The Apple Watch – Tipping Point Time for Healthcare

(steveblank.com)

209 points | by kulu2002 2010 days ago

18 comments

  • brandonb 2010 days ago
    If you're an engineer who wants to make the vision Steve paints into a reality--but for everybody, not just for Apple Watch owners--I'd love to talk with you.

    I'm a co-founder at Cardiogram. In multiple N=14,011 studies with UCSF Cardiology, we've shown that heart rate sensors on consumer wearables can detect multiple major health conditions like sleep apnea, hypertension, diabetes, and atrial fibrillation (https://cardiogr.am/research). These conditions affect more than one billion people worldwide, and are frequently undiagnosed -- for example, more than 80% of people with sleep apnea don't know they have it.

    We're live on iOS and Android, and we could use help in several areas: mobile and frontend engineering, senior machine learning engineers, and payer relations (the reimbursement from health insurers that Steve talks about). If that sounds like you, please email me at brandon@cardiogr.am!

    • jasode 2010 days ago
      > heart rate sensors on consumer wearables can detect multiple major health conditions

      It sounds so logical and inevitable where this technology is heading for health care. Over 10 years ago, I paid $1200 to wear a Holter monitor[1] for 24 hours.

      In contrast, a consumer wearable like Apple Watch is $399. Arguably, the Holter monitor fee also included the doctor's time to read the ECG recording. But it also seems like a lot of the rudimentary analysis of heart data from wearables will be done in the cloud with machine learning. Hence, the price of basic diagnosis goes way down.

      With the increasing aging population in USA, Europe, and Japan that will want to stay on top of medical issues, it seems like a big business opportunity. A bunch of players are going to compete in this space. Good luck to you!

      [1] link for those not familiar with the device: https://www.google.com/search?q=holter+monitor

      • JshWright 2010 days ago
        You're never going to diagnose something based on a watch (or other consumer focused wearable). The watch is just telling you that you should go talk to your doctor (so they can get you on a real cardiac monitor and get the level of information needed to make a diagnosis). Consumer wearables aren't going to be replacing Holter monitors.

        EDIT: A lot of folks seem to be interpreting my comment as implying there is no value in this technology. That is absolutely not the case. There is huge value in widely deployed screening like this (especially since it looks like the specificity is quite high). My point is that these devices will not be replacing diagnostic equipment (in fact, it may very well increase its use as more conditions that would otherwise have gone undetected will now be flagged for further diagnostic testing).

        • GeekyBear 2010 days ago
          There is value attached to having a device that monitors over the long haul.

          A tech journalist who was diagnosed with afib after taking part in the Apple Watch heart study reported that he had undergone traditional EKGs more than once without a problem being detected.

          >It's not the kind of thing that comes up in an EKG unless it is actually happening when the test is occurring. I've had EKGs a number of times, and there was never any indication anything was wrong.

          I've even had heart tests as a precondition for having bariatric surgery four years ago, and been under general anesthesia, with no adverse results of any kind.

          https://www.zdnet.com/article/how-apple-watch-saved-my-life/

          • JshWright 2010 days ago
            There's definitely value. I'm not disagreeing with that.

            The tech journalist in question still underwent more testing after the watch alerted them to make the actual diagnosis. The watch is a great screening tool, but it's not a replacement for more complete diagnostic tests.

            • someguydave 2009 days ago
              Another point most folks seem to be missing: even if you are screened early by one of these devices, it's not at all obvious that subsequent early treatment will deliver extra benefit. It's even less obvious that the extra benefit of early screening and treatment will outweigh the high false positive (and therefore possible overtreatment) costs.
              • GeekyBear 2009 days ago
                One of the major worries with untreated Afib is that it will trigger blood clots that cause strokes. (Not to mention other possible side effects of not treating the condition)

                Modern cardiac event monitors that the patient tapes onto their own chest, wears for a period of time, and then mails back in for analysis are so much cheaper than treating a stroke that it tilts the playing field.

                Many people have mentioned a Holter monitor, but those are not only more expensive, but would be overkill as a first step in seeing if there is a real issue.

                Here's a comparison between a Holter monitor and one brand of a more modern cardiac event monitor.

                https://www.medgadget.com/2014/01/zio-wireless-patch-may-be-...

            • GeekyBear 2010 days ago
              Agreed. Doctors are very conservative and would insist on verifying the data with a cardiac event monitor.

              However it's also true that the more comprehensive tests he had previously undergone didn't spot the problem.

              Since we're trying to spot an intermittent issue, the quantity of data was more important than the quality of the data.

        • coder543 2010 days ago
          The Apple Watch can perform an FDA-cleared diagnosis of certain forms of Atrial Fibrillation, and if what they showed on stage is to be believed, it can produce a really clear ECG that's also FDA-cleared. Just because you're redirected to a doctor doesn't mean the watch did nothing, it just means the watch can't provide a complete patient care cycle. The condition is identified, now what? False-positives can happen even with current medical-grade technology. It's just a question of how the false-positive rate compares.

          "Never" is just such a strong word, given how quickly technology has advanced, and given how you don't seem to be aware of what exactly the new Apple Watch is supposed to be able to do.

          Do you work for a Holter-producing company or something?

          • dang 2010 days ago
            As DenisM points out below, you broke the site guidelines with that last bit. Please review https://news.ycombinator.com/newsguidelines.html and follow the rules when posting here.
          • JshWright 2010 days ago
            I am very aware of what the watch does. A doctor is not going to diagnose atrial fibrillation based on a single ECG lead. They are going to do a more complete ECG (either in-office, or with a Holter monitor style device at home).

            The watch absolutely plays an important role (it's a widely distributed, high SNR screening tool; that's definitely valuable), but it's not replacing more complete diagnostic tests.

            As a meta comment... I think it's good to avoid using "you" too much when replying to someone. Respond to what someone said, not assumptions about who they are, what they know, or what their motivations are. For whatever it's worth, I am a software developer and paramedic.

            • wrycoder 2010 days ago
              It sounds like there is an opportunity for a displayless device on the other wrist.
              • JshWright 2010 days ago
                And a wire running between them...?
                • wrycoder 2010 days ago
                  Bluetooth, I would think.
                  • JshWright 2010 days ago
                    They would need to be electrically connected (like the leads on a multimeter).
          • DenisM 2010 days ago
            >Do you work for a Holter-producing company or something?

            This is against the rules [1]:

            [...] Please don't impute astroturfing or shillage. That degrades discussion and is usually mistaken. If you're worried about it, email us and we'll look at the data. [...]

