9 ms·

Apple is building an operating system for health

198 points by nbashaw 6y ago

m12k 6y ago
The question is, will all these data aggregated together actually give us any actionable data that we can and will act on? If there's one thing Google Analytics has taught me, it's that it's quite possible to have a lot of detailed data at your fingertips, but still not be able to answer any valuable questions with it.
- nbashaw 6y ago
  Totally agree! It's going to take a whole new sub-specialty of ML to make any sense of it. But I think there's a positive feedback loop where more data → better algorithms → more data, because more people opt into the system in order to get access to the algorithms.
  - ralph84 6y ago
    Do you really need ML to tell you to eat better and exercise?
    - SirHound 6y ago
      No but you might to pull together a bunch of noisy data points until a confident prediction of early stage serious disease.
      - alwillis 6y ago
        This happens relatively frequently actually. Guy buys an Apple Watch and gets notified of an arrhythmia, sees his doctor and he averts a potentially serious incident: https://www.medicaldevice-network.com/news/apple-watch-atrial-fibrillation/ https://www.medicaldevice-network.com/news/apple-watch-atria...
  - m12k 6y ago
    I think there might be an even bigger problem in coming up with any kind of response that we didn't already know. E.g. the advice "Don't smoke, stop eating before you're full, eat more vegetables, eat less bread and pasta, drink less alcohol, prefer water instead of drinks like juice, milk or soda, stop eating processed sugar, avoid saturated fats, get regular cardio, avoid stress, get enough sleep and do so at roughly the same time every night" is likely to be correct for the vast majority of people. Having top-of-the-line ML crunch a bunch of data only to spit out the exact same recommendation to everyone doesn't really accomplish much. Maybe more specific recommendations would be possible in a decade or two if we start having detailed data to look at, but considering how hard a time we've had just answering simple questions like 'are eggs good or bad for you?' in general, I'm not really all that optimistic about our ability to make precise individual recommendations that are not already obvious.
    - nbashaw 6y ago
      Generally I think you're right. But also I think there are a ton of edge cases we could discover based on complex interactions of genetics, environmental factors, disease history, etc. Also there's a lot more urgency when an algorithm detects an anomaly and asks you to schedule a blood test!
- alwillis 6y ago
  I’m using the Watch and with my iPhone. The Health and Activity apps work great together. The visualizations are clear and understandable. For example, I’m significantly less active this spring than last spring—average of 2.2 miles walking per day in 2019 vs. about 1 mile in 2020. That’s mostly due to stay at home orders due to COVID-19 the past 3 months. Once the weather got better and the number of cases subsided, I started taking walks in my neighborhood due to the actionable data I had. Remember, the Watch and the iPhone can do machine learning on the device. What’s missing is an easy way to do more advanced health data processing on my Mac if I wanted to. I’d like my public health department release an app for COVID-19 exposure notification, using the Apple/Google API. You could also envision broad clinical trials of treatments for COVID-19 using these components.
  - clairity 6y ago
    you should never have stopped walking. the chances of covid infection outside on a walk are essentially zero. this is one of the many little harms of blanket stay home orders rather than just distancing (with masks only when you can’t), where you get nearly all of the benefits with nearly none of the downsides.
    - alwillis 6y ago
      I live in New England; in addition to the stay at-home orders, it was also cold and rainy much of the spring, in addition to living in a state with the third most infections and deaths from COVID-19 in the country during March–May. As of today, we’ve had 8,860 confirmed cases of COVID-19 in my county alone. I have pre-existing conditions and live with a septuagenarian that clearly made it not worth the risk to be out and about.
      - clairity 6y ago
        i completely sympathize with the need to be cautious in the face of elevated risk, but taking a walk outside doesn't by itself present additional risk. the virus doesn't exist ambiently in the air. you need an infected person breathing into your face for some period of time for the risks to accumulate enough to successfully transmit the disease.
kine 6y ago
I hate Apple's approach of doing 70% of the work all the time. If they truly cared about health, they'd make it incredibly easy for any company to add health data in to their ecosystem and not just try to sell more Apple Watches. As a Whoop user, it's so much more beneficial than their basic Apple Watch stats (which btw are fine for most people, I just want more/better HRV data)
- nbashaw 6y ago
  Why doesn't Whoop integrate with Apple Health?
  - kine 6y ago
    You'd have to ask Apple. Probably because they just want to sell more watches
    - nbashaw 6y ago
      Well Apple Health is an open API that anyone can integrate with. So I'd assume Whoop either A) doesn't want to be modularized, or B) has a data format that doesn't fit with Apple's specification for some good reason.
      - kine 6y ago
        Oh interesting. I stand corrected then! I'd guess 2 things: 1) From the less-than-stellar quality of Whoop's app, their data is probably differently formatted and they don't want to bother 2) They want you to stay in their app and use their algos to manage your health data as opposed to Apple's, which they can't control.
        saagarjha 6y ago
        You can actually integrate with Health while still also showing it in your app. Health is like a database of sorts which you can choose to add your data to or access from yoUr app. (Similar to HomeKit, actually.)
BiteCode_dev 6y ago
Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data. Anytime you associate health with financial motivation, you end up with something twisted on the long run. Sure, you can say that Apple, right now, is in the proper state to do that (although given they were part of PRISM, it's debatable). But what about in 10 years? What if their executives decide that Apple Pay should lead to the creation of a bank? Then from a bank to an insurance company? Then they have a conflict of interest. Simpler than that, what if they change their stance on user data, and decide to exploit it to understand their customers better? Or sell it? Or just partner it to labs, insurance companies, hospitals? Like with facebook, it will of course all be "made anonymous", until it's not anymore. Money and health data are not meant to be mixed IMO. But even without all that, we are adding yet another tracking system on top of what is already a sensor packed pocket self-spying device. It's hard to not worry that such concentration of power has a high potential for suffering.
