Yeah I saw this video a couple of days ago and was surprised that it was by The Verge, not that they are great, but the video is so preposterous. They can do better than this. People keeping an eye on their heart health for preventive purposes is classified as a harmful? Such a dumb video that I’m surprised that even for clickbait The Verge would run it.
"...I don't want 100 out of 101 people spending their hard earned money at the primary care doctor's office or emergency room getting tests to confirm or exclude the diagnosis. If you are worried about atrial fibrillation, then there are many better portable methods to diagnose it that do not require a doctor's visit...."
How nice of you to worry about the hard earned money of people. Kind of their choice, isn't it?
And the Apple ECG app is directed at people who AREN'T "worried about atrial fibrillation", but should be. That's kind of the whole point of the Watch ECG feature that you glossed over there....
Again, so what if 99% of people don't have a medical issue? How many of them are going to be shelling out "hard earned money" finding out they don't have anything wrong? There might be a few cases where someone gets a false reading. The normal sane person would take multiple readings before jumping to conclusions and heading off to the emergency room.
Finally, your whole focus of treating people like statistics just grates on me. I wouldn't have you as a doctor if you paid me.
To clear up some of the issues raised in response to my post:
1) "I'm curious, is that 1 person diagnosed to 100 misdiagnosed only from "smart watches" or is that in general?" This would be in general based on the average age of people who own an Apple 4 watch. However, it is not Apple Watch specific. If you applied a screening test to this age population, the ratio would be the same because the number of people with atrial fibrillation in this age group is so low.
2) "Okay, so, to be clear, you don't want people seeking help if they get an alert from the Apple Watch because it might be wrong." Nope, that is the sarcastic interpretation of my post. I don't want 100 out of 101 people inconvenienced and worried for nothing. I don't want 100 out of 101 people spending their hard earned money at the primary care doctor's office or emergency room getting tests to confirm or exclude the diagnosis. If you are worried about atrial fibrillation, then there are many better portable methods to diagnose it that do not require a doctor's visit. Here is one, for example: https://store.alivecor.com/products/kardiamobile. Why are they better? Because you will have to be sitting still to get a good reading and avoid noise in the measurement.
3) "The truth also remains that if you really are a heart doc and you think that mess you linked to is how to communicate, then you need to do some serious continuing education on proper bedside manner. Be sure to invite Dr. Murthy to go with you." Thanks for the ad hominem attacks. I'm sorry you didn't enjoy the conversation amongst cardiologists on twitter right after this was released. If you would prefer a discussion on Bayes theorem and the value of a sensitive test in low risk populations, you can read here: First, the very low prevalence of atrial fibrillation in people under 50 (Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study.Circulation. 2014;129:837–847), second, a screening study that shows that in patients above age 65 years with a risk factor for stroke, atrial fibrillation is diagnosed in 1.4% of those screened (Screening to identify unknown atrial fibrillation: a systematic review.Thromb Haemost. 2013;110:213–222. doi: 10.1160/TH13-02-0165.), and third a discussion on screening for cardiovascular disease in low-risk populations: Screening Strategies for Cardiovascular Disease in Asymptomatic Adults. Prim Care. 2014 Jun; 41(2): 371–397. or one on ECG specific screening; Screening for Cardiovascular Disease Risk with Electrocardiography. JAMA. 2018;319(22):2308-2314.
4) "If our doctor rushed us into heart bypass surgery solely because of what he or she saw on our Apple Watches, it's not Apple we or our families would be suing afterwards." This is silly. Atrial fibrillation does not equal coronary artery disease (something wherein blockages may require bypass surgery). This is all about a rhythm disturbance and the risk of stroke or heart failure.
You should take up point 4 with the doctors in The Verge's video, because that was their assertion. That somehow, these readings would lead to that outcome. Thus, this piece.
Keep in mind, at no point did we say that an Apple Watch is a substitute for a doctor, or diagnostic tools. At no point did we say that this was a tool that would replace a 12-lead ECG. However, disregarding it as a potential data point at any level in the medical chain from patient to doctor is foolish.
You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?
The Verge is a crappy clickbait website. I noticed this article didn’t allow comments. Probably because they know they would all have been negative.