            [1] https://news.ycombinator.com/newsguidelines.html

            • coder543 2009 days ago
              Didn't realize, sorry. I was legitimately curious, because it was such an unusually hard-lined perspective to take in this discussion, one that they repeated in several very similar comments on this thread.
        • lostapathy 2010 days ago
          Even if they don't replace higher end gear, consumer devices will allow much better data to determine who needs to be hooked to a dedicated device. More people who need in depth can be brought in to do them, and less people who don't need it can avoid those tests.

          Even if the amount of uses for high end devices (Holter monitor or whatever) stays the same, consumer wearables should lead to that usage being allocated in a more productive way, which will bring don't costs and improve outcomes.

        • matheusmoreira 2010 days ago
          I agree. I've seen some electrocardiogram peripherals for phones and they apparently only support lead II. Ability to instantly start recording a long II anywhere anytime is awesome but it is not a complete electrocardiogram.
          • JshWright 2010 days ago
            It's lead I (accross the top of the heart). For lead II you would need an electrode on the left leg.
    • rootusrootus 2010 days ago
      Ever thought about opening an office in Portland? :-)

      I don't have any real desire to move to SF but I do miss the fact that a lot of the cool jobs only happen down there. Ah well.

      • brandonb 2010 days ago
        I'd love to open a second office one day. I'm from Seattle and my co-founder is from Vancouver, so the Pacific Northwest is a natural choice. Right now we're 10 people, so a second office isn't imminent, but we're definitely aware that not everybody can live or wants to live in the bay area.
    • agumonkey 2010 days ago
      I need a list of seriously precise devices that are below 200$. By ~seriously I mean something I could rely medically and not a tiny wrist watch that will have too much noise / jitter to be useful. It's for family members (including me).

      thanks

      • brandonb 2010 days ago
        For sub-$200 price range, I'd suggest some of the less expensive Garmin models (which Cardiogram is currently compatible with) or the Fitbit Charge HR 3 (which we'll hopefully be compatible with in the future).
    • avgDev 2010 days ago
      Is there any interest in developing software to help arrive at a diagnosis? As that would somewhat overlap with the ability to track users vitals.

      I suffer from chronic pain, and doctors are seriously unreliable when it comes to diagnosing something relatively complex, even though the research is there and has been available for many years.

      I would be interested in joining a project that would become a tool that helps diagnose complex conditions, or at least provide a path for diagnosis.

    • monkmartinez 2010 days ago
      What kind of stack are you currently developing in?
      • brandonb 2010 days ago
        For the Cardiogram app, most of the UI is developed in React, Redux, and D3 (for interactive charts). For functionality that needs to be native--for example, integrating with the Health app or Google Fit--we use Swift (for both iOS and watchOS) or Java (for both Android and WearOS by Google, which is itself based on Android).

        The backend is written in Node with PostgreSQL as the database. Since it's a large dataset (terabytes), we rely quite a bit on PostgreSQL 10's partitioning feature for our larger tables: https://www.postgresql.org/docs/10/static/ddl-partitioning.h...

        The machine learning code is written in Python, using Keras, TensorFlow, Pandas, scikit-learn, statsmodels. Our AAAI-2018 paper has a bit more info on how DeepHeart (our deep neural network) works. We also do feature engineering and traditional machine learning models when appropriate: https://www.aaai.org/ocs/index.php/AAAI/AAAI18/paper/view/16...

    • toomuchtodo 2010 days ago
      Thanks for your work! I bought an Apple Watch primarily to use with Cardiogram.
      • brandonb 2010 days ago
        Thanks for using it, and for the kind words!
    • DenisM 2010 days ago
      Your web site doesn't have a page about hiring, and I could not determine where your offices are located.
      • brandonb 2010 days ago
        Good point. We're in San Francisco, and yeah, we should add a hiring page. :)
    • dmead 2010 days ago
      I'm an engineer and i have valve disease. whats up.
  • mikekij 2010 days ago
    Medical device engineer / founder here. I'd love for the Apple Watch to fulfill Steve Blank's aims here, but there are very real clinical problems that don't automatically go away because Apple is great at industrial and UI design. The false positive risk with their a-fib detection will cause thousands of patients to ask their healthcare providers for further tests, only to find out they were fine. This isn't unlike the issue where iPhones have been inundating 911 call centers with unintentional "butt dials".

    This doesn't mean that Apple won't be successful in healthcare. It's just that the main challenge isn't in creating a nicer product. The challenge is in showing a net positive impact on patient outcomes.

    • bluGill 2010 days ago
      False positives are not really an issue. Last I heard 60% of chest pain cases ERs see are false positives (constipation or something like that doesn't require ER care). However it is sometimes the only symptom you get of real medical emergencies so you go to the ER anyway.

      There are also a number of people who die of heart attacks with no symptoms. If Apple can get even 1% of them to the ER that would be a huge win. If the false positive rate is 80% that is still enough real positives that ERs will be get used to telling people "This time it is nothing, but it is good you came in anyway because sometimes this is all the warning you get".

      The real worry is false negatives - someone who has chest pain and decides not to go because the watch says all is okay. These people will die when a hospital could save them.

      • d0mine 2010 days ago
        the time and other resources doctors spend on healthy people is the time and resources that are not spent on sick people. There is a useful number -- NNT that may help you understand how harmful the watch might be. https://www.ted.com/talks/daniel_levitin_how_to_stay_calm_wh...

        False positives are not harmless http://theconversation.com/routine-mammograms-do-not-save-li...

      • c-slice 2010 days ago
        There are big concerns about both false positives and false negatives. The one lead ECG in the apple watch will very likely only detect afib. one lead ECG's are not diagnostic for heart attacks or any other cardiovascular disease. If you're having a heart attack and your Apple watch says you don't have a-fib, that would be a big concern.
      • monkmartinez 2010 days ago
        The exploding ER / EMS system would like to have a word with you! Every niggle or discomfort, it seems, can generate a 911 call and a visit to the ER. Legally, EMS can not diagnose in the field so we send the bulk of people that call 911 into the ER for further evaluation... whether they really need it or not. I can tell you that most don't.
        • bluGill 2010 days ago
          There is a reason discomfort can generate a 911 call. I have known people who ignored a discomfort and died a few hours latter. If they had called 911 they would have lived.
        • BRAlNlAC 2010 days ago
          counterpoint. The healthcare system pushes people into emergency medicine for non-emergencies. About 10 years ago when I was in high school I got a cut on my chin that required stitches, my mom got an urgent appointment with my PCP later that day–who then told me to go the ER, saying, "we don't even have a suture in this clinic" We were trying to save time, money and not burden the system, and instead shot ourselves in the foot.
          • nradov 2010 days ago
            The healthcare system, or at least the insurance side of it, actively tries to push patients to urgent care clinics instead of ERs for that type of problem. Most health plans have a phone number where you can call a nurse to ask whether you should go to the ER or not.