- nbashaw 6y ago
  I think you're right about all of this! And to add another point, I worry the only people who will have access to this are those who can afford a bunch of health gadgets and a premium primary care provider. But, at the same time, it's impossible to imagine our government creating such a thing :(
  - barry-cotter 6y ago
    > I worry the only people who will have access to this are those who can afford a bunch of health gadgets and a premium primary care provider. A new iPhone SE costs $399 unlocked.
    - nbashaw 6y ago
      Totally, but in order to benefit from this system you'd probably also need a connected mattress, watch, maybe a continuous glucose monitor, some sort of workout device, etc. It adds up. This is a country where half the population earns $40k or less a year.
seesawtron 6y ago
What happened to Palantir handling NHS data in UK? There was some privacy concern there but it happened anyways. Call me a pessimist and this a rant but it seems like the public doesn't really control what their governments decide to do with their data. The best the tech firms do is issue an apology for infringing on privacy or pay a light fine while they get to keep majority of their profits.
- VLM 6y ago
  Its not much of a rant. Its taken centuries of hard work for the average person's body to mostly not be the owned property of other people or governments. The battle's barely been started for self determination and self ownership of our data.
weisser 6y ago
Apple Health is one of those products that's useless until it suddenly isn't. We're reaching that point for some folks and I only expect that group to expand rapidly in the coming years.
- kine 6y ago
  Sort of like Evernote. It's a note taking app until it's your 2nd brain.
  - person_of_color 6y ago
    Why not OneNote?
david-cako 6y ago
Apple has a talent for putting themselves right at the center of important technologies. I wonder if this strategy plays out as integrated medical devices and a full-blown healthcare platform. Their reputation for top-notch hardware, good UX, and their shift towards in-house SoCs gives them a serious edge there. Everything about their brand feels well suited for healthcare, and IMO they still don't have a killer enterprise app. This could be what Watson was promising to be.
- dariosalvi78 6y ago
  Top notch hardware, like their top notch keyboards?
  - the_other 6y ago
    No, not like their recent keyboards. But exactly like almost every model of their laptops, most of their desktops, their servers, their phones, tablets, watches, NAS/routers and set-top boxes. Every year, for >30 years.
    - dariosalvi78 6y ago
      I've owned 4 of their laptops in the past 5 years (not my choice) and all of them ended in the trash for different reasons that did not depend on me. Maybe the phones are better, I have never owned one. Ok most companies make some bad products and most companies have some top notch products. Is Apple any different?
      - reidjs 6y ago
        How?? I'm on a macbook air from 2011 and an iphone SE from 2012. Do you just pour soda all over them? Or has their laptop quality dipped in the last four years? I know that the butterfly keyboards were having all kinds of issues, but I wouldn't trash a computer over that, they would probably replace the keyboard.
        6y ago
P-NP 6y ago
Many studies show that modern machine learning could revolutionize healthcare. However, many hospitals and governments are extremely protective of patient data. And many hospitals don't even know how to exploit their data through deep learning. Enter Apple and Google and others with big machine learning departments. They are finding new ways of collecting health-relevant data. For example: Through Apple Heart Study, Stanford Medicine researchers show wearable technology can help detect atrial fibrillation https://med.stanford.edu/news/all-news/2019/11/through-apple-heart-study--stanford-medicine-researchers-show-we.html https://med.stanford.edu/news/all-news/2019/11/through-apple... https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhythmia_Detection.pdf https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhy... An OS with a focus on health seems to make a lot of sense.
- zyang 6y ago
  That's why it was genius for Apple to bet on privacy. It's the only big tech company I can trust with my health data.
  - brokenc0de 6y ago
    Apple's privacy marketing seems like just that. All of their proprietary software is highly suspect. And remember, the COVID-19 contact tracing APIs were built by both _Google_ and Apple. If Apple was so concerned about privacy they would have implemented the tracing APIs themselves for the iPhone and released the source code.
dloss 6y ago
Ever since I heard Mary Lou Jepsen (OLPC/Oculus Rift) talk about her work on a revolutionary holographic medical imaging system, I've been expecting Apple to buy her Openwater startup, add resources and introduce cheap, safe MRI-like body/brain scanners for the masses. If it works, it could be bigger than the iPhone. https://www.openwater.cc/technology https://www.openwater.cc/technology
- germinalphrase 6y ago
  She did a talk at the Long Now Foundation about the possible implications of this work. Definitely a bit out there - but fascinating. http://longnow.org/seminars/02018/oct/29/toward-practical-telepathy/ http://longnow.org/seminars/02018/oct/29/toward-practical-te...
m0zg 6y ago
I don't see why I'd need Apple to tell my personal trainer I have a herniated disk. I can tell them myself, and I'm looking to be less locked into the Apple ecosystem, not more. If that's what they're doing (which I bet it's not), I'd consider it as a good sign that Apple has run out of good ideas.
deleted 6y ago
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specialist 6y ago
