Jeff Williams, Chief Operating Officer of Apple

Jeff Williams, Chief Operating Officer of Apple

[Music]

Mark Masselli: This is Conversations on Health Care , I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret we find ourselves at the start of 2016 with yet another
attempt by the Republican led Congress to repeal the health care law. This is the firs t
time both the house and senate may find some agreement over a repeal of the ACA.

Margaret Flinter: Well Mark that underscores the deep divide that still exist over the
ACA. While Congressional Republicans are continuing the fight, many Republican
governors around the country are beginning to sing quite a different tune.

Mark Masselli: Many Republican governors are starting to understand the cause their
political stance has had not just a health of their c onstituents but as well on the state
coffers.

Margaret Flinter: Well, remember Mark the Supreme Court 2012 decision upheld the
Affordable Care Act but not the mandate requiring all states to expand Medicaid
coverage. Many Republican governors chose not t o extend that coverage to their
poorest residences as a result the move left millions of American still uninsured and
governors left billions of dollars of federal money on the table.

Mark Masselli: Republican governors Arizona and Arkansas, Indiana, Iowa , Michigan,
Nevada, New Jersey, New Mexico and Ohio have expanded their Medicaid program,
and some of their more reluctant colleagues are starting to see the wisdom of such a
move.

Margaret Flinter: We have to pay attention to the numbers for the first ti me America's
uninsured rate has dipped below 10% and that's thanks to the Affordable Care Act. So
as the saying goes progress not perfection.

Mark Masselli: And another big influence here in health care in 2016 will continue be
the influx of digital heal th technologies in the traditional health care space.

Margaret Flinter: And our guest today is focusing his efforts on the dramatic potential of
this emerging market. Jeff Williams i s the Chief Operating Officer of Apple and he also
oversees the tech gia nts foray into the growing health care space with Apple Health Kit,
ResearchKit and the Apple Watch.

Mark Masselli: We also will be hearing from Lori Robertson managing editor of
FactCheck.org who's always on the hunt for misstatements spoken about health policy
in the public domain, but no matter what the topic you can hear all of our shows by
going to chcradio.com.

Jeff Williams, Chief Operating Officer of Apple

Margaret Flinter: And as always if you have comments please email us at
[email protected] or find u s on Facebook or Twitter because we love hearing from
you. We'll get to our interview with Jeff Williams the Chief Operating Officer of Apple in
just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline news.

[Music]

Marianne O'Hare: I'm Marianne O'Hare with these Health Care Headlines. About two
and a half million Americans have already signed up for coverage in the latest ground of
open enrollment under the Affordable Care Act. The new numbers have brought the
nation's uninsured rate to below 10% for the first time but pro blems still persist cost are
on the rise for health coverage and there are rumblings among some big insurers like
United Health Care they may pull out of the exchanges in the future. The Republican
controlled congress already aiming for another repeal vot e as well. The president,
meanwhile, ready to use his veto pen if necessary to overwrite any repeal attempt.

What's the biggest health threat in coming decades according to Pew research and
other analyst antibiotic resistance could be the leading killer g lobally by 2050. The
rampant overuse of antibiotics in health care as well as in animal production leading to
the advent of super bugs that allude even the strongest antibiotics. Resistant infections
have caused an estimated 700,000 deaths globally this year but scientist warned that
number will be around 10 million per year if action isn't taken. They will also cause the
world about a 100 trillion dollars per year.

Opioid abuse is poised to become one of the hot health topics for the coming years as
the death toll rises to over a 150,000 Americans from either prescription Opioids or
illegal drugs like heroin. An alarming patterns has also emerged as public health
officials begin to delve more deeply into the epidemic. Researchers at Boston Medical
foun d that even those patients who overdosed on Opioids and were revived continued
to receive their Opioid prescriptions. They say a points to a fragmented care delivery
system where the primary prescriber may not even know the overdoses occurred, and
the Ame rican Cancer Society change its recommendation for breast cancer screenings
in 2015 leading to more confusion about diagnostics guidelines raising the
recommended start time for a baseline mammography at age 45 instead of 40 and only
screening every other year after 55 for the age of the end of menopause. Now come
some interesting new evidence on the efficacy of ultra sound as an effective screening
tool for women especially those with dense breast tissue and a three year test involving
over 2000 women wit h dense breast mammography was better at detecting

Jeff Williams, Chief Operating Officer of Apple

calcifications. Ultra sound however was better at detecting invasive cancers. I'm
Marianne O'Hare with these Health Care Headlines.