            And the vast majority of primary care clinics do have sutures in stock.

      • JshWright 2010 days ago
        > There are also a number of people who die of heart attacks with no symptoms. If Apple can get even 1% of them to the ER that would be a huge win.

        The Apple Watch cannot detect heart attacks.

        • reaperducer 2010 days ago
          Six months ago, the Apple Watch couldn't detect a-fib.
          • JshWright 2010 days ago
            A "heart attack" is the common term for a condition where part of the heart isn't receiving blood flow, and the tissue there is starting to be starved of oxygen (an infarction). That will show up on an ECG as elevation of a certain part of the tracing (the "ST" segment, between when the main part of the heart contracts and when it "resets"). In order to be clinically significant, you need to see that elevation in at least two adjacent leads, and each lead is only looking at a narrow "slice" of the heart, so you need several of them to be sure you're seeing the part that's involved (it's not at all uncommon for a heart attack to only show up on 2-3 leads (out of 12 on a typical ECG)).

            A watch cannot provide more than one lead (and the lead it does provide is really useless for detecting ST elevation, since it's a view across the "top" of the heart, which is not an area that will be involved in the infarction). It is not physically possible to detect a a heart attack from a watch.

            If you had asked me six months ago if a watch could detect atrial fibrillation, my answer would have been "sure, why not?". Just because one thing is possible with the advancement of technology, it doesn't mean all things are possible...

            • breckuh 2010 days ago
              In 2020 alone we will collect more high-dimensional health data than from the beginning of history to the present day combined. Given the improving sensors on the wrist generating high-dimensional data (heart beat, ecg, perspiration, blood oxygen, motion, vibration, body temperature, etc), and a sample size of 100M+ people, is it not possible that there is some previously unknown signal in there that could be detected by deep learning?

              I'm not saying there is, I just wonder if heart attacks might cause some discernible but very complex pattern visible in high-dimensional data that we haven't discovered yet, or if there is just too much physical distance between the wrist and heart to drown out all signal.

              • someguydave 2009 days ago
                I donno, I'm an electrical (non-medical) engineer and I think I would wager on the "false positive costs outweigh the new screening benefits" side.
            • Steko 2010 days ago
              Currently can't do it but saying it'll never be possible seems like you're setting yourself up to get burned by deep learning.
              • JshWright 2010 days ago
                I've got a fair bit of domain knowledge and experience (in both the medical and software engineering aspects of this topic). I'm pretty comfortable taking that "risk".
                • Steko 2010 days ago
                  Here's a more in depth argument of why maybe you shouldn't be:

                  https://www.reddit.com/r/apple/comments/9fkb3t/im_an_emergen...

                  "Medical grade" is hard to define, but you might actually be very surprised by how accurate this simple sensor could be in an era of deep learning AI.

                  Earlier this year, there was a paper published at AAAI (https://arxiv.org/pdf/1802.02511.pdf) that found that just using the sparse, noisy data from the AW sensors (non-continuous, noisy heart rate measurements and a handful of HRV estimates every day), they could diagnose diabetes, high cholesterol, high blood pressure, and sleep apnea with relatively high accuracy.

                  In fact, the diabetes diagnoses were comparable in accuracy to cheap lab tests specifically for diabetes. And even more surprisingly, the sleep apnea diagnoses could be made even if one doesn't wear the watch during sleep.

                  There are other recent papers showing extremely good accuracy in detecting rhythm abnormalities.

                  Deep learning can often magnify the power of cheap, simple sensors in ways that can in many cases seem unimaginable. Partly because of the power of multi-dimensional inference, and partly because the volume of data you get from wearing a device 24/7 helps to compensate for all the noise and sparsity.

                  And that was with the current gen AW sensors, which now are a generation behind some other consumer devices -- I'm sure the AW4 catches up (and can likely gather data like continuous HRV). Add in another data point like ECG, even if it's the simplest possible form of ECG, and I wouldn't be surprised if the diagnostic accuracy for many conditions is higher than some lab tests. Especially for transient rhythm abnormalities like transient afib, which might show up late at night after drinking, but not occur during a lab test, which probably makes detecting transient afib hard in a lab until a lot of cardiac changes have occurred.

                  Commenter /y/AlanYx continues in grandchild:

                  Yup. Humans also have difficulty thinking and reasoning multi-dimensionally, especially with conditional probabilities across those dimensions. So while the watch probably can't apply the "simplistic fill-in-the-blank style" of reading EKGs taught in the Dubin book that someone recommended above (because the sensors are just too simplistic and the data collected too limited), deep learning can see through the data in ways people often can't.

                  There's a good example of this in the DeepHeart paper I linked to -- the authors mention that no diagnostically predictive relationship between heart rate patterns during waking hours and sleep apnea was known prior to the work, likely because it is too complex to spot by just looking at heart rate graphs in the way humans do. (And in fact because a convolutional neural network is used, it's not easy right now to tease out in an explainable way to humans exactly what the computer is "seeing", although its specificity and sensitivity characteristics are known.)

                  • JshWright 2009 days ago
                    All of the diseases mentioned (diabetes, high cholesterol, high blood pressure, and sleep apnea) are chronic conditions, and ideal candidates for the "gather a bunch of data over a large time window and see what we can see" approach.

                    A heart attack is a very acute condition, and doesn't give you the same luxury of looking at things over time. You have to get it right, and you only have one shot at it. When looking at chronic conditions you can built up a confidence over time, and only raise the alert when you're very sure. With a heart attack, you have a window of minutes, to an hour or two. False positives are much more of a risk in that case, and the cost of false positives is magnified significantly when a screening tool is widespread.

                    I may be mistaken, but you seem to be extrapolating my comment to mean that I don't think we will see continued expansion of screening tools built into various wearables. That's not true at all. I think it's quite obvious that this is an area where we will see significant growth over the coming decade.

                    That doesn't change my stance that heart attacks are categorically different, and much harder to detect from a sensor isolated on the wrist. I think the most promising path to doing that is detecting elevated troponin levels in the blood, and while there is some work being done on accomplishing that noninvasively, it's still a long way from being readily available.