Feature request: Heat stroke prevention. Just heard an interview with author of recent paper about global risk of increased mortality due to climate change. (Radio, no cite, sorry.) Research team has clarified impact of "wet bulb", which is somehow combo of both ambient temperature and humidity, and prevalence of heat related deaths. Not just the Middle East, but also provided examples from Europe, Toronto, Louisiana. While wet bulb temp of 35 °C is life threatening, paper shows that with higher humidity even 27 °C can be dangerous for at-risk persons and has led to greater mortality. While the risk will certainly get worse, people have no intuition for it. Especially for outdoor work and activities. Any way. My immediate thought was my watch can alert me to wet bulb risks, a combination of weather and health monitoring. https://en.wikipedia.org/wiki/Wet-bulb_temperature#Wet-bulb_temperature_and_health https://en.wikipedia.org/wiki/Wet-bulb_temperature#Wet-bulb_...
- ben_bai 6y ago
  Feature request: Connect Diabetes Insulin Pump, and Sugar level measurement devices.
dangus 6y ago
Apple could be planning to make an EHR system, like Epic and Cerner. Google is supposedly working on one, too. (I don’t think the article really arrives on that possibility) Most electronic health record systems are really terrible software, and they’re also very profitable pieces of software. Google, Apple, and Microsoft are probably the only companies with enough money and software engineering talent to start from scratch and disrupt that space. Some interesting further reading: https://medium.com/design-and-tech-co/how-google-ehr-could-fix-one-of-healthcares-epic-flaws-280036a988e3 https://medium.com/design-and-tech-co/how-google-ehr-could-f...
- npunt 6y ago
  Rather than go through the trouble of entering a new complicated market building an EHR to unseat some very entrenched players and force retraining of millions of healthcare workers, which would be relatively antithetical to Apple’s consumer-not-enterprise approach, they could focus behind the scenes efforts on data portability and interoperability via EHR customers (hospitals) so that those EHRs worked better with Apple Health. You really don’t want to build an EHR if you can avoid it.
dariosalvi78 6y ago
I really welcome the Health Kit or Google Fit approach for sharing data among health app, I actually want to use that for health research. The main problem is that as soon as you mention the fact that patients data is going to be shared with a company (besides in the US) doctors shy away because of data protection, regulations etc. We need the data to be on the device and possibly outside of the control of one (or 2) companies. I know Apple says that data is encrypted end to end, and I wish Google did the same, but even so it is still problematic. When you add the fact that every manufacturers of wearables obliges users to share data on their dodgy platforms... I don't see a solution to this. At least not until the mindset changed completely.
b34r 6y ago
The notion that the industry isn’t exposing any data is patently false. FHIR and HL7 have been around for years now and I’ve connected many data sources into both Apple and other services that use those APIs.
- prepend 6y ago
  FHIR helps quotes a bit, but I think the challenge is that HL7 is expensive to work with and that integrations are point to point. I’ve also connected sources using HL7, but it’s hard to scale because it’s like everyone creating import/export interfaces to their system. I think the benefit of Apple health is that it’s a common, trusted intermediary. Me, the patient. I think it’s easier for me to pull data from multiple sources and show it to my doctor than for all those medical systems to share with each other so my doctor can see data. If I have 5 health services, it requires 5 export to Apple interfaces for me to collect my data, securely store it, and show it to my doc or to any one of those 5 providers. To have provider interoperability it requires 30 interfaces (maybe my math is off 2^5-2). There is stuff like Project Blue Button [0] that tries to make a standard interface to export data. The complaint that it’s easy to export data is only true if you want to pay some consultant to make an interface. In the US, there’s a report on information blocking [1] that called out areas in healthcare with blocking and proposed some changes to lessen it. [0] https://www.healthit.gov/topic/health-it-initiatives/blue-button https://www.healthit.gov/topic/health-it-initiatives/blue-bu... [1] https://www.healthit.gov/topic/information-blocking https://www.healthit.gov/topic/information-blocking
cheschire 6y ago
Microsoft's almost always either too late, or in this case too early. https://en.wikipedia.org/wiki/Microsoft_HealthVault https://en.wikipedia.org/wiki/Microsoft_HealthVault
- toast0 6y ago
  Often, they'll come in again, and be both too early and too late.
totalZero 6y ago
Traditionally, these data sets have lived in silos. But what could happen if it all was aggregated safely in one place? It seems unwise IMO for me to give a large corporation (Apple, Equifax, etc) rich data with which to characterize my lifestyle and physical health.
- someguydave 6y ago
  Which is why Apple is not looking at your data?
  - VLM 6y ago
    Not yet.
stefan_ 6y ago
What is all this "health data" people are talking about? When I go to a new doctor that has none of this apparently super complicated, dense health data, they give me a single page form to fill out where just about 90% of people below the age of 50 will tick every box with "no" or leave the field empty.
- VLM 6y ago
  Lets say they want to raise premium revenue by 25%. The solution will be to increase premiums on smokers, because everyone hates smokers, by 25%. How does that math work, you're asking? Right now you and I can check "non-smokers" on medical documents. And that's true, at least for me, medically speaking. However after we fuse all sources of data we can punish everyone. I bought two packs of cigars in the 90s when I was a dumb young kid. Medically speaking a quarter century later I'm a non-smoker from a health perspective. However, from a revenue generation perspective... Big brother is not going to fund this out of the goodness of their heart to be revenue neutral or (gasp) positive for the public. The only purpose for this expensive initiative will be to screw over the general population even more to increase income inequality a little more and make the rich just a little richer.
elchief 6y ago
Reminds me of The New, New thing! http://michaellewiswrites.com/index.html#the-new-new-thing http://michaellewiswrites.com/index.html#the-new-new-thing
atlasunshrugged 6y ago
I really wish Apple would get on with it - the process for trying to upload medical records was super broken for me (plus as an American, I can't even find most of my medical records since they're in different doctors offices across the 4 states and many cities I've lived in). That said, I am nervous about just how much data they'll own. Does anyone know if there are government backed open systems that someone from another country could use? I know that Estonia for instance has an okay patient health portal where you can see all your info but it's not useful unless you live there.
