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Digital Health Blunders and Wonders: The Apple Watch

Nick van Terheyden, MD
SEPTEMBER 18, 2018
Hello! I'm Dr. Nick, the Incrementalist, and I'm here today to talk about Blunders and Wonders.

Blunder: The Apple Watch

This week's blunder: The new Apple Watch. It would be challenging to omit the news covering the latest Apple releases, which included the new Apple Watch, which features a full detection and electrocardiogram, or EKG. That's a recording of the electrical signals that drive the heart muscles beating inside your chest.



Sounds like a great new device to add to the collection of tools and techniques to help monitor and diagnose patients.

But not so fast! Many years ago, I was part of a fantastic team that built a brand new hospital from the ground up in Glasgow, Scotland. When we started, it was an empty field. By the time we finished, we had a fully-functioning hospital equipped with the latest and greatest technology.

>> LISTEN: The High-Tech Hospital the World Wasn’t Ready For

But before we could see any patients, we had to test that everything was working correctly. To test the MRI system, the team decided to use volunteers from the staff. This device represents no risk, unlike a CT scanner, which would expose people to unnecessary radiation if it were tested on volunteers.

This idea was shut down very quickly as the MRI started finding things in these volunteers. One study noted that on average, about 20 percent of normal patients had something found, of which, at most five percent of those turn into any significant clinical finding that demands intervention or treatment.

This all links back to precision and recall – measures of how reliable a test is, and how good it is at identifying problems. In this instance, there's a genuine concern that the Apple Watch will generate a lot of false positives – people who receive a notice telling them that the watch has found something and they should see their doctor.

Using the statistics from the radiology paper, for 1,000 people wearing the watch, 200 might receive a notice of a problem, and of these only 10 of them would prove to be a clinical problem demanding attention and treatment. The remaining 190 would be subjected to worry and concern, as well as the inconvenience and cost of following up on this alert.

I know I don't want that worry, and neither does your doctor, who's already struggling to keep up with the workload.

Wonder: The Apple Watch Again

This week's wonder: The Apple Watch and it's new features of full detection and EKG data.

I know, some conflicting views represented here, adding to the confusion. But I think it's important to highlight the great progress being made by many companies with the addition of new and innovative sensors to the world of medicine.

I'm often heard to quote Lord Kelvin: "If you cannot measure it, you cannot improve it." A perfect case in point is the measurement of blood pressure, which only relatively recently was identified as causing a slate of diseases in humans, but is traditionally only being measured infrequently.

For many people, it's measured perhaps once or twice a year when they visit their physician's office – a suboptimal location for measuring physiological factors, given the stress associated with booking, traveling, dealing with doctor's appointments. So managing blood pressure is a major challenge to the healthcare professionals without the necessary data.

The Apple Watch offers a big step towards the need for more data, offering an almost always-on, constant data stream of physiological values from our bodies. New insights into what's normal for you, an individual, and a clear step towards a more precise form of medicine, treating you, the individual patient.

I'm excited by the prospect of new data streams linked to our daily activities and behavior, and I applaud Apple for moving us further down that path. The data emerging will likely show that many correlations exist, and open new doors to discoveries of yet unimagined ideas and concepts, because we could never conceive the detail.

But remember, correlation does not equal causation, so we need to approach these data streams with suitable caution and skepticism, and apply the rigors of science and study to the emerging insights.

Until next time, I'm Dr. Nick, the Incrementalist. Don't let perfection stand in the way of progress.

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