[Music]

Mark Masselli: We're speaking today with Jeff Williams, Chief Operating Officer of
Apple overseeing the development of Apple Watch and driving the company's health
initiatives including ResearchKit which is aimed at simplifying medical and health
research. Jeff joined Apple in 1998 as head of worldwide procurement a nd he played a
key role with Apple's entry into the mobile phone market with the launch of the iPhone in
2007. Since 2010 he's overseeing Apple's entire supply chain as well as service and
support and social responsibility initiatives. Prior to his 10 ye ar at Apple Mr. Williams
worked at IBM for 13 years both engineering and operational capacities. He earned his
master's in mechanical engineering from North Carolina State, his MBA from Duke. Jeff
welcome to Conversations on Health Care .

Jeff Williams: T hanks Mark, great to be with you.

Mark Masselli: Since his birth in that California garage in the 80s Apple's been
synonymous with innovation in groundbreaking technology. We've cycled through quite
a few consumer products since then multiple iterations of the Mac, the iPod, the iPhone,
the iPad and the most recent Apple launch is the Apple Watch which CEO Tim Cook
has described as a new intimate way to communicate from your wrist. Could you tell
our listeners about the genesis of the Apple Watch and how its advancing this idea of
wearables as the ideal communication device that may help facilitate the advance
medical research as well.

Jeff Williams: Yeah actually Mark the process is much more organic. In this case,
many years ago Johnny and the ID team started looking at how you might interface with
a small screen and we were surprised at how compelling that was, new idea surfaced
and it ultimately ended in us producing the Apple Watch but the process is very organic
and in terms of health and communica tion the two biggest things we've seen in terms of
response on the watch are actually in those two categories. The first is people are
telling us that the watch helps them be more present. The fact that they're able to triage
their communications quickly is been really helpful but the biggest impact is actually
been on health.

Quite honestly we've been surprised and very inspired so many people have written to
us saying it's help them lose weight, it's help them be more active, they were pre -
diabetics and have changed course and even we've gotten a ton of emails where
people are saying the watch actually saved their life. First thing though I got the only
thing on the Apple Watch from a true medical sensor standpoint is the heart rate sensor
and anybody c an get their pulse you just put two fingers on your wrist and watch the

Jeff Williams, Chief Operating Officer of Apple

clock but having the information readily available and possibly more important the fact
that it's passively tracked, it's tracked in the back around has prove to be profound in a
way w e didn’t anticipate.

We've gotten so many emails where people or their cardiologist have written us and
said this person detected something on their watch and came in and they had a life
threatening situation and if we had not intervene they probably would have died, and
they look at their iPhone because they have an Apple Watch and they see that wow I
can see my heart rates throughout the day and I notice I have this severe drop in blood
pressure. The fact that it's monitored it gives people a more contin uous view versus just
a snapshot into their health and so we think we're just at the beginning and couldn’t be
more excited about the future.

Margaret Flinter: Well you initially develop the Apple Health Kit as a place for users to
be able to store their health data, and other company certainly had entered the space
and we've had some of those participants from those initiatives on the show who
thought it was just too soon for people to feel comfortable storing personal health data
in the cloud. What's di fferent about Apple Health Kit and what kinds of health data is it
design to capture?

Jeff Williams: I don’t know that it was too soon. We took a completely different
approach, in fact we don’t store your information at all, we put the user squarely in
c ontrol of their health data. Think of your phone inside your phone there's a little save
and you are the save manager and so let's say you have a blood pressure cup whatever
that collects input you decide whether to let that device write information into your little
save that's on your phone, and then let's say you want to share that data. You got
hypertension and you've got a health care provider that wants to track your blood
pressure result.

You decide whether you want to allow data to leave that littl e save on your phone and
go to the health care provider through their app and Apple doesn’t store your data, it's
not out in the cloud and that's the approach but you are right, we did not set out with the
goal to go into the health data business. It reall y surfaces a need we're working on the
watch, we needed a place to store data and as we looked at it we said well I think
there's a problem to solve and so we don’t actually think in terms of markets that this is
the health care market. We tend to think i n terms of is there a problem that needs to be
solve for people and can we produce something that's really inspiring and helpful and
that's how entered here.

Mark Masselli: And if you connect the dots there you have 700 million iPhone users
around the world and after Apple launched its Health Kit in 2014 you realize that this

Jeff Williams, Chief Operating Officer of Apple

treasure trove of health information was being generate by users, how did Apple Healt h
Kit lead to Apple ResearchKit and how do all of those pieces fit together?

Jeff Williams: We were talking with medical experts because we were building the
watch and we had this idea of health kit is a place to store it and the conversations
would often drift to problems they faced and in research and as we listen to these
problems we saw a huge opportunity to help. In fact there's been such amazing
progress in medical research but the number one problem that researchers face is
actually recruiting part icipant and as a result you can have 20, 50 maybe a 100 people
in a study if you're lucky. If you participate in a research study you have to usually drive
to the location, you have to sign legalities documents for consent. So we saw a huge
opportunity t o take advantage of the phone the fact that people have it with them all the
time, the fact that it has powerful sensors that can aid and research and so we started
working on the ResearchKit .