gumby 6y ago
Just last night I read an essay by Galloway where he pointed out that the really huge companies (Apple, Google, etc) have a hard time maintaining growth so have to move into different sectors where there are huge pools of money. Health is the most obvious one.
deleted 6y ago
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carapace 6y ago
The epistemology of the thing... In the immediate human sense recall that this was the health app that launched with no way to record your menstrual cycle (a very important aspect of health for about half of humanity, the half that makes new humans I should add.) In the deeper sense, we might encode "humors" into the design of our system. Our knowledge is incomplete. (E.g. the microbiome, or the "interstitium" which has been called "a new organ" https://www.livescience.com/62128-interstitium-organ.html https://www.livescience.com/62128-interstitium-organ.html ) It's important that our data systems handle open-world rather than closed-world data, eh? https://en.wikipedia.org/wiki/Open-world_assumption https://en.wikipedia.org/wiki/Open-world_assumption (As a practitioner of Reiki I can attest that scientific medicine does not yet capture all relevant variables.) Last but not least, the crux of the issue turns on what Martin Buber called "I and Thou": https://en.wikipedia.org/wiki/I_and_Thou https://en.wikipedia.org/wiki/I_and_Thou > Buber's main proposition is that we may address existence in two ways: > The attitude of the "I" towards an "It", towards an object that is separate in itself, which we either use or experience. > The attitude of the "I" towards "Thou", in a relationship in which the other is not separated by discrete bounds. There is a subtle trap in thinking of the body as "it" (and also a trap in thinking of the body as "thou", and another as "I"). It behooves us to be careful what we automate.
mister_hn 6y ago
I would be happy if they would still support older machines with macOS. A macmini of 2010 that is still working good can't be left without security updates!
rapjr9 6y ago
If you want to learn more about where research in this area is headed: Santosh Kumar has been heading a large NSF research center investigating wearable medical sensing and how to turn sensor data into actionable health advice: https://md2k.org/ https://md2k.org/ Tanzeem Choudhury has been doing some work at the intersection of AI and sensing and health: https://pac.cs.cornell.edu/ https://pac.cs.cornell.edu/ Deborah Estrin's Small Data Lab is doing some interesting work too: https://smalldata.io/#portfolio https://smalldata.io/#portfolio
rapjr9 6y ago
The USA has been making plans for widespread sharing of Electronic Health Record data for many years: https://www.healthit.gov/hitac/committees/health-it-policy-committee https://www.healthit.gov/hitac/committees/health-it-policy-c... This is seen as desirable for more than one purpose, including allowing people to move their medical records to a new doctor or hospital easily, and for doing research on what makes for the best care, as well as giving doctors the ability to look at case histories similar to that of a patient they are treating. Computerization of medicine has been resisted by doctors for a long time, which has meant that all the data and observations and diagnosis made over the years has essentially been lost when it could have been informing doctors decisions and being used in research. There are definitely privacy and abuse problems with putting everyone's health data in a central database run by the government, and it is very difficult to de-identify health data (how many people have your height, weight, age, and diseases?), but without some way to gather all the knowledge and experience and data from the practice of medicine we have been missing important correlations and creating harm due to each doctor making their own decisions instead of having a set of best practices informed by hard data. Whether the police, FBI, NSA, courts, and politicians should have access to this data are difficult questions and hard to implement so they are not subject to abuse. The police already can make some kinds of queries at hospitals for medical data. The UK has started a large scale Precision Medicine project that is collecting health data on 500,000 people: https://en.wikipedia.org/wiki/UK_Biobank https://en.wikipedia.org/wiki/UK_Biobank There are other ongoing large scale projects collecting health data also: https://www.hdruk.ac.uk/ https://www.hdruk.ac.uk/ and I'm sure there are others, in many countries. A lot of this is part of the move towards Precision Medicine, medicine based on data and personalized to an individual, rather than treating all people as being identical and letting each doctor make their own guess on how to treat a patient (I've been in meetings where doctors say that 80% of the time they are guessing, though guesses get better as they see what works and what doesn't for any one patient): https://en.wikipedia.org/wiki/Precision_medicine https://en.wikipedia.org/wiki/Precision_medicine The space Apple is aiming to dominate is currently one small part of all this. One big question is what do doctors do with all this data? It's too much to look at it all. They have no experience with such detailed info also. What is normal for the way your blood pressure changes as you go about your day? Your doctor doesn't know and hence even if she had continuous blood pressure measurements from you 24/7 wouldn't know what to do with it. What is a reasonable blood pressure while having sex? When climbing stairs? The only measurements like this that we've had historically are from astronauts. Machine Learning may help, but what do you do with an opaque message from an algorithm that there is a 75% chance you have some abnormality in some obscure biological parameter? The chance of 25% of those notifications being wrong means you can't use it as the basis of a diagnosis. Maybe it suggests something you can investigate further, but then how much time will you waste following up on those 25% of notifications that are in error? Was the ML trained for your age, weight, and specific set of health conditions or will it fail to detect anything for people outside the scope of the training data, yet be used to evaluate your health (incorrectly) anyway? And using ML also creates yet another path for bad actors to steal and tamper with your data. There are a lot of complicated questions surrounding medical data.