            • gondo 2010 days ago
              what about a combination of devices? watch on a wrist, phone in a palm of another hand, AR glasses on a nose and side of a head, (going to the extreme) maybe some necklace or a ring
              • JshWright 2010 days ago
                They would need to be electrically connected. Are you going to run wires between them?
                • lz400 2010 days ago
                  Couldn't they be connected wirelessly and send the electric signal they receive digitized?
                  • JshWright 2010 days ago
                    It works by comparing the voltage potential across two or more points (in the case of the watch it's comparing the right arm against the left)
      • thfuran 2010 days ago
        False positives absolutely are an issue. To be sure, they aren't as inherently dangerous as false negatives, but false positives can still waste time and money. And depending on what the followup for a false positive is, they may carry actual health risks as well.
      • mikekij 2010 days ago
        Great point. I should have focused on false negatives in my original comment to make my point. Thank you!
    • ascagnel_ 2010 days ago
      AFib detection will only be reported if it's detected six times, to reduce the impact of false positives.

      https://twitter.com/benbajarin/status/1040018930637520896

      • mikekij 2010 days ago
        This is good to know! I'm still genuinely curious how many false positives this leads to.
        • MBCook 2010 days ago
          It will be interesting to see, but they ran that study for year and a half or more (listed in article) collecting data based on the old watch is probably to try to see how well they could detect afib just from the heart rate sensor.

          Apple is a big rich company, but I imagine their lawyers wanted to make sure they were REALLY sure they weren’t about to screw themselves over with tens of thousands of lawsuits, above and beyond the FDA requirements.

          • monkmartinez 2010 days ago
            You sure do put a lot a faith into a $500 watch. I routinely see $40000 cardiac monitors spit out false positives Ie. actute MI or Afib with RvR on healthy patients in the field.
            • MBCook 2010 days ago
              It’s not supposed to be in the same category. That’s why doesn’t worry me. All they have to do is not generate too many false positives and maybe help a few people out.

              It certainly not designed to replace a REAL device at a doctors office/hospital for diagnostic purposes.

            • Arn_Thor 2010 days ago
              And this watch is not supposed to be perfect, nor replace medical devices. If it works well it will be an added benefit to the user, and could alert users about heart issues (and has done so!)
        • nomel 2010 days ago
          I think the ratio of true to false positives is vastly more interesting and an indicator for how well the technology is performing and if the burden is reasonable or not.
    • ska 2010 days ago
      Working in the industry you already know this but FP vs TP rates are a fundamental issue in nearly any system like this (i.e. non diagnostic). You typically can’t get rid of them, so the trick is to balance it in such a way for net positive benefit as you note. This may mean some unneeded visits, balanced by more needed interventions that would otherwise be missed.

      Apple Watch isn’t really any different here, except potentially in scale. While that does mean potential impact is large, there is no a priori reason to assume apple has got it wrong; it’s not that difficult to find the right people for this sort of project.

      It would be very interesting to see an ROC curve ...

    • walkingolof 2010 days ago
      John Mandrola, a cardiac electrophysiologist have some interesting insights on the Apple Watch

      http://www.drjohnm.org/2018/09/thoughts-on-the-apple-watch/

    • oflannabhra 2010 days ago
      > The question is are they are going to create millions of unnecessary doctors’ visits from unnecessarily concerned users or are they going to save thousands of lives? My bet is both – until traditional healthcare catches up with the fact that in the next decade screening devices will be in everyone’s hands (or wrists.)
      • mikekij 2010 days ago
        True! But a similar debate has played out in the mammography space. While routine mammograms have undoubtedly saved thousands of lives, some researchers have concluded that the complications caused by false positives (e.g. infections after a biopsy) may make the net contribution of routine mammograms negative. In other words, any individual is more likely to be harmed by routine mammograms than helped.

        I'm not saying that the healthcare features in the new Apple Watch are bad; just that it will be interesting to see what their net contribution to healthcare will be.

        • JProthero 2010 days ago
          Isn't there a meaningful difference in this case between the consequences of false positives from routine mammograms, or, say PSA testing, compared to detecting Atrial Fibrillation?

          False positives will always cause undue distress, and that's a factor worth considering, but the consequences of a false positive from a mammogram or PSA test could be an invasive biopsy, as you point out, or even unnecessary treatment. Wouldn't the consequences of a false positive AF detection typically be much less serious though, such as some additional non-invasive tests? There's a financial and psychological cost to that, but is it really comparable to a false positive indication for cancer, which would be much more difficult to follow up, especially weighed against the benefits of detecting undiagnosed conditions?

          When I saw the product launch I shared your concerns about emergency services being inundated with calls from watches detecting falls, but apparently the chief executive of the US National Emergency Number Association isn't concerned. He said this about it:

          “These are the real beginnings of exciting innovation. I don’t see, at least initially, an overwhelming number of false positives coming in. But only time will tell.”

          https://www.bbc.com/news/technology-45518040

        • oflannabhra 2010 days ago
          In your example, what is the measure for determining that routine mammography is net-negative? By what measure is "any individual more likely to be harmed" determined?

          I totally understand the caution medical boards use when crafting their recommendations. However, I don't think consumer access to medical screening equipment is similar. In fact, I think that empowering consumers and patients to be more in control of their medical decisions is vastly net-positive, and as the article points out, the healthcare industry is going to need to adapt to it.

          • DanBC 2010 days ago
            > By what measure is "any individual more likely to be harmed" determined?

            Do mammograms detect cancer? Yes.

            Do mammograms lead to reductions in all cause mortality? Probably not, no.

            There's a bunch of stuff where we use proxy measures when we should be using different measures (all cause mortality; days lost to disability; QALYs).

            > However, I don't think consumer access to medical screening equipment is similar. In fact, I think that empowering consumers and patients to be more in control of their medical decisions is vastly net-positive, and as the article points out, the healthcare industry is going to need to adapt to it.

            You get a scan. It shows a lump. What do you do? Most people say "get a biopsy", which is ok if we're saving lives or reducing days lost to disability, but if we're not doing those and we're causing harm then giving power to people really just means hurting them.

            Here's a nice infographic: https://twitter.com/Jia_Luo/status/951985691772293120

            18 deaths vs 21 deaths, and that's important, but look at the extra harm caused.

    • ghaff 2010 days ago
      >where iPhones have been inundating 911 call centers with unintentional "butt dials".

