I work at a related company (Cardiogram), and there's a surprising amount of signal locked in the humble heart rate sensor -- we've run multiple studies with UCSF showing accurate detection of sleep apnea, high blood pressure, and even diabetes using off-the-shelf heart rate sensors and a deep neural network, DeepHeart:
https://blog.cardiogr.am/screening-with-wearables-what-do-th...
If you're an engineer or payer relations expert and you'd like to help build the future of healthcare, definitely drop us a line! hello@cardiogr.am. We're especially looking for Javascript engineers, Android engineers, and salespeople with payer experience.
Does this mean insurance companies are interested in this heart rate data stream, and are making inferences from it? Are they already collecting it? Do any of these wearables provide this data to these companies without the user's express permission?
The link isn't working for me (in Japan, if that helps) after the renewal, still.
I couldn't find a copy of the page in Google's cache or in the wayback archives.
I'm curious since I don't know anything about Cardiogram at all; is DeepHeart a part of Cardiogram? That is, are all of those detection capabilities part of your app if I have an Apple Watch?
Some feedback - your website is very lacking in information about what your app actually does, what devices it works with etc. The blue "personal healthcare assistant" looks like a link but isn't.
I'm curious about your service, but without knowing if it's compatible with my smartwatch etc, I wouldn't go as far as downloading the app.
I’ve tried sending an email to the address you posted here, but the email is failing to send to that address. Very interested in talking about engineering opportunities though!
I wish there was a heartbeat-measuring watch with the battery life of a dumb watch. My watch goes like 5 years (I've lost count honestly) on its original battery. I'd love to have something watching out for my health but I just can't see myself moving to a smartwatch that needs recharging every 18 hours when I don't even need the smartness crap...
Purely anecdotal, but my Series 3 goes about two days on a full charge. I can usually get away with just charging it in the morning while I shower and get ready, and otherwise just wearing all the time. Workouts deplete the battery more, mostly because I’m usually using the GPS in addition to the more frequent heart rate monitoring.
My Amazfit Bip ($99) is supposed to have 45 days and lasts about 30 days on minute heart rate monitoring intervals (based on a month and a half of trying it).
I wanted something a bit smaller, to fit under the shirt cuff, so got the Mi Band 3 ($50) which lasts about 10 days (probably 20 days if you don't allow it to display notifications and set a higher HR interval).
The Mi app is pretty bad, which forces you to buy an extra app (for me, Notify & Fitness, for Google Fit sync).
You should look at brands like Garmin and Polar, then. Samsung and Apple put these bright, colorful OLED panels on their smartwatches and drain the batteries too fast. Garmin in particular does a good job of building smartwatches with almost all the features of a Galaxy Watch or Apple Watch, but with a lot more battery life because they aren't wasting so much energy on the bright, pretty screen. Instead, they focus on lower energy LCD panels with backlights. The reason they do this is largely because they are fitness and sports focused and you don't want your watch dying on a two day hike and leaving you stranded, but in day-to-day activity I love having that extra battery life. It makes the drawbacks of a less vibrant screen totally worth it. I still get all my emails, texts, calls, music, etc. except I also get sleep tracking (because I'm not taking it off every time to charge) and less stress.
I've done a fair amount of research and am still pretty conflicted. I really only care about having a smart watch for the gym. I definitely need music and heart rate tracking but I would also like some app support for workout tracking. Most recently I've started using http://fitbod.me. My main goal is to not carry my phone around at the gym and not be any more connected (read: distracted) than I currently am with my phone.
The Garmin Forerunner 645 Music covers what I need short of the app support. The Nike Apple Watch Series 3 looks very tempting but I really don't like the aesthetic and I feel like it's just perpetuating the problem of being too online all the time. Though it's a far more feature rich device for less than the 645.
I'm thinking I'll sit back and wait for broader app support.
My pebble watch lasts 10 days. Its kind of an awkward length though because things that I charge nightly I do all at once but I often forget to change my watch. Thankfully it falls back to dumb time only mode for a day before turning off
The Suunto 9 GPS watch claims up to 120 hours between charges depending on how you configure the GPS. It's mostly marketed to ultra-runners and hikers who need that kind of battery life.