198 points by nbashaw 6y ago

m12k 6y ago

The question is, will all these data aggregated together actually give us any actionable data that we can and will act on? If there's one thing Google Analytics has taught me, it's that it's quite possible to have a lot of detailed data at your fingertips, but still not be able to answer any valuable questions with it.

nbashaw 6y ago
Totally agree! It's going to take a whole new sub-specialty of ML to make any sense of it. But I think there's a positive feedback loop where more data → better algorithms → more data, because more people opt into the system in order to get access to the algorithms.
- ralph84 6y ago
  Do you really need ML to tell you to eat better and exercise?
  - SirHound 6y ago
    No but you might to pull together a bunch of noisy data points until a confident prediction of early stage serious disease.
    - alwillis 6y ago
      This happens relatively frequently actually. Guy buys an Apple Watch and gets notified of an arrhythmia, sees his doctor and he averts a potentially serious incident: https://www.medicaldevice-network.com/news/apple-watch-atrial-fibrillation/ https://www.medicaldevice-network.com/news/apple-watch-atria...
- m12k 6y ago
  I think there might be an even bigger problem in coming up with any kind of response that we didn't already know. E.g. the advice "Don't smoke, stop eating before you're full, eat more vegetables, eat less bread and pasta, drink less alcohol, prefer water instead of drinks like juice, milk or soda, stop eating processed sugar, avoid saturated fats, get regular cardio, avoid stress, get enough sleep and do so at roughly the same time every night" is likely to be correct for the vast majority of people. Having top-of-the-line ML crunch a bunch of data only to spit out the exact same recommendation to everyone doesn't really accomplish much. Maybe more specific recommendations would be possible in a decade or two if we start having detailed data to look at, but considering how hard a time we've had just answering simple questions like 'are eggs good or bad for you?' in general, I'm not really all that optimistic about our ability to make precise individual recommendations that are not already obvious.
  - nbashaw 6y ago
    Generally I think you're right. But also I think there are a ton of edge cases we could discover based on complex interactions of genetics, environmental factors, disease history, etc. Also there's a lot more urgency when an algorithm detects an anomaly and asks you to schedule a blood test!
alwillis 6y ago
I’m using the Watch and with my iPhone. The Health and Activity apps work great together. The visualizations are clear and understandable. For example, I’m significantly less active this spring than last spring—average of 2.2 miles walking per day in 2019 vs. about 1 mile in 2020. That’s mostly due to stay at home orders due to COVID-19 the past 3 months. Once the weather got better and the number of cases subsided, I started taking walks in my neighborhood due to the actionable data I had. Remember, the Watch and the iPhone can do machine learning on the device. What’s missing is an easy way to do more advanced health data processing on my Mac if I wanted to. I’d like my public health department release an app for COVID-19 exposure notification, using the Apple/Google API. You could also envision broad clinical trials of treatments for COVID-19 using these components.
- clairity 6y ago
  you should never have stopped walking. the chances of covid infection outside on a walk are essentially zero. this is one of the many little harms of blanket stay home orders rather than just distancing (with masks only when you can’t), where you get nearly all of the benefits with nearly none of the downsides.
  - alwillis 6y ago
    I live in New England; in addition to the stay at-home orders, it was also cold and rainy much of the spring, in addition to living in a state with the third most infections and deaths from COVID-19 in the country during March–May. As of today, we’ve had 8,860 confirmed cases of COVID-19 in my county alone. I have pre-existing conditions and live with a septuagenarian that clearly made it not worth the risk to be out and about.
    - clairity 6y ago
      i completely sympathize with the need to be cautious in the face of elevated risk, but taking a walk outside doesn't by itself present additional risk. the virus doesn't exist ambiently in the air. you need an infected person breathing into your face for some period of time for the risks to accumulate enough to successfully transmit the disease.

kine 6y ago

I hate Apple's approach of doing 70% of the work all the time. If they truly cared about health, they'd make it incredibly easy for any company to add health data in to their ecosystem and not just try to sell more Apple Watches. As a Whoop user, it's so much more beneficial than their basic Apple Watch stats (which btw are fine for most people, I just want more/better HRV data)

nbashaw 6y ago
Why doesn't Whoop integrate with Apple Health?
- kine 6y ago
  You'd have to ask Apple. Probably because they just want to sell more watches
  - nbashaw 6y ago
    Well Apple Health is an open API that anyone can integrate with. So I'd assume Whoop either A) doesn't want to be modularized, or B) has a data format that doesn't fit with Apple's specification for some good reason.
    - kine 6y ago
      Oh interesting. I stand corrected then! I'd guess 2 things: 1) From the less-than-stellar quality of Whoop's app, their data is probably differently formatted and they don't want to bother 2) They want you to stay in their app and use their algos to manage your health data as opposed to Apple's, which they can't control.
      - saagarjha 6y ago
        You can actually integrate with Health while still also showing it in your app. Health is like a database of sorts which you can choose to add your data to or access from yoUr app. (Similar to HomeKit, actually.)

