![]() There has been an enormous amount of research on people with a-fib who enter the health care system through conventional means - most often by going to a doctor about their symptoms or by having the problem diagnosed during a physical examination. ![]() The Apple Watch 4 is an iffy atrial fibrillation detector in those under age 55Įven if the Apple Watch does work correctly, it is by no means clear it will generate benefits to the public’s health. Venkatesh Murthy, a cardiologist at the University of Michigan who has studied this issue, told me that more than 90 percent of irregular rhythm alerts in younger and middle aged users will be false alarms. But experts who have looked at this issue already know that there will be a large number of false positive alarms, far more than the number of accurate positive alarms. You may think it’s a mistake to focus on false positives and false negatives because the watch is highly accurate at detecting a-fib. Is this really the best use of time for those seeking care or those providing it? Can our already overburdened health care system absorb this sort of influx? What will happen to the underserved sick and elderly people who really do need the services of a cardiologist? Then imagine the impact on a health care system as thousands of young, healthy people suddenly want to schedule appointments with cardiologists. Imagine the impact of such an alert on a perfectly healthy person who suddenly believes he or she might have a heart rhythm disorder. The new study provides no evidence about the true rate of false negatives in the study population because the researchers did not independently monitor people in whom the device did not detect a-fib.Ī far more common problem will be false positives, in which the watch delivers an alert to people who do not have a-fib. One is when people who have atrial fibrillation don’t consult a doctor about symptoms such as heart palpitations or shortness of breath because they feel falsely reassured by the absence of any alert from their Apple Watch. There are always false negatives, in which the device fails to detect a real problem, and false positives, in which it wrongly detects a problem that doesn’t exist. To understand these potential harms, it’s important to recognize that no medical test is perfect. Nevertheless, they can be real and potentially significant. In others, such as with something as apparently benign as the Apple Watch, the risks may be less immediately apparent. With some drugs and devices, the risks are obvious. ![]() When evaluating a new drug or device, it is a cardinal rule that the benefits must be weighed against the risks. ![]() But that assumption may not hold up if the cost of the benefit means harm to many other healthy people. Some people will inevitably argue that saving the life of a young girl, as related by the Apple CEO, is proof the watch can contribute to our health. (Just because your friend’s uncle got rich playing the lottery you shouldn’t conclude that it’s a good idea to spend your next paycheck on the lottery!) The study will therefore be a rich source of anecdotes but, as good scientists know, anecdotes aren’t data. But because the study does not contain a control arm, it can’t say what might have happened to a similar group of 400,000 people who did not use the Apple Watch. Instead, it is a purely observational study designed to see whether the Apple Watch’s heart pulse monitor can identify people who have a-fib. Why the ‘gold standard’ of medical research is no longer enough Exclusive analysis of biotech, pharma, and the life sciences Learn More ![]()
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