Margaret Flinter: So of course some of your ground floor medic al research partners
then maybe the ki n ds of advances that you've seen by tapping into these larger pools of
research participants.

Jeff Williams: Maybe the best way to explain ResearchKit is to talk about a disease.
Let's talk about Parkinson's, Parkins on's a movement disorder it affects millions of
people. If you think about how you would study Parkinson's today you would have to
recruit patients, they have to come into the office, they have to have assessments from
doctors, and there i s problems with that. So we did something different, we took
advantage of the fact that there are powerful sensors on the phone. One of the prime
ways that you study Parkinson's is to have a patient walk in front of you and the doctor
assesses their gait im balance.

With ResearchKit you can use the accelerometer and the gyroscope on the phone and
a person can just do a walk test put the phone in their pocket and conduct a walk test
and they can do it anywhere not just in the doctor's office and so what this did is it
allowed people all over the United States and other parts of the world participate in the
study that in a prior process would have require them to go to a physical location and
now they can sign up, they can participate, they can do it multiple times a day, you get
much better data, and so what ended up happening when this app was released is
within 24 hours it became the largest Parkinson study in the history of the disease and
so what's even more interesting is as you pointed out we're already seeing insights
usually it takes a long time in these studies to see insigh ts and we're already seeing
cases where it's clear that the medication that people are taking is not helping their
symptoms.

Jeff Williams, Chief Operating Officer of Apple

We also believe that this app or some modification of it could ultimately diagnose
Parkinson's which is -- which is just powerful w hen you think of the democratization of
medicine. So we think the potential is huge. You know, another example is asthma,
Mount Sinai wanted to study what are the exacerbator s of asthma and Mount Sinai is
based in New York if they were doing the study in the traditional process they would
have had people around New York City. So with ResearchKit they launch an app and
people all over the United States now are sending information into the ResearchKit
study. The GPS on the phone tracks where the person is going, the Bluetooth inhalers
that they use for asthma record how often they're using their inhaler and so it's this
fascinating way that you can study in a broad population in getting these powerful
insights.

Mark Masselli: We're speaking today with Jef f Williams Chief Operating Officer of
Apple, overseeing the development of Apple Watch and thriving the company's health
initiatives including ResearchKit which is aimed at simplifying medical and health
research. Jeff there are approximately 50 million A mericans now utilizing some health
tracking wearable device and but statistic show that some of these devices tend to sort
of fall off. Tell our listeners how you envision the growth of the health sector within
Apple, what are you envision the future will look like from Apple's perspective?

Jeff Williams: We think Apple Watch marks the end of single function wrist devices in
the same way the iPhone mark the end of single function cell phones. The fact that you
interact throughout the day with your Apple W atch for communications and payment
and scheduling so we're just at the beginning of this. We don’t as I mentioned really
think in terms of segments and markets, we think in terms of what do people want and
I'm a strong believer that people want to be mor e active participants in their health.
Physicians will tell you that having the consumer engage in their own health will have
more impact than any medicine they can give them and we think we have a huge
opportunity to help do that.

Margaret Flinter: Well Jeff when you think about global health in the world's
underserved population give us a little bit of an insight or understanding of how scalable
is this technology in advancing global health research and improving global health and
how are you going to b ring this to bear maybe in some of the third world markets?

Jeff Williams: Yeah I think that's one of the things that interest us most in Apple. We're
big believers in the democratization potential of this. The injustice of fantastic health
care availab le in some parts in the world and others suffering needlessly and so I'll give
you an example. One of my favorite ResearchKit study apps is on autism and the early
detection of autism. The goal of the study is to determine whether you can use a cell
phon e to detect autism at an early age, and when they first approach me I thought does
it really make a difference just labeling a child early and it turns out it really does

Jeff Williams, Chief Operating Officer of Apple

because there are interventions but you need to do these interventions while the brai n's
developing and if you -- you wait till a child is five or six or seven years old it's too late.

The average age of diagnosis in the US is about six years and so in other countries it's
even later than that and so the concept here is put the child your lap, you play a little
video on the phone and the front face in camera actually watches the child's face the
special recognition and looks for how the child response to the video, and they believe
with a high degree of certainty that they can detect autism and so not only could you do
the diagnosis and screening the interventions are largely activities that you would do to
help develop the brain and you can actually deliver the therapy and treatment over the
phone. In Africa what they told us is there are 55 people in all of Africa that are trained
specialist in autism to do this, for a population of over a billion and so the power of
taking smart phones into that region and having an impact on people's lives in terms of
their IQ and their social skills by intervening early on autism. That's the kind of thing
that makes us get up in the morning.

Margaret Flinter: Yeah.