BiteCode_dev 6y ago

Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data. Anytime you associate health with financial motivation, you end up with something twisted on the long run. Sure, you can say that Apple, right now, is in the proper state to do that (although given they were part of PRISM, it's debatable). But what about in 10 years? What if their executives decide that Apple Pay should lead to the creation of a bank? Then from a bank to an insurance company? Then they have a conflict of interest. Simpler than that, what if they change their stance on user data, and decide to exploit it to understand their customers better? Or sell it? Or just partner it to labs, insurance companies, hospitals? Like with facebook, it will of course all be "made anonymous", until it's not anymore. Money and health data are not meant to be mixed IMO. But even without all that, we are adding yet another tracking system on top of what is already a sensor packed pocket self-spying device. It's hard to not worry that such concentration of power has a high potential for suffering.

nbashaw 6y ago
I think you're right about all of this! And to add another point, I worry the only people who will have access to this are those who can afford a bunch of health gadgets and a premium primary care provider. But, at the same time, it's impossible to imagine our government creating such a thing :(
- barry-cotter 6y ago
  > I worry the only people who will have access to this are those who can afford a bunch of health gadgets and a premium primary care provider. A new iPhone SE costs $399 unlocked.
  - nbashaw 6y ago
    Totally, but in order to benefit from this system you'd probably also need a connected mattress, watch, maybe a continuous glucose monitor, some sort of workout device, etc. It adds up. This is a country where half the population earns $40k or less a year.

seesawtron 6y ago

What happened to Palantir handling NHS data in UK? There was some privacy concern there but it happened anyways. Call me a pessimist and this a rant but it seems like the public doesn't really control what their governments decide to do with their data. The best the tech firms do is issue an apology for infringing on privacy or pay a light fine while they get to keep majority of their profits.

VLM 6y ago
Its not much of a rant. Its taken centuries of hard work for the average person's body to mostly not be the owned property of other people or governments. The battle's barely been started for self determination and self ownership of our data.

weisser 6y ago

Apple Health is one of those products that's useless until it suddenly isn't. We're reaching that point for some folks and I only expect that group to expand rapidly in the coming years.

kine 6y ago
Sort of like Evernote. It's a note taking app until it's your 2nd brain.
- person_of_color 6y ago
  Why not OneNote?

david-cako 6y ago

Apple has a talent for putting themselves right at the center of important technologies. I wonder if this strategy plays out as integrated medical devices and a full-blown healthcare platform. Their reputation for top-notch hardware, good UX, and their shift towards in-house SoCs gives them a serious edge there. Everything about their brand feels well suited for healthcare, and IMO they still don't have a killer enterprise app. This could be what Watson was promising to be.

dariosalvi78 6y ago
Top notch hardware, like their top notch keyboards?
- the_other 6y ago
  No, not like their recent keyboards. But exactly like almost every model of their laptops, most of their desktops, their servers, their phones, tablets, watches, NAS/routers and set-top boxes. Every year, for >30 years.
  - dariosalvi78 6y ago
    I've owned 4 of their laptops in the past 5 years (not my choice) and all of them ended in the trash for different reasons that did not depend on me. Maybe the phones are better, I have never owned one. Ok most companies make some bad products and most companies have some top notch products. Is Apple any different?
    - reidjs 6y ago
      How?? I'm on a macbook air from 2011 and an iphone SE from 2012. Do you just pour soda all over them? Or has their laptop quality dipped in the last four years? I know that the butterfly keyboards were having all kinds of issues, but I wouldn't trash a computer over that, they would probably replace the keyboard.
      - 6y ago

P-NP 6y ago

Many studies show that modern machine learning could revolutionize healthcare. However, many hospitals and governments are extremely protective of patient data. And many hospitals don't even know how to exploit their data through deep learning. Enter Apple and Google and others with big machine learning departments. They are finding new ways of collecting health-relevant data. For example: Through Apple Heart Study, Stanford Medicine researchers show wearable technology can help detect atrial fibrillation https://med.stanford.edu/news/all-news/2019/11/through-apple-heart-study--stanford-medicine-researchers-show-we.html https://med.stanford.edu/news/all-news/2019/11/through-apple... https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhythmia_Detection.pdf https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhy... An OS with a focus on health seems to make a lot of sense.

zyang 6y ago
That's why it was genius for Apple to bet on privacy. It's the only big tech company I can trust with my health data.
- brokenc0de 6y ago
  Apple's privacy marketing seems like just that. All of their proprietary software is highly suspect. And remember, the COVID-19 contact tracing APIs were built by both _Google_ and Apple. If Apple was so concerned about privacy they would have implemented the tracing APIs themselves for the iPhone and released the source code.

dloss 6y ago

Ever since I heard Mary Lou Jepsen (OLPC/Oculus Rift) talk about her work on a revolutionary holographic medical imaging system, I've been expecting Apple to buy her Openwater startup, add resources and introduce cheap, safe MRI-like body/brain scanners for the masses. If it works, it could be bigger than the iPhone. https://www.openwater.cc/technology https://www.openwater.cc/technology

germinalphrase 6y ago
She did a talk at the Long Now Foundation about the possible implications of this work. Definitely a bit out there - but fascinating. http://longnow.org/seminars/02018/oct/29/toward-practical-telepathy/ http://longnow.org/seminars/02018/oct/29/toward-practical-te...

m0zg 6y ago

I don't see why I'd need Apple to tell my personal trainer I have a herniated disk. I can tell them myself, and I'm looking to be less locked into the Apple ecosystem, not more. If that's what they're doing (which I bet it's not), I'd consider it as a good sign that Apple has run out of good ideas.