Apple added gamification elements to the Apple Watch.
“Closing the rings” which means completing 100% of the move, stand and exercise targets adds a competitive element to fitness which has worked well for many users.
It should be noted though that this study does not say that an Apple Watch will overall provide medical benefits. It also doesn't follow automatically from the fact that it detects things with a certain reliability.
The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
If I'm reading this right, the Apple Watch was actually more accurate in detecting arterial fibrilation episodes than the ECG patch they used for initial confirmation. The Apple Watch identified 2,000 people. The patch confirmed 33% of those, but then another 51% were confirmed by some undisclosed method.
That's not an accurate interpretation. Atrial fibrillation episodes are not constant- they come and go, and different people will have them at different frequencies. It's possible that people had an episode while wearing the watch but haven't had any episodes while wearing the ECG.
ECGs are also less comfortable to wear than watches, so it's possible the people they sent them to didn't wear them as often (it's even possible that they didn't wear them at all).
They mention ECG patch, so it might not have been too bad. Those are good for longer studies than a typical Holter monitor, and they are waterproof so you can shower with them. I agree that a real Holter monitor is a bit of a pain in the ass and probably would affect compliance rate.
The future is your insurance company making you wear a smart watch 24/7 if you don’t want to pay a huge premium. I predict it’s going to be a huge quagmire over the next decade or so.
It would be a huge invasion of privacy for an insurance company to do this - and not only privacy, but the fact that insurance companies can discriminate based on this data means that the healthy don't end up subsidising the unhealthy (which is the whole point of insurance). SO premiums go up regardless, and only the insurance company win in this scenario.
Right now, the right choice is to combat this problem before it becomes a real problem. Before it sets root as cultrually acceptable to hand over your biometrics data to private companies without the right payment and compensation.
It'll probably be more like auto insurance companies where they offer a voluntary tracking program and if you're better than average you get a discount
The real issue is how this is implemented. Will they just require that you wear the watch (and act on the data when it shows you have an issue), or share all the health data collected with the insurer?
It's already happening. Some insurers are giving lower rates to people who wear this stuff and allows the insurer to see the data for better pricing premiums for each individual. I also had purchased stock in a small cap company that makes tech to allow telemedicine to be possible.
Like with any medical test: if you do more tests you will find more incidence.
The same thing happened with various forms of cancer screening. If we were to test everybody for everything very few people would be found to be 100% and a lot of unnecessary procedures would be the result.
Given the obesity problem this result should not be a surprising finding anyway.
Ok, so what? Shouldn’t we be cheering the fact that a consumer device can potentially detect this without ever requiring a much costlier visit to the ER or doctors office?
My Apple Watch was a few hundred bucks. My latest ER visit for tachycardia (idle heart rate over 100) came to over $3000, with health insurance. And all they did was tests.
Are you advocating that we shouldn't bother testing instead? I'd imagine that many people would be quite interested in knowing the ways they're not 100% that might actually kill them... like cancer.
It's a question of false positives and false negatives. Most medical tests have a decent percentage of both.
> Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks. [1]
It's complicated... Not all instances of cancer are harmful, more men die with prostate cancer then die because of of it and thyroid cancer is found as an incidental in ~30% of autopsies. More detection can cause more harm than good, as what happened in South Korea with thyroid cancer screening, a huge increase in detection and treatment without any decrease in survival rates.
If you simply go looking, you'll find a lot of abnormalities associated with various conditions that turn out to be false positives and, for that person, fairly normal.
Nothing specific to this article, but this comes up often in medicine. Sure, you can pay to run more tests, find some things earlier (along with some false positives), but the outcomes and treatment aren't any different than if you waited for more obvious symptoms and could take a more accurate test.
Just imagine all the stress and suffering caused by the misdiagnosis and unnecessary visits to the doctor and unnecessary tests and imagine that on a grand scale (to say nothing of wasted resources).