      This happened to me just a few months ago. I'm sitting in the passenger's seat of a car and, out of the blue, I get a call from a weird Caller ID which, of course, I hang up on. I get another call, this time from a regular looking number in the local area code. I reluctantly answer it (in spite of my friend driving telling me to hang up) and it's nearby emergency services. I'm of course totally confused and ended up hanging up on them when they start asking my name etc.

      It turns out there's a setting you can change to make this harder to do by accident but I had no idea until I looked it up.

    • netwanderer2 2010 days ago
      Has anyone actually had a chance to try this feature on the Apple Watch 4? All the demo videos so far keep saying the feature is coming but no one actually has used it yet. I'm curious in how frequent it produces false positive results and in what types of situations or activities.

      Having said that, I love the direction Apple is taking with this product. Smart watches have been on the market for quite a number of years now but they're pretty much restricted to being gimmicky devices only as most people don't find it very useful or have a real need for it. If Apple could achieve the breakthrough in blood glucose monitoring feature then I strongly believe we will see mass adoption in very near future.

    • debt 2010 days ago
      Not to mention the health angle requires Apple lock down the device even further to stay HIPPA compliant; to keep from prying eyes. Apple has pit the FDA against the FBI.
      • nradov 2010 days ago
        Nothing in HIPAA would require Apple to lock down the device in ways that would inhibit the FBI. Those are entirely separate issues. For example, a key escrow scheme (which I don't support) could still be fully HIPAA compliant.
    • visarga 2010 days ago
      > iPhones have been inundating 911 call centers with unintentional "butt dials"

      Because they fill that lock screen with junk making it a butt dial magnet.

    • killjoywashere 2010 days ago
      As a pathologist I worry less about false positives and a lot more about false negatives.
    • soperj 2010 days ago
      >Apple is great at industrial and UI design

      This is no longer the case.

  • chrisBob 2010 days ago
    I have signed up for, but not yet started a study at University of Michigan that is giving out apple watches and blood pressure monitors as part of a health study. Apple Inc is listed as a sponsor that will have access to all of the data. Among other things they are collecting blood samples and survey data. It has a concentrated period of 45 days of data collection, but goes on for 3 years. I am slightly concerned about the privacy issues, but I decided its worth it to see what they can come up with.

    The study that I am joining "MIPACT" is not well publicized, and I only heard about it through a friend at work. I wonder how many similar projects they are supporting around the country.

  • kendallpark 2010 days ago
    Pardon my cynicism, but it strikes me either as naivety or fanboy-ism to label the Apple Watch as the "tipping point" for healthcare tech. Wearables for consumer health that touch on actual healthcare in a few areas are a pretty low hanging, low yield fruit if you want to talk about 'disrupting' the industry. Maybe I'll eat my words in a few years when wearables somehow force EHR systems to be interoperable or tackle some of the other massive issues in healthcare tech. I doubt it, though.

    This is nothing against the Watch tech itself. There's probably a lot of cool applications for that tech. I just don't think Apple's advancement of wearables is monumental to the healthcare industry, or potentially disruptive.

    > The FDA – Running Hard to Keep Up With Disruption

    Honestly, I don't really know what he's talking about with this 'disruption.' Just because the FDA is trying to keep pace with all the tech being built by health tech startups, it doesn't mean anything is getting disrupted. I have yet to see what I would consider a disruptive technology sweeping over the healthcare industry.

    • gwbas1c 2010 days ago
      The point will come when not regularly wearing one of these devices is considered hazardous to one's health... And this point will probably come before self-driving cars.

      Some examples:

      I always wondered why I had a lot of trouble sleeping. Doctors laughed at me, until an orthodontist told me I should get checked for sleep apnea. Turns out I had very severe sleep apnea. I would have like this diagnosed much sooner in my life.

      My Dad had afib, had it been diagnosed sooner, his surgery wouldn't have been a "get it done now" situation.

      Once the true positives outweigh the false positives, everyone's going to consider these essential for health. That moment will probably be in 2-5 years.

      • breckuh 2010 days ago
        > The point will come when not regularly wearing one of these devices is considered hazardous to one's health

        I 100% agree. I think we are on the cusp of the "cyborg" era, like it or not. Humans will wear health tracking devices at all times. Already 10M+ do, from basically 0 a decade ago.

        Personally the sleep tracking and heart rate data from wearing my bands since 2014 led me to a diagnosis and fix for a number of health issues.

        But the real promise lies ahead, as new and better sensors are engineered. In addition to helping with traditional health issues, devices will increasingly allow the conscious part of your mind to have real-time self-awareness of the biological factors going on that influence your thoughts and decisions and answer questions like these:

        - Did you say "no" to that thing because it was the right decision or because your blood glucose level was so low? - Was your high productivity level today a fluke or influenced by the high caffeine level in your system? - How "tired" are you really?

        Some people might not like it, but I don't know if they'll have a choice. Not taking advantage of these technologies would put them at a disadvantage in school, work, sports, and perhaps all other areas in life.

        I think that moment is more like 10-20 years out, but otherwise agree with you.

    • pg_bot 2010 days ago
      Speaking as someone who owns a company that makes electronic health records, interoperability between systems is not the bottleneck that people in technology think it is. The time it takes to request and receive records on a patient is measured in days not minutes. Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself. (Why would I expect EPIC to be able to talk with Cerner if it can't even talk with itself)

      I think most doctors and patients would agree that getting information in a timely manner is more important than the mechanism by which it is transferred. While interoperability is something to strive for it's not the thing holding the system back.

      • kendallpark 2010 days ago
        > Often the larger EMRs aren't even interoperable with themselves, each deployment is an island unto itself.

        This is what I'm talking about. We're so far away from actual interoperability it's not even funny.

        > The time it takes to request and receive records on a patient is measured in days not minutes.

        Yup.

        > While interoperability is something to strive for it's not the thing holding the system back.

        Not sure I follow you. The siloed data seems to be a pain point for most docs. Patient is admitted for evaluation of X, Y, Z concerning symptoms. Patient was admitted to a different hospital a week ago for the same symptoms. Different hospital is on a different system, so I can't get the patient's history from that visit. Guess I need to have the records faxed over tomorrow morning. In the meantime, let me go order a bunch of tests that are probably totally redundant to what was run last week, but I can't get that data right now, so gotta run them again. Huh, that's a interesting x-ray. Wish I had the prior.

        • pg_bot 2010 days ago
          The problem is that the fax takes until tomorrow morning, not that it comes as a fax. You could get the information over the phone, carrier pigeon, or smoke signal it doesn't matter the mechanism. (the latter two are likely not HIPAA compliant) The systems could be completely interoperable, but you would still have the same bureaucracy that slows everything down.

