'm pretty sure everyone heard about this, but definitely I can see that in the future or very near future, doctors are going to start using this information. The only problem I can see is it's too much information. So now we need to help them to understand the information from the wearables and the other data sources that they already have. That's the problem, what I can see right now. Well, one, you mentioned Garmin, and I'm going to actually head up to New York for the Garmin Health Summit, which starts tomorrow. So I'm looking forward to that.

4:15We also know the scale of the opportunity, which is that there's more than 1.2 billion wearables that's expected to be in use globally by 2028, which is up from about 900 million today. That is a staggering number. Given this scale and the exponential growth of wearables, only this is on the consumer side, but only 10%, I would even say less than 10 % of gyms and clinics are actually using the data in a structured way. Like they just don't know what to do with it. From your perspective, what has been the hardest part about helping gyms and healthcare systems move from just collecting the data, which a lot of people are doing, but then to actually using it to improve health outcomes?

4:58Honestly, only a few people is using all the data that we are receiving from these devices. Also, think about it as an end user. When you're collecting your data from your Apple Watch, are you using it? Do you really use that information? It's super complicated. And if you go directly to the Apple Health Kit, it's a mess. It's like trying to identify all these patterns only if you are really good, savvy people. and really try to correlate all this information, probably you will make sense of something. But you need another layer. The other layer, it's like, do something with that information. So from the end user's perspective, it's very difficult.

5:41And I think that's the big differentiator with, for example, with Whoop or with Aura. It's like, okay, I'm collecting all this data, but I can tell you something about this data. and now if we extrapolate this information to the you know insurance companies or the hospitals it's again we need to help them to make sense of all this information and I can tell you only few of them already are using for that I can tell you like less than five percent maybe they are starting to use this information to do something meaningful and there is a couple of we have some clients and partners that they are doing really cool stuff with information because that can help you to do an holistic picture of the patient.

6:25It's not only because the good and cool things about these wearables is that you have trends and you have information from your story card data from maybe five years ago, two years ago, one year ago, six months ago, three months ago, you have all this information from the past. And when you are going to the doctor, it's like, okay, you have this type of trends, but you have to narrow wing to them to understand everything, which is really cool. So again, too much information. It's like you have to cover everything. You have to narrow wing a little bit more and start to doing something. And I think there's a lot of platforms outside trying to make all this information usable.

7:04Matthew Januszek:I want to jump to a news story about the Apple press release and the Apple Watch Series 11. From what I understand, It now has FDA cleared hypertension alerts and also sleep score features. And I was just thinking it from the perspective of people that own fitness facilities, personal training studios, so people in the health and wellness space who make up a lot of the listeners on this podcast. What are your thoughts and suggestions or even experience from some of the people that you've been working with in terms of how gym owners and trainers should interpret this when their members start quoting some of the data that they're receiving from these watches now?

7:47Probably it's like if healthcare, if FDA, if they really are using this information and they think that nothing, they prove that this information is really impactful in your life, definitely the fitness clubs and coaches and you know all these all people that it's involved in the fitness industry they have to take serious this information it's like okay i need to take care of you it's like another level of personalization it's like now man in front of you have this data that it's meaningful it's you have a disease you have you are really good whatever that you are finding in the blood pressure, for example.

8:34So it's like now we have an actionable. It's like you have to eat well, you have to drink more water, you have to eat less, whatever. So it's the hyper-personalization and using the information that you are receiving from this Apple Watch, for example. And Apple Watch is just an example, but we have other brands that they are doing really great in terms of how accurate the information you are receiving from your device. So it's like the CGMs. You are collecting blood pressure. That really helps. And I have a lot of friends that their daughters have problems with sugar, with the blood pressure and everything.

9:18So it's changing the lives of those people. So again, to your point, it's like finally it's like you are you have to be using this information if as a fitness coach or a fitness club you are not using this information man you are done it's it's you have to use it well i think it's no secret since apple launched the apple watch i think every watch except the first one version zero um wasn't really focused on health care right and then they added the heart rate sensor. They added all these sports features. Now we're at Apple Watch 11 with the Apple Watch Ultra 3, which was also released last week and a whole new, this whole new OS, which actually came out yesterday.