I’m not saying that to automatically disqualify and increase in the availability of testing – but it does have to be implemented with the proper care and caution.
The magic here is that this is baked into an otherwise useful, relatively cheap non-medical device. That device (and this test) are also entirely self-service, and the cost for both is borne by the consumer, effectively elective.
Also: The heart beat monitoring features account for some portion of the Apple Watch's price, surely, but I suspect for most people this feels like a "free" benefit.
Edit: reading further in the thread, this comment said it better than I did (though they aren't speaking about the video, it makes the same argument): https://news.ycombinator.com/item?id=19409734
> It should be noted though that this study does not say that an Apple Watch will overall provide medical benefits. It also doesn't follow automatically from the fact that it detects things with a certain reliability.
The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
The only thing I would add is the last thing I mentioned in this comment, namely that you might consider buying one for a higher risk person like your grandpa rather than yourself.
--- (original comment) ---
Watched the whole thing, basically the argument is that overdiagnosis leads to people worrying (increasing stress) when the doctor says "based on this I can't give you drugs since the drugs aren't completely harmless", or the doc might recommend follow up tests that give ambiguous results and escalate (in the example) to an operation to test a certain thing where the patient has a 1 in 3k chance of dying from the procedure itself. Additionally, experiments where they strap a bunch of such devices to healthy patients (basically what apple's watch does as well, especially the young and modern people will buy it) and while it lead to more diagnoses, it didn't decrease the chance of stroke or heart attacks in that group.
I don't think any of this is a significant reason not to buy it. I'm not going to buy one for various reasons, but this isn't one of them. It is good to be aware of the arguments, though: it might lead to someone buying one for their grandma rather than healthy and young(ish) self.
I don't want to live in a world where insurance companies or employers have any need or incentive to have this data. Like most developed nations outside the U.S. for example.
I'm from the US, but I live in a country with "national health care" and... look it sucks. You know what I miss? 1990s era health care for tech workers in the US. When you went in and everything was covered for a $20 co-pay.
You want a specific medication, or a non-generic medication in Australia? Too bad. It's not that it costs more, you just can't get it. Things like Wellbutrin are as illegal as crack. And if you do something like tell your doctor that you tried a bunch of medications and Vyvanse is what works best... they'll literally treat you like someone trying to score opiates. They don't like it when you have an opinion on medications, and you get all sorts of lectures about how bad drug advertising is. It's a very dated, "I'm the doctor, you have to do what I say..." mentality.
And the wait times... "Oh, did you need back surgery? Because you're under 65 and you are over weight, that means you're now bottom on the list... and you'll have to wait for 1-2 years to have this done." A co-worker of mine here is a larger woman, but she just paid out of pocket rather than go on a 2-year wait list. Oh, and the recovery room... there were like 4 people crammed in one room sharing one bathroom. Doctors came in and were talking about care and medical details, in front of total strangers and her visiting guests. No privacy at all. The government would absolutely use health / fitness data to prioritize care... it's not that everyone gets unlimited treatment, they still have budgets.
What else? Remember those classes in college where you couldn't understand the professor because he had such a thick accent? Yeah, that's pretty much every doctor here now. You go to the ER and you need stitches, you end up waiting for a few hours and when you're finally seen the doctor is like, "Why weren't you escalated faster?" "I couldn't understand what your triage nurse was saying, she doesn't speak English... and I haven't got a clue if she understood me... she just told me to sit and wait..." My friend needed 14 stitches and waited over 3 hours in the ER holding a bloody towel on her hand. Only got someone to do something when she started dripping blood on the floor after it had soaked through the towel.
Anyway I know health care sucks in the US, and I do want to get to a point where governments pick up the bill... but holy hell, if the choices at present are what we have in the US or what they have in Australia... man, they both really suck. If you're someone with a job, and with any money, the US model works slightly better.
Universal healthcare systems merely change the point of information demand based on who is responsible for the cost, from private companies to governments.
