Gradually, then suddenly

In Hemingway's The Sun Also Rises, Bill asks Mike how he went bankrupt. “Two ways,” Mike says. “Gradually and then suddenly.”

I keep coming back to that line when I look at wearables this September.

The gradual part took about a decade, mostly unnoticed. The watch counted steps, then learned to flag an irregular heart rhythm. The ring scored our sleep. The strap told athletes whether to train hard or rest. The whole category sat in the fitness-gadget drawer, something clinicians nodded at politely when a patient held up a wrist.

The suddenly part

Then came a September that rewrote the category's job description.

On 8 September, an EU filing revealed that Apple had quietly bought Sonera, a California startup building a chip that measures the magnetic fields produced by nerve and muscle activity, with no need for direct skin contact. The next day, Apple announced a redesigned Health app with a Health Age score and a $119 lab panel of more than 50 biomarkers that US users will be able to book and pay for in the app, with the blood drawn at one of roughly 2,000 Quest Diagnostics sites. On 22 September, Bloomberg reported that Apple has prototyped a screenless band to take on Whoop, though it is still weighing the project and would not ship before 2028.

Oura, meanwhile, started its IPO roadshow on 21 September at a fully diluted valuation of up to $15.6 billion. Its five million paying members wear the ring a median of 23 hours a day, Dexcom's Stelo glucose sensor already feeds into the app, and Eli Lilly, which works with Oura inside its LillyDirect channel, indicated it may buy up to $100 million of shares. Two days later, the women's health platform Xella plugged Oura data into its multi-omic lab testing, so its physicians can read a woman's sleep, temperature and cycle trends next to her blood results.

Read those together and the wearable starts to look like the front door to the lab, the pharmacy and the doctor.

Nobody decided that wearables would become healthcare infrastructure. The companies behind them simply kept adding connections until those connections added up to a care pathway.

Where would Apple put a sensor you don't have to touch?

The Sonera deal is the piece I'm most intrigued by, because it hints that the next health sensor may not be something you wear at all.

Sonera's own pitch was to make brain activity as easy to measure as heart rate or temperature. The caveat: the body's magnetic signals are faint and fade quickly with distance, so “no skin contact” probably means centimetres, not across the living room. Nobody outside Apple knows what it plans. But spend a minute on where Apple devices already sit within centimetres of you, for hours every day:

• The MacBook palm rest, under your wrists all day, picking up fatigue or a tremor before you notice it
• The iPad propped on the kitchen table, or in an older parent's lap during a video call
• AirPods, already resting against your head, the obvious home for brain signals
• A HomePod or bedside device that could follow a night's sleep without asking you to wear anything

Put that next to the Whoop-style band and a direction appears. Apple seems to be exploring how to measure you while asking less and less of you: no screen to check and, eventually, perhaps nothing to put on. That's when monitoring becomes ambient, and consent gets much harder than a toggle in the settings. TechCrunch already argued this month that Apple's new audio features are normalising technology that is always listening. A laptop that reads your nervous system would take that debate somewhere far more intimate.

Who is in the room

Map the stakeholders and the imbalance is hard to miss.

Consumers are voting with their wrists: 23 hours of daily wear is adherence most chronic-care programmes can only dream of. Tech platforms hold the sensor and the app, and Apple is adding the lab order. Pharma is buying in directly, as Lilly's IPO interest shows. Physicians are interested but mostly outside the loop: in an AMA and Medscape survey of more than 2,200 doctors across six countries, no more than 6% in any country said wearable data was fully integrated into their clinical workflow. And payers are still debating reimbursement codes while the care pathway ships in a software update.

In Belgium, where I live, you can't order that $119 panel from your phone. You can buy a private blood test without a prescription, but it sits outside the health system, and the reimbursed route still starts with the GP. That feels like protection today. It may look like wasted lead time once a European version arrives with regulatory approval and a nicer app than anything our health system has built.

That's the “suddenly” moment for health systems. The wearable companies spent ten years building the habit, the data and the user experience. The connections to labs, pharma and physicians are now arriving all at once.

So here's a small exercise for this week. Picture a patient walking into your practice or hospital on Monday with a Health Age, a readiness score and a self-ordered panel of 50 biomarkers on their phone. Who in your organisation owns the follow-up? And what would it take to welcome that data instead of shrugging at it? If nobody can answer, you've found your first project.

If you follow the longevity side of this shift, from Health Age to biomarker panels, the longevity event calendar is where these conversations happen in person.

💥 May this inspire you to spot what's changing gradually in your own sector, before it changes suddenly.