deleted 6y ago

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specialist 6y ago

Feature request: Heat stroke prevention. Just heard an interview with author of recent paper about global risk of increased mortality due to climate change. (Radio, no cite, sorry.) Research team has clarified impact of "wet bulb", which is somehow combo of both ambient temperature and humidity, and prevalence of heat related deaths. Not just the Middle East, but also provided examples from Europe, Toronto, Louisiana. While wet bulb temp of 35 °C is life threatening, paper shows that with higher humidity even 27 °C can be dangerous for at-risk persons and has led to greater mortality. While the risk will certainly get worse, people have no intuition for it. Especially for outdoor work and activities. Any way. My immediate thought was my watch can alert me to wet bulb risks, a combination of weather and health monitoring. https://en.wikipedia.org/wiki/Wet-bulb_temperature#Wet-bulb_temperature_and_health https://en.wikipedia.org/wiki/Wet-bulb_temperature#Wet-bulb_...

ben_bai 6y ago
Feature request: Connect Diabetes Insulin Pump, and Sugar level measurement devices.

dangus 6y ago

Apple could be planning to make an EHR system, like Epic and Cerner. Google is supposedly working on one, too. (I don’t think the article really arrives on that possibility) Most electronic health record systems are really terrible software, and they’re also very profitable pieces of software. Google, Apple, and Microsoft are probably the only companies with enough money and software engineering talent to start from scratch and disrupt that space. Some interesting further reading: https://medium.com/design-and-tech-co/how-google-ehr-could-fix-one-of-healthcares-epic-flaws-280036a988e3 https://medium.com/design-and-tech-co/how-google-ehr-could-f...

npunt 6y ago
Rather than go through the trouble of entering a new complicated market building an EHR to unseat some very entrenched players and force retraining of millions of healthcare workers, which would be relatively antithetical to Apple’s consumer-not-enterprise approach, they could focus behind the scenes efforts on data portability and interoperability via EHR customers (hospitals) so that those EHRs worked better with Apple Health. You really don’t want to build an EHR if you can avoid it.

dariosalvi78 6y ago

I really welcome the Health Kit or Google Fit approach for sharing data among health app, I actually want to use that for health research. The main problem is that as soon as you mention the fact that patients data is going to be shared with a company (besides in the US) doctors shy away because of data protection, regulations etc. We need the data to be on the device and possibly outside of the control of one (or 2) companies. I know Apple says that data is encrypted end to end, and I wish Google did the same, but even so it is still problematic. When you add the fact that every manufacturers of wearables obliges users to share data on their dodgy platforms... I don't see a solution to this. At least not until the mindset changed completely.

b34r 6y ago

The notion that the industry isn’t exposing any data is patently false. FHIR and HL7 have been around for years now and I’ve connected many data sources into both Apple and other services that use those APIs.

prepend 6y ago
FHIR helps quotes a bit, but I think the challenge is that HL7 is expensive to work with and that integrations are point to point. I’ve also connected sources using HL7, but it’s hard to scale because it’s like everyone creating import/export interfaces to their system. I think the benefit of Apple health is that it’s a common, trusted intermediary. Me, the patient. I think it’s easier for me to pull data from multiple sources and show it to my doctor than for all those medical systems to share with each other so my doctor can see data. If I have 5 health services, it requires 5 export to Apple interfaces for me to collect my data, securely store it, and show it to my doc or to any one of those 5 providers. To have provider interoperability it requires 30 interfaces (maybe my math is off 2^5-2). There is stuff like Project Blue Button [0] that tries to make a standard interface to export data. The complaint that it’s easy to export data is only true if you want to pay some consultant to make an interface. In the US, there’s a report on information blocking [1] that called out areas in healthcare with blocking and proposed some changes to lessen it. [0] https://www.healthit.gov/topic/health-it-initiatives/blue-button https://www.healthit.gov/topic/health-it-initiatives/blue-bu... [1] https://www.healthit.gov/topic/information-blocking https://www.healthit.gov/topic/information-blocking

cheschire 6y ago

Microsoft's almost always either too late, or in this case too early. https://en.wikipedia.org/wiki/Microsoft_HealthVault https://en.wikipedia.org/wiki/Microsoft_HealthVault

toast0 6y ago
Often, they'll come in again, and be both too early and too late.

totalZero 6y ago

Traditionally, these data sets have lived in silos. But what could happen if it all was aggregated safely in one place? It seems unwise IMO for me to give a large corporation (Apple, Equifax, etc) rich data with which to characterize my lifestyle and physical health.

someguydave 6y ago
Which is why Apple is not looking at your data?
- VLM 6y ago
  Not yet.

stefan_ 6y ago

What is all this "health data" people are talking about? When I go to a new doctor that has none of this apparently super complicated, dense health data, they give me a single page form to fill out where just about 90% of people below the age of 50 will tick every box with "no" or leave the field empty.

VLM 6y ago
Lets say they want to raise premium revenue by 25%. The solution will be to increase premiums on smokers, because everyone hates smokers, by 25%. How does that math work, you're asking? Right now you and I can check "non-smokers" on medical documents. And that's true, at least for me, medically speaking. However after we fuse all sources of data we can punish everyone. I bought two packs of cigars in the 90s when I was a dumb young kid. Medically speaking a quarter century later I'm a non-smoker from a health perspective. However, from a revenue generation perspective... Big brother is not going to fund this out of the goodness of their heart to be revenue neutral or (gasp) positive for the public. The only purpose for this expensive initiative will be to screw over the general population even more to increase income inequality a little more and make the rich just a little richer.