10:02They're a launch event. And I don't know if either one of you had a chance to look at it, but it was just beautifully staged. They didn't just show new features. They told stories. They had users come on and stories of literally how Apple Watch saved lives, catching heart conditions, alerting people to irregular rhythms, and even helping emergency responders locate someone who I think was stuck in the California mountains in distress. And it was just incredible to see what an integral role the Apple Watch played. Then they dropped this massive headline that Apple Watch is going to have the first FDA-cleared hypertension alert on a consumer wearable, plus an upgraded sleep score.

10:42Let's unpack for why this is important. Hypertension affects one in two adults in the US, one in two adults. That is 119 million people. So you talk about trying to expand your market, you now have a device in your wrist, which is going to be able to capture that. Yet only a quarter of that 119 million people have hypertension under control. And then there's sleep. I mean, this is like none of us gets enough sleep, but literally as a country, we do not sleep enough. And insufficient sleep is linked to$411 billion in lost productivity every single year in the US alone. This is why I'm just obsessed about trying to get people to focus more on sleep.

11:22Probably should start with me first, but nevertheless, I'm the messenger. If Apple can make those problems even 1 % better at scale, this is now just not some tech gadget. It is true public health intervention. Apple is going to have a more meaningful impact on the health of the U.S. than our government can do with changing legislation. And I think people are underestimating the impact of what some of these news mean, which is why I've been trying to talk about it and post about it more. And I think if I even take it a step further, when you watch an Apple Watch launch and you watch those life-saving stories, it was really emotional.

12:03And it made me think, right, looking at that, would a consumer now trust their doctor more that they might see once a year? Or do they trust their wearable? That's a question. And I mean, I would love to get both your perspectives on that.

12:16Matthew Januszek:Just jumping back on that, like you mentioned sleep score, all of us seem to be wearing an aura ring. So obviously, we've all got some level of confidence in aura. And from what I've been told that the accuracy of picking up the information from your finger compared to a watch is a lot higher. I don't know whether that's still the case. But what's the quality of the information that you're getting on an Apple Watch? Because both in things like heart rate from people that are developing heart rate products, they'll always argue that chest is better than the wrist. Sleep, I'm hearing people argue that finger's better than wrist as well.

12:51Matthew Januszek:Is this a little bit of hype, which Apple do fantastically well, or is this really a superior product or are they just kind of making sure that they're ticking the boxes in all of the key areas that are important to people? I probably question to both of you. I love that question because my background, I'm biomedical engineer and we built before medical devices. And on college, the first time that someone told us, it's the first time someone is taking wearable seriously and was Apple Watch. The Apple Watch technology is really great. Honestly, it's really great. It's really accurate. They are doing amazing things.

13:34They are taking the medical devices environment and narrowing into your hands. So I'm not saying they are best than Aura or than Whoop or Polar or Garmin or Huawei, all the brands that are outside. But I can tell you that the Apple Watch, they are taking seriously the part of the healthcare industry in the healthcare, generally speaking. To the point of Mo, it's like they are changing lives. I do believe Aura is really good. It doesn't matter at the end of the day, and I tell you why. And it's because you are receiving information 24-7. So now you can do metrics. You can correlate the information.

14:25Because how accurate is this one versus this one? It doesn't matter because you have a lot of information. And now you can measure all the information that you are receiving here. You will have your own algorithms. and you will do some studies that can do correlations between what happened with the medical devices and what happened with yours. And now you can do an statement about your wearable, your aura. So it doesn't matter at the end of the day. What is important is if you want to correlate the information from one user that has a wearable, another one who is using an Apple Watch, then you will need a middleware that can make sense of all this information and clean the information, normalize the information, standardize the information so you can measure apples to apples and not apples to pineapples.

15:15That's the important thing, right? I think, look, the main thing is you're collecting data. But Matt, I want to get back to your point for a second. You're talking about Apple Watch versus the Ring versus the Band and all these things. I would say that the data and the hardware has actually gotten to a point where the fidelity of what you're collecting is really, really good. So whether it's a chest strap, which uses one method of collecting heart rate, which has been the gold standard for decades, or if it is optical, which is what you're talking about from a wrist-based or finger-based sensor, the hardware, for the most part, is actually pretty good.