Mark Masselli: Yeah and that's exciting morning. You have a pretty big portfolio at
Apple and liked you to just share a little of the wor k that you've been doing the company
social responsibilities initiatives not only here in United States but around the globe.

Jeff Williams: Yeah we're big believers that anybody involved in the process of working
on an Apple product they deserve to be tr eated with respect and dignity and we've really
decided that workers rights are human rights and we do a lot of work to make sure that
workers are protected and we are training workers on their rights, we've trained millions
of workers on their fundamental rights. We are bringing new levels of health and safety
into regions and it go -- extends well beyond Apple. We set up universities to help
develop skills that train people on how to run safer factories and let me tell you no
company wants to talk about child labor, they don’t want to be associated with that.

We shine a light on it, we go out and search for cases where an underage worker is
found in a factory somewhere and then we take drastic actions with the supplier, the
upstream labor groups to try t o make change and then we report it publicly every year
and we take a lot of heat for that but we think the only way we're going to make changes
to go hit ahead on and talk about it. So we're doing a lot of work in the space, we post
that on our web I don ’t know that a lot of people read it but if you go there you'll see a lot
of information about what we're doing and I couldn’t be happier.

Margaret Flinter: Great. Well we've been speaking today with Jeff Williams Chief
Operating Officer of Apple. You c an learn more about their work by going to Apple.com
or follow them on Twitter @Apple. Jeff, thank you so much for joining us today on
Conversations on Health Care .

Jeff Williams, Chief Operating Officer of Apple

Jeff Williams: Thanks it was a pleasure to be with you.

[Music]

Mark Masselli: At Conver sations on Health Care we want our audience to be truly in the
know when it comes to the facts about health care reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org a nonpartisan,
nonprofit consumer advoca te for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: Hillary Clinton made a shaky claim about cost shifting in the December
democratic debate. She said that private insurance pr emiums have gone up in some
states that didn’t expand Medicaid because hospitals shifted their cost for providing
emergency care for the uninsured but we found no data to support that claim and the
idea that such cost shifting occurs is debated among exper ts. Clinton describe the
controversial concept of cost shifting the idea that hospitals charge higher rate to those
with private insurance to cover uncompensated cost for caring for the uninsured. The
federal government does provide some payments to hosp itals that treat low income
patient but they aren't enough to cover all of the uncompensated care cost.

Some researcher say this cost shifting occurs and other say it doesn’t but we could find
no research that shows cost shifting has led to increased priva te premiums in states
that didn’t expand Medicaid compared with states that did. It is the case however that
uncompensated care cost are higher in non - expansion states than they could have
been if those states has expanded Medicaid but it's still not clea r that hospitals would
shift that cost on to private insurers. A 2010 review of the available literature
determines that cost shifting does occur but at a low rate and in urban institute analysis
in 2014 found limited evidence to show an increase in the u ninsured led hospitals to
charge the privately insured more, and that's my fact check for this week I'm Lori
Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political pl ayers and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conver sations on Health Care .

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Cancer research could be long
laborious frustrating isolating and often when research breakth roughs in treatment or
pathology occur they remain in trends within their respective institutions for far too long
before being shared with a broader clinical populations. Researchers at the University
Of Pittsburg School Of Medicine have launched a progr am to address that research

Jeff Williams, Chief Operating Officer of Apple

fragmentation. They've created a new system that facilitates data and bio specimen
sharing among cancer centers that may significantly speak cancer research findings
from the laboratory to patient care.

Dr. Rebecca Jacobson: Yo u know, one of the major problems is that the data is very
siloed and information system and the data that is probably the most relevant especially
when you're interested in sharing and using bio materials. The data that's most relevant
is often in text. So not only is it locked away sort of within a vendor clinical system but
it's also in a lot of ways locked away in the text.

Mark Masselli: Dr. Rebecca Jacobson Professor of Biomedical Informatics at Pitt
School of Medicine and Chief Information Officer at the Institute for Personalize
Medicine says the system they've created the TIES Cancer Research Network or TCRN
was built upon their development of an advance data texting system that can easily
share a complex research data across a broad spectrum of users. With the TCRN they
can now aggregate and access data and biomaterials across multiple institutions.

Dr. Rebecca Jacobson: Our software is combined with the legal agreements, the
procedures that enable individual researchers at different institutio n to be able to access
data across the network and once they know that they have a sufficient number of
cases then they can use the policies and processes that we've set up to be able to get a
set of biomaterials from those institute.

Mark Masselli: They already have a number of partners connected through their TCRN
federation of cancer hospitals and are hoping to significantly expand their research
scope to many more partners. The TIES Cancer Research Network linking cancer
researchers on a new sort of d ata and biomaterial sharing super highway aimed at
getting researchers the breakthrough information they need to accelerate the path to
cures. Now that's a bright idea.

[Music]

Margaret Flinter: This is Conversations on Health Care , I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Conversations on Health Care , broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.