          Just because the systems can talk to each other, it doesn't mean that I can just automatically grab whatever patient data whenever I want. There are rules and procedures you need to follow when dealing with PII. If you are cavalier with these systems you will be fined or sued into oblivion. Time until transfer of data is the hard part, which is independent of interoperability.

          There are bigger fish to be fried in this space, so if we are triaging healthcare technology I would put this low on my list of things to take care of.

          • kendallpark 2009 days ago
            > Just because the systems can talk to each other, it doesn't mean that I can just automatically grab whatever patient data whenever I want. There are rules and procedures you need to follow when dealing with PII.

            Yes.

            > Time until transfer of data is the hard part, which is independent of interoperability.

            This depends if you consider dealing with the human and/or legal factors as part of interoperability or not. If the technology exists but the regulations or human factors don't allow for timely communication between systems, the systems are not interoperable. When we talk about "implementation" of a system in healthcare, we're not just talking about the setting up the technology, but changing hospital procedure, training, getting it approved by various committees, navigating legal issues, etc.

            When we talk about 'disrupting' healthcare, most people don't realize that making a sexy piece of technology is the easiest part. FDA approval is effort-consuming and expensive, but plenty of health tech start ups and company initiatives have also done what Apple has done. And hence why I don't consider Apple's ability to get de novo 510k on a cool wearable 'disruptive' or a 'tipping point.' It could be influential on the consumer side of things, building a bridge between consumer health and healthcare. But how much does it touch the massive, unwieldy machine that is the healthcare system?

            > There are bigger fish to be fried in this space, so if we are triaging healthcare technology I would put this low on my list of things to take care of.

            No one is saying interoperability is the biggest fish. But it's a pretty damn big one. Perceived fish-size will likely vary from specialty to specialty, big urban hospital to rural clinic to private practice. What would you consider the bigger fish?

    • nradov 2010 days ago
      Today the primary driver for clinical systems interoperability is federal government regulations (Meaningful Use, HITECH Act, MACRA, etc) plus requirements from payers (insurers). Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs, but that's really for iPhone / iPad devices and not directly related to wearables.

      EHR vendors are actively working to enhance their applications to cope with new data streams coming in from consumer wearables as well as connected home healthcare devices such as smart scales and blood pressure monitors.

      • kendallpark 2010 days ago
        > Apple's support for HL7 FHIR has also been a positive influence in convincing more provider organizations to open up public APIs

        Is this actually the case? I haven't heard any talk of this at my institution, or on r/medicine.

        • nradov 2009 days ago
          Apple has signed up a number of prominent provider organizations but it's certainly not universal. Federal regulation will probably be necessary to get that data opened up everywhere.
  • post_break 2010 days ago
    I have to wonder if the subsidizing of the Apple watch is a huge push for healthcare on it. For instance I was able to get the Series 3 for $120 through my provider. Which is a hefty drop from $400. I can't get the same discount on the Samsung watch, or any other smart watch, which is ironic since my Samsung watch works on both Android and iOS and does health tracking as well.
    • graeme 2010 days ago
      Interesting. Is the Samsung watch less effective at heart health tracking, or does Apple just have better partnerships with insurers?
      • brandonb 2010 days ago
        For what it's worth, United Healthcare's Motion program supports Fitbit, Garmin, Samsung, Apple Watch, and more: https://www.mobihealthnews.com/content/unitedhealthcare-adds...

        UHC is the U.S.'s largest insurer, and they claim to have validation data that shows this program saves money.

        • awakeasleep 2010 days ago
          UHC's Motion program is an incentive program for higher value employees.

          It's more of a perk for the c-suite or law partners than a serious attempt to improve health.

      • breckuh 2010 days ago
        I recently was looking to see where Samsung watch's health team was in the U.S. As far as I could tell there isn't one. I could be wrong, but that would seem to be a disadvantage compared to Apple/FitBit/Garmin/etc, since the more health focused these apps get the more they'll have to work with the FDA, insurers, hospitals, etc.
      • post_break 2010 days ago
        They both use the same crappy way of reading heart rate through a camera so it can't be that drastic of a difference. My samsung watch tracks flights of stairs, heart bpm through out the day, nags about water just like the Apple watch, etc. Even has a samsung health app that lets you do a video call to an actual doctor who can send scripts for sickness.
        • Eric_WVGG 2010 days ago
          Crappy? I was seeing a physical therapist for a while, he'd strap a heart monitor around my chest and have me doing exercise. When I got my Watch, I’d sometimes compare the figures — they were never more than two BPM off.

          Maybe that's not precise enough for doctors, but "crappy"?

          • CedarMadness 2010 days ago
            The accuracy of an optical HRM varies a lot based on the person. Skin tone, muscle, bodyfat, and band tightness all play a part. Apple's implementation is one of the better ones, but they all have problems to some degree. Although I haven't used the new watch, the fact that they're advertising this functionality tells me that they're very confident they've worked out these issues.
          • post_break 2010 days ago
            Crappy might have been a bit too rough, I know that it varied a lot based on how dirty it got under the watch. Like when working out the readings went out the window compared to my chest strap. The ECG on the new watch seems like the best way to do it. And I'd add yes, if it's not precise enough for doctors, then it shouldn't be touted as something my health insurance foots the bill for.
            • bluGill 2010 days ago
              >if it's not precise enough for doctors, then it shouldn't be touted as something my health insurance foots the bill for.

              That isn't true. There are level of information. The information I need to decide if I need to see a doctor or not is much lower quality that the information my doctor needs to make a diagnosis.

              Health insurance should foot the bill if ultimately the data is good enough to get people to the doctor when the problem is small and easy to treat. If a 100 dollar device for everybody allows them to turn a few $200,000 dollar procedures into $10,000 treatments that will be a big win and they will. (note that the above two may or may not be related)

  • nradov 2010 days ago
    It's surprising that the Apple Watch still doesn't include an ANT+ radio receiver to gather data from dedicated heart rate monitors and other devices. Of course it's possible to use Bluetooth (BLE), but it's less efficient, less reliable, and not as well supported by third-party devices. I wonder why Apple left that feature out considering that most of their competitors have it and it doesn't cost much or really impact battery life?
    • mikestew 2010 days ago
      It's surprising that the Apple Watch still doesn't include an ANT+ radio receiver

      Most of their competitors? Garmin's latest watches won't even talk to an ANT scale anymore (well, there's $300 kinda wasted). Garmin still has their line of ANT+ accessories, though.