15:51I would even argue that Apple Watch has the best hardware today. But there's a big difference in how they collect the data. And this is really important. I actually just did recently a LinkedIn post on this. So Apple Watch tracks your HRV via something called SDNN. When you look at Aura or Whoop, they capture HRV via a method called RMSSD. So here's the difference. It is getting a bit technical here. But these are the two ways of calculating HRV, and this is why it's so different. So SDNN stands for Standard Deviation of NN Interval. So it captures the overall variability across a long window.

16:29So Apple uses this because it fits in intermittent readings, but it's less sensitive for day-to-day recovery. So they take a much longer time between each sample set. So this is why the recovery scores in Apple aren't as accurate as an OR or WHOOP. OR and WHOOP use something called RMSSD, which stands for root mean square of successive differences. This captures short-term vagal tone, parasympathetic activity. and this is the gold standard for recovery tracking using HRV. This is what Orr uses, this is what Garmin uses, this is what Whoop uses, Polar, and so on. This is measured frequently during sleep.

17:09So it's not like a few minutes, but it's literally mentioning it, tracking this all in real time. So because of that, I would say that hardware usually is pretty good for most manufacturers, as long as you're dealing with the reputable manufacturer. But if you go a step deeper, how they calculate HRV is really material. Now back to Marco's point, for the general consumer, heck, they're okay with just getting the data. Like some data is okay. But for people like us and maybe people who are listening who want to go a bit deeper, understand the impact of having one glass of wine, the impact of being dehydrated, the impact of doing a hard work on what that's going to mean for your recovery.

17:48The Apple Watch is most likely not going to meet the needs of that consumer. This is where you have to go with a fitness, sport, or wellness-based wearable like a Garmin or a Whoop or whatever. So I don't know, Matthew, hopefully you learned something and I didn't get too technical there.

18:01Matthew Januszek:No, and just to follow up on that, to put some scat on this, because I had a conversation with someone just yesterday about it. Like in terms of penetration and because obviously the fitness audience and people that are really looking to get that information on a high level still represents a very, very small percentage of the general population. what what would you say is the how would you sort of describe the penetration of something like an apple watch and people that are using some of those health metrics to the the progress that people like whoop and aura have made is it is it a massive difference or is there similar did you have any information or data to show like how much those two different products are penetrating the general population and then sort of tapping into that type of information now.

18:52I can tell you from the 50 millions of data sets that we have already, we now understand a little bit more about the end user and how they are using these devices. It's really interesting. And this is something that I am always doing every single time I'm in with any presentation or whatever. I can tell you if you are using a wearable is because you, if you are using, sorry, an Apple Watch is because you are using it for your, it's a extension of your phone. That's sad. That's really sad, but that's the truth. A lot of people, they are not using your, the Apple Watch for only, you know, for doing sports or taking another thing, another step.

19:35But if you are talking about runners, they are using Garmin. if you are a crossfitter they are using polar if they are they are taking care of the sleep data they are using between aura or whoop because someone told that aura is better with the sleep data they are doing really great i'm not saying they are not doing but a lot of people they believe that the aura ring will give you more information about your sleep stages, which I think that the Apple Watch is doing much better. That's my only thought. But to your point, it's like, now that we have all this information and all this data, now we are correlating all this information.

20:20And unfortunately, the people who is using the Apple Watch is not too much on the sports. It's only for an extension of your phone. But now that they are changing the game, And that's why I think they are trying to move more to the healthcare industry. Because it's like, hey, this is important. I can give you more information. I can help you to impact with this data to move to the next level to most point. It's like we can save lives. And that's why they are doing all these stories. In fact, I have my own reels. I do a lot of reels and these type of things, trying to share stories about how wearables are helping lives.

21:05I'm doing that in Spanish because it's easier for me, and I'm trying to help Latin America because the penetration of wearables in Latin America is very low. If you think about it here in the U.S., it's way higher than in Latin America. And in Latin America, we have a big problem of obesity, which I know also here in the U.S. is a big problem that unlock the hypertension or diabetes. So it's a huge thing over there. But again, sorry for going. No, I think it's really good. I mean, Apple has focused a lot on features. Samsung is also getting really big into healthcare. I would even argue that I think the Samsung adoption of phones might actually be higher in Latin America.