Yep I stopped visiting the site a couple years ago. And shame on Dieter Bohn who I came to respect from his coverage on webOS days. Now at the Verge he’s apparently joined the 'bottom feeders' over there. Good on AI to call the BS for what it is.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
This is how I would use the Series 4 watch.
If I receive a notification of a possible AFib, I would immediately launch the EKG app and take a few consecutive EKG samples. If the EKG reports AFib, I would PANIC!
Then, I would probably drive myself (or be driven) to an emergency room. I would not call an ambulance because the price of an ambulance ride is insane. You may end up paying thousands of dollars just for an ambulance trip. Believe me, it happened to me even though I had insurance.
At the emergency room, I would be at the mercy of their triage team, depending on what their views are of this new feature in the Apple Watch. Perhaps, in some emergency rooms, I would be put in the front of the line and immediately taken to the back for an EKG. It's also very possible that in other emergency rooms, I would be scoffed at for coming with this silly reason and placed at the end of line.
If the latter happens, I would probably be mad and worried for hours while waiting in the reception room for my turn. Then, I would probably wait in one of the rooms in the back for a few more hours until they finally come to do my EKG. Then, about three or four hours later (totaling 7-8 hours of waiting), a doctor (or most likely a PA) would show up and tell me that there may be a little deviation from the norm in my EKG and that I need to see a cardiologist. Two thousand dollars later, I will come home in the middle of the night, worried, upset, etc.
The following day, I would call a cardiologist to make an appointment, and would go through the regular cardio checkup.
I'm a little ambivalent about these new features. I'm sure there will be people whose lives it will save, but I'm afraid there will be people who will have a heart attack from a self-diagnosis. So for now, I will stick with my Series 3 watch.
You need to find a doctor or medical plan that has call-in service for at minimum a nurse. This would be the first step I’d take. Most doctor’s offices and hospitals also have websites with secure email that usually are monitored by professionals who would initiate a return call if they felt the results were an issue. Use all 21st century methods instead of racing to ER.
You mean find a doctor or a NP who will diagnose you over the phone? Thank you.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Wired ran a much more reasoned discussion of the potential pros, cons and unknowns regarding the Apple Watch ECG. It includes comprehensible discussions with cardiologists and references to trials, including some specifically conducted on the AW.
Wired ran a much more reasoned discussion of the potential pros, cons and unknowns regarding the Apple Watch ECG. It includes comprehensible discussions with cardiologists and references to trials, including some specifically conducted on the AW.
Why do I get the feeling if Google or Microsoft has brought this to a wearable product the coverage would be all positive lauding the innovation and and saying see Apple this is innovation. Apple brings it to the market and we get skepticism and cynicism because negative Apple articles drive clicks.
Wired ran a much more reasoned discussion of the potential pros, cons and unknowns regarding the Apple Watch ECG. It includes comprehensible discussions with cardiologists and references to trials, including some specifically conducted on the AW.
Why do I get the feeling if Google or Microsoft has brought this to a wearable product the coverage would be all positive lauding the innovation and and saying see Apple this is innovation. Apple brings it to the market and we get skepticism and cynicism because negative Apple articles drive clicks.
If Google had been the one to introduce it many here would have tagged it as malware and spyware and the media would have come out in force at how much evil potential there was. If it had been Microsoft we would all say who cares, no one will buy it anyway. /s
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Nope, wrong again. The Apple Watch alerts users to atrial fibrillation, rarely, and noise a lot. The question you keep ignoring is the effect of finding noise the vast majority of the time and the effect of finding noise. Doctors order tests in response to events, symptoms, physical exam findings, tests, etc. Tests will be ordered when the tracing isn't clear enough to make a determination. This will occur much more commonly for a false positive test than a true positive one.
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
Wired ran a much more reasoned discussion of the potential pros, cons and unknowns regarding the Apple Watch ECG. It includes comprehensible discussions with cardiologists and references to trials, including some specifically conducted on the AW.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Nope, wrong again. The Apple Watch alerts users to atrial fibrillation, rarely, and noise a lot. The question you keep ignoring is the effect of finding noise the vast majority of the time and the effect of finding noise. Doctors order tests in response to events, symptoms, physical exam findings, tests, etc. Tests will be ordered when the tracing isn't clear enough to make a determination. This will occur much more commonly for a false positive test than a true positive one.