      Moreso, I view ANT+ as the protocol for the athlete that isn't going to be using an Apple Watch during their workouts. "Oh, your $600 Garmin power meter pedals don't work over BLE with your Apple Watch?", asks no one ever. There are BLE heart monitors, foot pods, and power meters if you absolutely must use your sensors with something Apple. No, it's probably the optimal solution, but it's the solution Apple's market will be happy with.

      • nradov 2010 days ago
        You'd be surprised how many athletes are wearing Apple watches now, either alone or along with other fitness trackers or bike computers. I see Apple watches more and more at races and on Strava activities.
  • clamprecht 2010 days ago
    I have a question about the Apple Watch's EKG/ECG feature, maybe someone can answer:

    I had a routine EKG last week for a pilot medical certificate. Before the EKG, the nurse rubbed a cold gel on my skin, at the places where she then placed the EKG contacts. I'm assuming this gel was to ensure good contact. If doctors have to rub this gel before an EKG, why doesn't the Apple Watch need this, to ensure good contact?

    • mikestew 2010 days ago
      If doctors have to rub this gel before an EKG, why doesn't the Apple Watch need this, to ensure good contact?

      It probably varies by person, but heart monitor chest straps such as those that come with higher-end exercise watches, can benefit from the gel. However, most folks (including myself) either just slap 'em on dry, or with a little spit, and they usually work fine. But at the doctor's office "usually" probably doesn't cut it. If a little gel changes "usually" to "always", then they probably apply as a matter of course.

      That's my long-winded way of saying that a little gel on your wrist and finger would help (I guess; I've not seen the watch yet, nor am I a medical professional). But for the not-a-lab-or-medical-office setting, it's good enough.

    • harshreality 2010 days ago
      If you're measuring (or applying) voltage on skin, you get cleaner data if you use conductive gel, since you have less chance of a poor electrical contact between sensor and skin.

      If you can't use it though, you can't use it. The data may have glitches, anomalous readings, but most of it will be pretty good most of the time, or they wouldn't bother with the feature. I'm also not sure what the apple watch's sensing mechanism is. Is it reading voltage or is it measuring something else that's correlated?

      • ip26 2010 days ago
        Also worth thinking about- the EKG is your "golden reference". You do it once, you want it to come out clean, you want it to come out right, and you may make treatment decisions based upon it.

        The watch is always running, can throw out large quantities of glitches & anomalous readings, and only produces an alert to seek followup.

    • monkmartinez 2010 days ago
      You probably had a either a 12 lead or 3 lead EKG... the Watch is only a single lead. Therefore, much less is needed in terms of conductivity for the sensors to measure.
    • mtw 2010 days ago
      In the same manner that in a conventional ECG, 10 electrodes are used while this only requires you to put your finger on the crown. The data is less accurate but apparently good enough to detect 98% of AFib cases.
      • GeekyBear 2010 days ago
        The 12 lead ECG is used for a different diagnostic purpose.

        The Apple Watch is positioned as a cardiac event monitor. Those are intended for extended wear and only need to take measurements between a single pair of electrodes to function.

        For instance, a Zio Patch is a modern version designed to be compact and unobtrusive.

        Here's a comparison between a Zio Patch and the old school tech of a Holter Monitor.

        https://www.medgadget.com/2014/01/zio-wireless-patch-may-be-...

        One of the tech journalists at Ziff Davis who took part in Apple's heart study ended up being dignosed with Afib by his cardiologist. He wrote about the process he went through.

        TLDR: The watch flagged that there was a potential problem, he was given a traditional tape on cardiac event monitor to wear for an extended period to confirm the watch data, and was then diagnosed and treated.

        https://www.zdnet.com/article/how-apple-watch-saved-my-life/

        For me, this was the money quote: "I've had EKGs a number of times, and there was never any indication anything was wrong."

      • JshWright 2010 days ago
        It's not necessarily "less accurate" data (it may or may not be), there is just less of it. A conventional ECG uses those 10 electrodes to view the heart from 12 different "directions", which allows you to understand how impulses are moving throughout the heart as a whole. A watch only gets you one of those leads (Lead 1, specifically).
    • MBCook 2010 days ago
      I’m guessing it just relies on pressure. The watch is held against your skin by the band, your finger is held against the crown by your muscles. I guess they’ve tested it and it seems to be good enough.

      As EKGs go it’s a relatively basic test, is the equivalent of having a single wire.

      I’m very curious to see what doctors/etc. make of it once the feature is released.

  • walterbell 2010 days ago
    Can Apple Watch be used without iCloud, with sensor data sent only to a local iOS device (iPad without LTE baseband radio, only WiFi) for local analysis?

    If so, there could be open-source iOS apps that enable privacy-oriented health data collection on the watch, e.g. with E2E encrypted messaging initiated by the device owner, when data review is wanted.

    • oflannabhra 2010 days ago
      Yes, you can use an Apple Watch without using iCloud. You cannot pair an Apple Watch to an iPad.

      iCloud Syncing for your HealthKit data encrypts and stores your data in iCloud, similar to iCloud Keychain. If this is enabled, HealthKit information is stripped from iCloud backups, if you use them. You can also do local encrypted backups through iTunes. If you don’t use any of the above options, HealthKit data stays on the device.

      On device, HealthKit has lots of permissions for apps to access health data, including per app reading and writing permissions for each data category.

    • sirn 2010 days ago
      Apple Watch can be used without iCloud for sure. iCloud Sync for Health data were added in iOS 11, and it can be disabled easily by a toggle.

      Apple Watch can only be connected to iPhone, though (not iPod touch) so have it sync to a device without LTE baseband radio is not possible.

    • maxerickson 2010 days ago
      On device only is the model they are promoting:

      https://developer.apple.com/documentation/healthkit/protecti...

    • Pamar 2010 days ago
      I think this could be doable, the only problem is that you are introducing an extra failure point (i.e. watch works, support device is down/battery dead/unable/ to connect to Internet/outside of wifi range) and if I have to choose between "data privacy" and "I had a stroke and need medical care" I'd go for the latter.
    • graeme 2010 days ago
      Apple watches can only be paired with iphones. I suppose you could use an iphone without LTE setup, but it would still have a radio.

      That said, I believe health data is end to end encrypted within icloud.