21:52and or tire in Latin America, and it is here in the US. They have spent so much time focusing on digital health. They've been very open to third-party partners kind of coming in. They integrate with many hospital systems. And I'm just curious, you know, from what Samsung is doing here in the US, we tend to be so Apple-centric. What do you think about Samsung's initiatives in healthcare? Do you think that they're ahead of Apple? They're taking a different approach than Apple? We'd love to get your thoughts there. That's a really tough question, Mo. But yeah, we saw this trend so hard in other countries, in Latin America, also because the price.

22:31At the end of the day, not everyone can buy an Apple Watch in Latin America or even in any place. It's like, so Samsung is becoming also more important. There's another brand named Xiaomi, which they are from China. They are so big and the penetration over there, it's really high because it's super cheap and give you a lot of information, right? So, but it doesn't matter. At the end of the day, what I can see in Samsung, they are moving really fast into the hell with Europe, for example. Spain, it's becoming even more interesting for Samsung. um india all these places are starting to use more samsung than um the the apple watch definitely us is the biggest market for the apple watch no it's obviously it's that's a truth um but samsung i think they are doing really great and something that that i was very surprised is they are going to start integrating medical charts that give you more information about what's the next step for them.

23:42That's pretty impressive. Matthew, any follow-up questions on that?

23:47Matthew Januszek:Yeah, I've just put it into chat just to get an idea. So roughly, and I'm not sure how accurate this, but I reckon total smartwatch users are around about 454 million, Apple 21%, Huawei. is it Huawei or Huawei, 16%, and then Samsung, which are around about 10%. And then interestingly, Aura and Whoop are just relatively smaller, between sort of 1 % and 2%. So I guess when you look at some of these devices that you said, and I'd be interested to see how Garmin and that fits into it, it's obviously Apple, Huawei, and Samsung are the dominant players in the market, and some of these other brands are relatively fringe.

24:31Matthew Januszek:And I guess, Marco, with your company and how you integrate with a lot of these brands, where do you see that shaking out? I know Aura in particular, I was watching the Canelo fight at the weekend and they seemed to put a huge amount of money getting their products out. It was quite interesting to see Aura at an event like that and clearly pushing to have this mainstream. Do you see brands like that having a real challenge to compete with people like Samsung, Apple, and Huawei? And do you think they'll eventually sort of move to the side? Or do you think there's a really strong future for some of these smaller players where they're offering these niche features?

25:14Matthew Januszek:Just probably interested in both of your thoughts on that one. Yeah, that's a really good question. because at the end of the day, what I think is that everyone will be specialized in one biomarker. For me, it was very interesting to see that Dexcom invest in Aura. For me, that was a really big step because it's a big pharma in Dexcom. It's a big enterprise of medical devices, CGMs. So it's like they are taking seriously about the hardware. So for me, that was really interesting move. So I can see this world where everyone will be using a wearable. Probably it's going to be a pill. Probably something that you will have in your body and trying to check all time, 24-7 information about your health and all these type of things, which are very important.

26:13so they can make a prediction about what's going to happen with you if you continue having these X, Y, and Z behaviors. So definitely, definitely each brand will find their own path. Again, Apple Watch, they are doing really great. Samsung, they are doing really great. And probably they are going to start buying other companies probably, or maybe they are going, because for example, Samsung, they also build their own ring. They have their own ring and the other brands aren't doing the same thing because we start to see this war of rings everywhere from other brands. So I don't know. For me, I'm very excited to see all of that because I am a geek with talking about wearables.

27:04I love them. I really love them. My goodness, I have four right now in my body. I have my CGM. I have the O 'Reilly. I have the Whoop. I have the Apple Watch and I have others over there in my, I have the eight sleep also in my bed, you know, and I love it. By the way, I love sleep. They are not any type of sponsors, but they are really great with your sleep. I've got to get an eight sleep. Matt, I don't think you have one either. Maybe that's the next sponsor or purchase we need to make is to look at an eight sleep. Well, Marco, this has been a fascinating conversation. And if we take a step back, I think the big picture is clear.