You can imagine a dash board, much like this one.
This is from a company that was called Pulse.io,
that I think has gone out of business, but I found their slide very compelling.
They attempted to kind of collect data from a bunch of different devices.
From smart pill bottles from fitness trackers, from Wi-Fi scales and
develop a composite picture that could be then given to subscriber.
Like a family member, a loved one or a doctor or a healthcare team.
And someone would been get a snapshot of the patients well being, and
it's kind of Orwellian look in to a patients life.
But you can get all kinds of information such as sleep quality, and how often
the refrigerator door is being open, how often the pill bottles are being open.
When someone is coming and going, how many steps they're taking, and
things like blood sugar and weight and other scales.
So I can understand the appeal of wearables, and kind of giving a snapshot.
What's not clear though is when numbers don't add up or
don't trend to the direction that we want to see, how do we intervene?
That's still very much unclear.
Wearables, we can imagine them as just a consumer version of what we have in
healthcare.
We do telemetry monitoring in the hospital,
we track all kinds of vital signs over time.
We can view wearables as an offshoot of that field or
we can view it as an entirely new field,
where we're collecting data that doctors never used to collect on a regular basis.
And we don't really know the value of monitoring everyone at all times for
things like heart rate and step counts and so forth.
And it totally, it seems that this data has value, but
the truth is the large trial aren't there yet to help us make sense of some of this.
I'll give you an example.
This is a tweet from Eric Topol where he talks about
a patient who had an Apple watch that was tracking heart rate.
And it found the heart rate was going up and down and all over the place.
And occasionally, the patient would feel some dizziness and
seemed to correlate with the variable heart rates.
And so he thought he had sick sinus syndrome which is a real entity.
It's actually pretty rare and unusual, but he went to his doctor.
They confirmed the diagnosis, the patient got a pacemaker.
Kind of sounds like a victory.
It sounds like the Apple watch unearthed a condition that
could have led to harm in the patient had not had it checked out.
I would argue the opposite, that if the patient was feeling dizzy and
checking their own pulse,
they would have been able to achieve everything that the Apple watch did.
And there are times when you work out wearing an Apple watch and
the heart rate detection goes off kilter.
Turns out that it’s very reliant on a steady blood flow to your hand.
So if you're lifting weights, you disrupt the blood flow slightly and
the watch can figure out your actual pulse.
And if you look at that trend over time,
you would may be diagnose yourself with sick sinus syndrome.
Apple watches not marketed as a sick sinus syndrome device detector.
It's marketed as a fitness and health tool.
So if you happen to use it to detect a disease, that's great.
But you have to ask yourself,
how many times is the Apple watch leaving to unnecessary workups or
scaring patients that actually are quiet healthy?
What we would call a false positive with expensive or
even risky interventions that are triggered by a readings that you get on
a consumer device that was never really even intended to detect disease.
So in addition to false positives that lead to sometimes unnecessary work ups,
expensive or even risky medical interventions.
There is also such a thing as lead time bias where detecting
a condition early seems to give an opportunity to intervene.
However, it turns out that no interventions are effective, and
just knowing about the condition earlier.
Well that might have some benefit on its own, but
doesn't actually improve mortality or improve outcomes.