The notion that the authoritarian-creep and spy-on-everyone mentality that continues rapidly spreading in most developed nations, won't apply to this type of healthcare data, is obviously false. There is no entity that wants to track people more than governments (and in all possible regards), it's not even remotely close. It doesn't matter whether we're talking about the US, France, UK, Australia, South Korea, Japan or Germany.
Readit News
If you're an engineer or payer relations expert and you'd like to help build the future of healthcare, definitely drop us a line! hello@cardiogr.am. We're especially looking for Javascript engineers, Android engineers, and salespeople with payer experience.
Does this mean insurance companies are interested in this heart rate data stream, and are making inferences from it? Are they already collecting it? Do any of these wearables provide this data to these companies without the user's express permission?
Is this a good thing?
I couldn't find a copy of the page in Google's cache or in the wayback archives.
I'm curious since I don't know anything about Cardiogram at all; is DeepHeart a part of Cardiogram? That is, are all of those detection capabilities part of your app if I have an Apple Watch?
I'm curious about your service, but without knowing if it's compatible with my smartwatch etc, I wouldn't go as far as downloading the app.
Deleted Comment
https://www.reddit.com/r/AppleWatch/comments/a40qm5/heading_...
https://www.reddit.com/r/AppleWatch/comments/9zrdq5/how_an_a...
I'm sure there is a lot more.
(Also all the people losing weight)
Some Garmin and Fitbit models have good battery life — often about a week.
I wanted something a bit smaller, to fit under the shirt cuff, so got the Mi Band 3 ($50) which lasts about 10 days (probably 20 days if you don't allow it to display notifications and set a higher HR interval).
The Mi app is pretty bad, which forces you to buy an extra app (for me, Notify & Fitness, for Google Fit sync).
The Garmin Forerunner 645 Music covers what I need short of the app support. The Nike Apple Watch Series 3 looks very tempting but I really don't like the aesthetic and I feel like it's just perpetuating the problem of being too online all the time. Though it's a far more feature rich device for less than the 645.
I'm thinking I'll sit back and wait for broader app support.
I bought it for her primarily for the hypnograms.
“Closing the rings” which means completing 100% of the move, stand and exercise targets adds a competitive element to fitness which has worked well for many users.
https://www.reddit.com/r/AppleWatch/comments/8nk4vr/apple_wa...
https://www.reddit.com/r/AppleWatch/comments/8pm0qr/my_apple...
Deleted Comment
The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
There's more information on this here:
https://www.apple.com/healthcare/site/docs/Apple_Watch_Arrhy...
ECGs are also less comfortable to wear than watches, so it's possible the people they sent them to didn't wear them as often (it's even possible that they didn't wear them at all).
Deleted Comment
Though maybe it gets even better than that and we just all start wearing watches again.
I want that feature but I'm not a watch wearer.
Right now, the right choice is to combat this problem before it becomes a real problem. Before it sets root as cultrually acceptable to hand over your biometrics data to private companies without the right payment and compensation.
The same thing happened with various forms of cancer screening. If we were to test everybody for everything very few people would be found to be 100% and a lot of unnecessary procedures would be the result.
Given the obesity problem this result should not be a surprising finding anyway.
My Apple Watch was a few hundred bucks. My latest ER visit for tachycardia (idle heart rate over 100) came to over $3000, with health insurance. And all they did was tests.
For less than three grand, you could fly to Europe for a weekend, stay in a five star hotel, and have all the tests done while you're there.
> Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks. [1]
[1] https://www.cancer.gov/types/colorectal/patient/colorectal-s...
Here's a good overview:
https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
Info about thyroid cancer over diagnosis:
https://www.npr.org/sections/health-shots/2017/05/09/5275692...
Here's a piece on the subject; http://www.journalgazette.net/features/20180604/anomalies-in...
Deleted Comment
I’m not saying that to automatically disqualify and increase in the availability of testing – but it does have to be implemented with the proper care and caution.
I've heard this line parroted a lot but a robust Bayesian analysis should mitigate this.