  • appleiigs 2010 days ago
    I cringe thinking about people using an Apple Watch for healthcare. I had to give my Apple Watch 3 away because:

    1) its heart rate monitoring while running was terrible. I run in a HR range and AW3 wasn't accurate enough for that. It would show a rate too low and then impossibly high within a couple minutes... couldn't use it to pace myself.

    2) battery life. If you run for 2 hours, you likely can't get through the day. I had to charge it every night. In the case of a medical monitoring device, I guess you'll have to settle for being monitored for only part of the day???

    I ended up buying a Garmin Forerunner 935 and its HR is more accurate and battery life is much better. (But not saying Garmin is OK for health care either)

    • joegahona 2010 days ago
      Also a runner -- I had slightly different problems to you:

      - The GPS on the watch was terrible, often dropping out for me, and leaving out a mile here and there. Is this an Apple thing? My Garmin is way more accurate.

      - I need an always-on mode. I realize it drains the battery, but I own the battery and that is my choice. I need to be able to glance down and see my pace immediately, not fiddle with my wrist flicking until it comes on.

      - I'm also bummed that there's no Spotify support yet, and that it's not a true standalone LTE device. I want to ditch my phone and have a watch only.

      • appleiigs 2010 days ago
        Yes, GPS on AW was worse than Garmin in my experience. That also caused the speed pacing on AW to not be usable. The GPS difference with friend who has Garmin Fenix 5 was even noticeable on the map. AW had a jagged line, whereas the Garmin tracked the trail exactly.

        Often when glancing at my AW when running it would show the wrong screen. It would either show "now playing" music (even though I don't run with headphones) or my Strava app... when I actually wanted to see the heart rate app.

    • stcredzero 2010 days ago
      I run in a HR range

      I'm not familiar with this term. I just had an image of our Human Resources officer shooting at people running on an indoor track with a nerf gun.

      • nradov 2010 days ago
        Endurance athletes commonly do workouts around heart rate ranges, sometimes holding a steady rate or sometimes cycling up and down between zones. Heart rates are typically divided into 5 zones based on the athlete's maximum rate. Targeting specific zones for specific amounts of time can be an effective way to boost aerobic or anaerobic capacity.
      • appleiigs 2010 days ago
        When I run, I target a heart rate of 140 beats per minute, plus or minus 10 beats per minute.
    • nradov 2010 days ago
      This shouldn't be down voted, you are exactly correct. Optical heart rate monitors can do fairly well for casual use as long as the watch band is fairly snug. But all of them whether from Apple, Garmin, or another vendor lose accuracy when they're bouncing around on a sweaty wrist. This is just a fundamental limit of the technology.
      • skunkworker 2010 days ago
        There are armbands for apple watch that make it feasible to wear during a workout. But if I am going on a long run nothing beats the Garmin chest heart monitor I use with my forerunner.
  • wink 2010 days ago
    > Sooner than people think, virtually all home and outpatient diagnostics will be performed by consumer devices such as the Apple Watch, mobile phones, fitness trackers, etc.

    Well I do think 'not very soon' - because I only know a handful of people (all doing computery things) with an Apple Watch or FitBit/Android thingy, and even of those fond of tech it's only a minority.

    I cannot even fathom how long it would take to have this data even be acknowledged or just being able to be interchanged with German doctors and hospitals.

  • paul7986 2010 days ago
    What about the Apple toilet? No joke!

    A toilet that analyzes specimen data and alerts you of potential issues.

    • breckuh 2010 days ago
      https://www.youtube.com/watch?v=DJklHwoYgBQ

      This is a parody but actually has some great product ideas :)

      • paul7986 2010 days ago
        That pipe sounds solid ... maybe you can’t get solid data by analyzing poo? Though you sure can from urine.

        Overall I guess I’m missing things... like why is this idea being parodied?

        • breckuh 2009 days ago
          It's more of a parody of the Valley than the idea itself. Most of the aspects of the idea surround things like Tweeting, followers, et cetera.

          I like the idea of a pipe! Perhaps makes more sense than a smart toilet.

  • IBM 2010 days ago
    Guess he's just going to ignore this post:

    Why Tim Cook is Steve Ballmer and Why He Still Has His Job at Apple (2016)

    https://steveblank.com/2016/10/24/why-tim-cook-is-steve-ball...

  • SeanFerree 2010 days ago
    Great information! Thanks!
  • gaius 2010 days ago
    I have a watch with wrist HRM and I can say without a doubt that it is a complete gimmick. Sometimes I will be sitting calmly at my desk and I glance down and see it thinks my heart rate is 190. Or I will get back from a hard run and it thinks my heart rate hasn’t been above 70. A chest strap however gives plausible results.

    Anyone basing serious health stuff on this is crazy.

  • trophycase 2010 days ago
    Yes, the tipping point for human privacy.
  • chicob 2010 days ago
    Insurance companies are already salivating to the prospect of ever accessing their customers' health monitor data.

    Cross that data with customer loyalty card data regarding groceries purchases for the next decades, and one can practically automate ineligibility.

  • unionjack22 2010 days ago
    An EKG is done via a 12-point lead at specific areas of the body. At the moment, there is only one ECG sensor on the watch. When I told my SO who is currently in medical residency, the look on her face was of pure horror. I think to physicians and medical professionals, all this feature will do is to create more false positives and needlessly clog up already stressed clinics with wasteful checkups and add to the number of hypochondriacs.

    Maybe through ML Apple could enhance the accuracy and precision of the measurements but given Apple's history with iterating on intelligent features(Siri), it won't happen for a while. If Apple wants to have a meaningful impact on the health of their users, then maybe they ought to use the ECG sharing feature as a means of getting their foot in the door of the medical records industry where their product approach and design rigour is much needed. Moreover, Apple could leverage the ECG feature as part of the product experience to motivate people to engage in activities that get them moving which, at the end of the day, is where most users derive the most value from.

    • briandear 2010 days ago
      So the president of the American Heart Association as well as doctors at Stanford are all masking the “horror” of your resident wife?

      You know what’s worse than a false positive? A real positive and no way to know about it.

      • bennyelv 2009 days ago
        On an individual basis, yes. Across a population, not necessarily.

        If the false positives result in investigations that carry medical risk then it's possible that on the whole, more harm than good is done.

        There's also an interesting consideration around real positives that we've never detected in the past and that never presented any symptoms or negative outcomes. It's possible that we now start detecting cases which previously the patient went their whole life without knowing about and would be totally unaffected by, and introducing medical interventions that have downsides.

        How it all stacks up in the end we can't possibly know, but this development isn't automatically "good".