elchief 6y ago

Reminds me of The New, New thing! http://michaellewiswrites.com/index.html#the-new-new-thing http://michaellewiswrites.com/index.html#the-new-new-thing

atlasunshrugged 6y ago

I really wish Apple would get on with it - the process for trying to upload medical records was super broken for me (plus as an American, I can't even find most of my medical records since they're in different doctors offices across the 4 states and many cities I've lived in). That said, I am nervous about just how much data they'll own. Does anyone know if there are government backed open systems that someone from another country could use? I know that Estonia for instance has an okay patient health portal where you can see all your info but it's not useful unless you live there.

gumby 6y ago

Just last night I read an essay by Galloway where he pointed out that the really huge companies (Apple, Google, etc) have a hard time maintaining growth so have to move into different sectors where there are huge pools of money. Health is the most obvious one.

deleted 6y ago

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carapace 6y ago

The epistemology of the thing... In the immediate human sense recall that this was the health app that launched with no way to record your menstrual cycle (a very important aspect of health for about half of humanity, the half that makes new humans I should add.) In the deeper sense, we might encode "humors" into the design of our system. Our knowledge is incomplete. (E.g. the microbiome, or the "interstitium" which has been called "a new organ" https://www.livescience.com/62128-interstitium-organ.html https://www.livescience.com/62128-interstitium-organ.html ) It's important that our data systems handle open-world rather than closed-world data, eh? https://en.wikipedia.org/wiki/Open-world_assumption https://en.wikipedia.org/wiki/Open-world_assumption (As a practitioner of Reiki I can attest that scientific medicine does not yet capture all relevant variables.) Last but not least, the crux of the issue turns on what Martin Buber called "I and Thou": https://en.wikipedia.org/wiki/I_and_Thou https://en.wikipedia.org/wiki/I_and_Thou > Buber's main proposition is that we may address existence in two ways: > The attitude of the "I" towards an "It", towards an object that is separate in itself, which we either use or experience. > The attitude of the "I" towards "Thou", in a relationship in which the other is not separated by discrete bounds. There is a subtle trap in thinking of the body as "it" (and also a trap in thinking of the body as "thou", and another as "I"). It behooves us to be careful what we automate.

mister_hn 6y ago

I would be happy if they would still support older machines with macOS. A macmini of 2010 that is still working good can't be left without security updates!

rapjr9 6y ago

If you want to learn more about where research in this area is headed: Santosh Kumar has been heading a large NSF research center investigating wearable medical sensing and how to turn sensor data into actionable health advice: https://md2k.org/ https://md2k.org/ Tanzeem Choudhury has been doing some work at the intersection of AI and sensing and health: https://pac.cs.cornell.edu/ https://pac.cs.cornell.edu/ Deborah Estrin's Small Data Lab is doing some interesting work too: https://smalldata.io/#portfolio https://smalldata.io/#portfolio

rapjr9 6y ago

The USA has been making plans for widespread sharing of Electronic Health Record data for many years: https://www.healthit.gov/hitac/committees/health-it-policy-committee https://www.healthit.gov/hitac/committees/health-it-policy-c... This is seen as desirable for more than one purpose, including allowing people to move their medical records to a new doctor or hospital easily, and for doing research on what makes for the best care, as well as giving doctors the ability to look at case histories similar to that of a patient they are treating. Computerization of medicine has been resisted by doctors for a long time, which has meant that all the data and observations and diagnosis made over the years has essentially been lost when it could have been informing doctors decisions and being used in research. There are definitely privacy and abuse problems with putting everyone's health data in a central database run by the government, and it is very difficult to de-identify health data (how many people have your height, weight, age, and diseases?), but without some way to gather all the knowledge and experience and data from the practice of medicine we have been missing important correlations and creating harm due to each doctor making their own decisions instead of having a set of best practices informed by hard data. Whether the police, FBI, NSA, courts, and politicians should have access to this data are difficult questions and hard to implement so they are not subject to abuse. The police already can make some kinds of queries at hospitals for medical data. The UK has started a large scale Precision Medicine project that is collecting health data on 500,000 people: https://en.wikipedia.org/wiki/UK_Biobank https://en.wikipedia.org/wiki/UK_Biobank There are other ongoing large scale projects collecting health data also: https://www.hdruk.ac.uk/ https://www.hdruk.ac.uk/ and I'm sure there are others, in many countries. A lot of this is part of the move towards Precision Medicine, medicine based on data and personalized to an individual, rather than treating all people as being identical and letting each doctor make their own guess on how to treat a patient (I've been in meetings where doctors say that 80% of the time they are guessing, though guesses get better as they see what works and what doesn't for any one patient): https://en.wikipedia.org/wiki/Precision_medicine https://en.wikipedia.org/wiki/Precision_medicine The space Apple is aiming to dominate is currently one small part of all this. One big question is what do doctors do with all this data? It's too much to look at it all. They have no experience with such detailed info also. What is normal for the way your blood pressure changes as you go about your day? Your doctor doesn't know and hence even if she had continuous blood pressure measurements from you 24/7 wouldn't know what to do with it. What is a reasonable blood pressure while having sex? When climbing stairs? The only measurements like this that we've had historically are from astronauts. Machine Learning may help, but what do you do with an opaque message from an algorithm that there is a 75% chance you have some abnormality in some obscure biological parameter? The chance of 25% of those notifications being wrong means you can't use it as the basis of a diagnosis. Maybe it suggests something you can investigate further, but then how much time will you waste following up on those 25% of notifications that are in error? Was the ML trained for your age, weight, and specific set of health conditions or will it fail to detect anything for people outside the scope of the training data, yet be used to evaluate your health (incorrectly) anyway? And using ML also creates yet another path for bad actors to steal and tamper with your data. There are a lot of complicated questions surrounding medical data.