Like by setting appropriate thresholds you should be able to either
* do the same amount of interventions with more of them being helpful
* maintain the rate of helpfulness but doing more procedurees.
or even a mix of the two. Testing all the things all the time on all the people would be a boon if we just did it correctly.
Also: The heart beat monitoring features account for some portion of the Apple Watch's price, surely, but I suspect for most people this feels like a "free" benefit.
Super underrated channel (British humor, anyone)--shows how the Apple Watch's ECG feature can be actually bad for overall health.
edit: though the amount of positive outcomes (the reddit thread) makes me reassess this...
> It should be noted though that this study does not say that an Apple Watch will overall provide medical benefits. It also doesn't follow automatically from the fact that it detects things with a certain reliability. The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
The only thing I would add is the last thing I mentioned in this comment, namely that you might consider buying one for a higher risk person like your grandpa rather than yourself.
--- (original comment) ---
Watched the whole thing, basically the argument is that overdiagnosis leads to people worrying (increasing stress) when the doctor says "based on this I can't give you drugs since the drugs aren't completely harmless", or the doc might recommend follow up tests that give ambiguous results and escalate (in the example) to an operation to test a certain thing where the patient has a 1 in 3k chance of dying from the procedure itself. Additionally, experiments where they strap a bunch of such devices to healthy patients (basically what apple's watch does as well, especially the young and modern people will buy it) and while it lead to more diagnoses, it didn't decrease the chance of stroke or heart attacks in that group.
I don't think any of this is a significant reason not to buy it. I'm not going to buy one for various reasons, but this isn't one of them. It is good to be aware of the arguments, though: it might lead to someone buying one for their grandma rather than healthy and young(ish) self.
But what I am concerned about is that this kind of stuff is a Pandora's box that can cause some undeserved panic...
I don't want to live in a world where insurance companies and employers force us to hand over this data.
Just feels really creepy to me. Like way over the line.
You want a specific medication, or a non-generic medication in Australia? Too bad. It's not that it costs more, you just can't get it. Things like Wellbutrin are as illegal as crack. And if you do something like tell your doctor that you tried a bunch of medications and Vyvanse is what works best... they'll literally treat you like someone trying to score opiates. They don't like it when you have an opinion on medications, and you get all sorts of lectures about how bad drug advertising is. It's a very dated, "I'm the doctor, you have to do what I say..." mentality.
And the wait times... "Oh, did you need back surgery? Because you're under 65 and you are over weight, that means you're now bottom on the list... and you'll have to wait for 1-2 years to have this done." A co-worker of mine here is a larger woman, but she just paid out of pocket rather than go on a 2-year wait list. Oh, and the recovery room... there were like 4 people crammed in one room sharing one bathroom. Doctors came in and were talking about care and medical details, in front of total strangers and her visiting guests. No privacy at all. The government would absolutely use health / fitness data to prioritize care... it's not that everyone gets unlimited treatment, they still have budgets.
What else? Remember those classes in college where you couldn't understand the professor because he had such a thick accent? Yeah, that's pretty much every doctor here now. You go to the ER and you need stitches, you end up waiting for a few hours and when you're finally seen the doctor is like, "Why weren't you escalated faster?" "I couldn't understand what your triage nurse was saying, she doesn't speak English... and I haven't got a clue if she understood me... she just told me to sit and wait..." My friend needed 14 stitches and waited over 3 hours in the ER holding a bloody towel on her hand. Only got someone to do something when she started dripping blood on the floor after it had soaked through the towel.
Anyway I know health care sucks in the US, and I do want to get to a point where governments pick up the bill... but holy hell, if the choices at present are what we have in the US or what they have in Australia... man, they both really suck. If you're someone with a job, and with any money, the US model works slightly better.
The notion that the authoritarian-creep and spy-on-everyone mentality that continues rapidly spreading in most developed nations, won't apply to this type of healthcare data, is obviously false. There is no entity that wants to track people more than governments (and in all possible regards), it's not even remotely close. It doesn't matter whether we're talking about the US, France, UK, Australia, South Korea, Japan or Germany.
No one is handing over health data to insurance companies or employers.