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
I love this place! A lot of smart people wind their way thru here. AI at its best, when a discussion isn't overrun with name-callers, and intelligent discussion wins the day.
btw there might be additional anti-Apple watch bias due to editor Nilay Patel's ridiculous argument with ex apple exec jean-louis gassee. If you haven't read about it its a hoot
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
Sorry, but you’ve failed your logic class. The person making a claim is responsible for proving the assertion. Requiring the opponent to “prove that it doesn’t!” (prove a negative) is a fallacy. Look it up.
Ex: I assert that there is an invisible gremlin under my bed who can avoid detection at will. If as prove I say “Well, prove to me that there isn’t!” it’s fallacious. But my opponent requiring *me* to prove it in the positive is legit. You aren’t legit.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
Jesus it’s as if you don’t actually own a Watch. It doesn’t do a single test that is the final authority — it does continuous pulse monitoring while worn, and trends for afib. If there is matching data it notifies you. You can then be aware of it and continue to monitor your data.
No one has claimed its 100% perfect, so congrats on another logic fail by deploying a straw man.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Nope, wrong again. The Apple Watch alerts users to atrial fibrillation, rarely, and noise a lot. The question you keep ignoring is the effect of finding noise the vast majority of the time and the effect of finding noise. Doctors order tests in response to events, symptoms, physical exam findings, tests, etc. Tests will be ordered when the tracing isn't clear enough to make a determination. This will occur much more commonly for a false positive test than a true positive one.
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
I love this place! A lot of smart people wind their way thru here. AI at its best, when a discussion isn't overrun with name-callers, and intelligent discussion wins the day.
In the spirit of “You might be a redneck...”:
“You might be a troll if...” —you go out of your way to call attention to people calling other people trolls, despite the fact that nobody is calling anybody a troll.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
Sorry, but you’ve failed your logic class. The person making a claim is responsible for proving the assertion. Requiring the opponent to “prove that it doesn’t!” (prove a negative) is a fallacy. Look it up.
Ex: I assert that there is an invisible gremlin under my bed who can avoid detection at will. If as prove I say “Well, prove to me that there isn’t!” it’s fallacious. But my opponent requiring *me* to prove it in the positive is legit. You aren’t legit.
Yeah, that's wrong. Medical devices require extensive testing by the FDA to make sure that they are Safe and Effective. We know neither whether this method of atrial fibrillation determination is safe for the population that uses it nor whether it will effectively reduce the adverse events associated with the disease for which it is used. Establishing a benefit and excluding harm (proving the negative) is what happens for every diagnostic and treatment. I am happy to discuss these issues and show how the medical community looks at them, but the ad hominem attacks are junior league. You may not agree, but you also don't do this for a living, so perhaps being civil would be reasonable in this case.
"You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?"
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
No, I got your point. I don’t think that you get ours, and that’s okay. But, asking "someone else" to prove a negative, to prove that it won't cause an increased chance of unnecessary medical procedures that they, themselves can't order is nonsensical. The Apple Watch can, and does, alert people to Afib. What you as the physician does with data as provide by the Apple Watch is up to you, and blaming the Apple Watch for people taking more responsibility for their own health, in this case, cardiac health, makes absolutely no sense.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
Nope, wrong again. The Apple Watch alerts users to atrial fibrillation, rarely, and noise a lot. The question you keep ignoring is the effect of finding noise the vast majority of the time and the effect of finding noise. Doctors order tests in response to events, symptoms, physical exam findings, tests, etc. Tests will be ordered when the tracing isn't clear enough to make a determination. This will occur much more commonly for a false positive test than a true positive one.
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
I love this place! A lot of smart people wind their way thru here. AI at its best, when a discussion isn't overrun with name-callers, and intelligent discussion wins the day.
In the spirit of “You might be a redneck...”:
“You might be a troll if...” —you go out of your way to call attention to people calling other people trolls, despite the fact that nobody is calling anybody a troll.
Well thanks for coming along and ruining the good Karma....
By the way only one of us regularly calls other members here trolls, so using your "spirit of the redneck" logic it could mean ...
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People keeping an eye on their heart health for preventive purposes is classified as a harmful? Such a dumb video that I’m surprised that even for clickbait The Verge would run it.
And the Apple ECG app is directed at people who AREN'T "worried about atrial fibrillation", but should be. That's kind of the whole point of the Watch ECG feature that you glossed over there....
Again, so what if 99% of people don't have a medical issue? How many of them are going to be shelling out "hard earned money" finding out they don't have anything wrong? There might be a few cases where someone gets a false reading. The normal sane person would take multiple readings before jumping to conclusions and heading off to the emergency room.
Finally, your whole focus of treating people like statistics just grates on me. I wouldn't have you as a doctor if you paid me.
You still didn't answer the question from the editorial. What's the acceptable body count avoided, before you lot consider the Apple Watch ECG a potentially life-saving tool?
I think you're still missing my point. Again, this is not likely to be a life and death issue. The prevalence of a fib in this age population is low. The rate of stroke in patients with atrial fibrillation is low, say 1-7% per year. The question is what is the net clinical benefit of a new diagnostic tool. Or, will a lot of people have unnecessary evaluations and procedures to explain a test finding that doesn't actually have meaning for a person's health. Finding something doesn't mean that it's discovery leads to a person feeling better or living longer. There are many examples of this in medicine. An example: Patients with type 2 diabetes have a much higher rate of heart attack and stroke compared to patients without diabetes. In a large study, 1123 patients with type 2 diabetes were randomly screened with a stress test or had nothing. Everyone got appropriate medicines. Screening did not reduce heart attack, death from heart disease, stroke, or all-cause death beyond the value of standard medical treatment. Yet, the people who were tested were more likely to have heart angiograms and have stents placed for no benefit to the patient. Screening led to more unnecessary procedures (JAMA. 2009;301(15):1547-1555). Abnormal tests raise the anguish of patients and clinicians who then usually do something more to resolve the anguish. It is the second half of the sentence where the danger lies.
So, I don't have to prove that a new device can or cannot find a fib. Someone else has to prove that it doesn't increase the chances that people get unnecessary medical procedures in that absence of making them live longer or feel better.
It isn’t up to Apple to not do the extra crap, based on a single point of data that expressly tells the the user to talk to their doctor. They’re not the ones who can refer or order anything. That’s up to you guys.
https://www.wired.com/story/apple-watch-heart-monitoring-pros-and-cons/amp
Why do I get the feeling if Google or Microsoft has brought this to a wearable product the coverage would be all positive lauding the innovation and and saying see Apple this is innovation. Apple brings it to the market and we get skepticism and cynicism because negative Apple articles drive clicks.
/s
Finally, stop pushing the Apple Watch as though it perfectly captures atrial fibrillation. It doesn't. There is no 100% perfect test. It is not a yes/no, up/down, black/white finding. You can check their own data. All tests are imperfect and perform better with a clinical situation that permits the results to determine the likelihood of an event.
Since I seem to be unable to get across my point well enough, perhaps reading this Health Review article will make it clearer: https://www.healthnewsreview.org/2018/09/what-did-journalists-overlook-about-the-apple-watch-heart-monitor-feature/.
You can then read why the United States Preventive Services Task Force, the group charged with determining the value of screening in the Agency for Healthcare Research & Quality, did not find that screening was beneficial https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/atrial-fibrillation-screening-with-electrocardiography. ;
AI at its best, when a discussion isn't overrun with name-callers, and intelligent discussion wins the day.
Ex: I assert that there is an invisible gremlin under my bed who can avoid detection at will. If as prove I say “Well, prove to me that there isn’t!” it’s fallacious. But my opponent requiring *me* to prove it in the positive is legit. You aren’t legit.
Jesus it’s as if you don’t actually own a Watch. It doesn’t do a single test that is the final authority — it does continuous pulse monitoring while worn, and trends for afib. If there is matching data it notifies you. You can then be aware of it and continue to monitor your data.
No one has claimed its 100% perfect, so congrats on another logic fail by deploying a straw man.
“You might be a troll if...” —you go out of your way to call attention to people calling other people trolls, despite the fact that nobody is calling anybody a troll.
By the way only one of us regularly calls other members here trolls, so using your "spirit of the redneck" logic it could mean ...