Apple is building an operating system for health
divinations.substack.com
divinations.substack.com
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.
But, at the same time, it's impossible to imagine our government creating such a thing :(
A new iPhone SE costs $399 unlocked.
It adds up. This is a country where half the population earns $40k or less a year.
Even more if taking in consideration planned obsolescence.
You have to compare apples to apples. This is the kind of industry where a visit to the ER for a broken arm can and should cost $50K, supposedly.
Government institutions created the internet ...
But that's what we got now, so If I have to chose, I chose the gouvernement. At least in my country: they are paying for health already.
Assuming that you pay taxes it will be you paying for health care services, albeit indirectly. If you live on government subsidies it is others who pay for your health services. The government is the intermediator between tax payers and beneficiaries.
I made my tax declaration this month.
I made it with a smile.
No to mention it assumes you would know about their change of heart, which you may not.
Apple said they were not part of any spying program, until it was revealed they were part of PRISM.
They also said their home button had a hardware problem and you had to buy a new phone, when it's been later demonstrated it could be fixed with software.
Everything a company says must be considered marketting until proven otherwise.
It's not specific to Apple, and it's not a moral stand. It's a practical approach to have with every companies since their driver is being profitable.
This does not seem like an accurate statement. After the PRISM revelations, which named Apple, Apple said they were unaware of the program and were not giving them access. As far as I know, this is the way things still stand today. The leaks claim access to Apple, Apple says they are not providing access. This may be explained through either party lying, or by the FBI being able to access Apple without their cooperation.
> They also said their home button had a hardware problem and you had to buy a new phone, when it's been later demonstrated it could be fixed with software.
This also seems inaccurate. Apple has never claimed you need to buy a new phone if the home button breaks. The actual issue is that the home button is part of the security system of the phone, runs its own fingerprint detection and is paired with the mainboard, and thus cannot be replaced without updating this pairing, otherwise there would be a trivial security break for the fingerprint protection. As a result, only Apple have the required access to replace the button, and thus third-party replacements are impossible.
As far as I know this is also still the case.
Congrats, you've successfully swallowed both the marketing of Apple the corporation, and the marketing of the 'benevolent' rentier hacker empire that is America! [1]
I believe PRISM, Crypto AG, Dual_EC_DRBG, Intel Management Engine, etc. are just the tip of the iceberg. I think we're only just now starting to understand the massive impacts of the continued existence of these backdoors. The immense covert power the NSA has had since the beginning of the digital age (and in the case of the CIA-owned Crypto AG, even long before [2]), most of these powers it has actually been able to keep post-Snowden. Have you heard of the United States Foreign Intelligence Surveillance Court, which Snowden revealed is used extensively by the NSA [3]? If yes, then you know that it is undemocratic, yes? We cannot have courts that are closed, and at the same time call ourselves a democratic country. That is Doublespeak.
Is it strange that many are starting to see the US as essentially the biggest propaganda machine in our new hyperconnected digital world? That it is selling the wasteful consumerist nuclear family way of life, plundering the commons, while at the same time being a militant (military industrial complex) hypocritical rogue agent through parasitical corporate neo-colonial practices [4]?
How many times do these things need to happen for us to start believing it?
Fuck Captain America. Fuck Hollywood. Fuck the NSA powered US empire. Fuck the corporate charter.
I am talking about the power we humans have given to these ideas. I mean the people in them no harm. I am campaigning for us to collectively transcend these ideas and to stop destroying our earth's capacity to support humanity. The idea of America, the NSA etc. are in actual fact metaphysical power systems that do violence to hundreds of millions of people, daily [5]. The sooner we dismantle the current racist systems [6], especially black-box surveillance apparatus, and shift away from Platform Surveillance Capitalism and move towards Protocol Cooperativism, the better. We can do this using technologies like Ceptr and the Holographic chain pattern/framework by the MetaCurrency Project (an agent-centric Ruby on Rails-type framework for distributed networking applications, built using ideas from Git and BitTorrent)[7].
I believe Commons based peer production (instead of firm production) has to be our future. For beautiful visions I often turn to the works of Kevin Carson, Arthur Brock and Eric Harris-Braun.
[1] https://www.resilience.org/stories/2017-08-03/book-day-corru...
[2] https://www.npr.org/2020/03/05/812499752/uncovering-the-cias...
[3] https://theintercept.com/2019/10/10/fbi-nsa-mass-surveillanc...
[4] https://www.youtube.com/watch?v=btF6nKHo2i0
[5] http://www.openculture.com/2017/11/carl-jung-psychoanalyzes-...
[6] https://lareviewofbooks.org/article/banking-against-black-ca...
[7] https://medium.com/holochain/holochain-reinventing-applicati...
Of course, gag orders (and PR common sense), prevent them from giving you this information.
But given what we know about the NSA and the context around it, I'm enclined to trust The Guardian and Snowden about it.
> This also seems inaccurate. Apple has never claimed you need to buy a new phone if the home button breaks. The actual issue is that the home button is part of the security system of the phone, runs its own fingerprint detection and is paired with the mainboard, and thus cannot be replaced without updating this pairing, otherwise there would be a trivial security break for the fingerprint protection. As a result, only Apple have the required access to replace the button, and thus third-party replacements are impossible.
No, the failure I'm refering to is of the iPhone 4 home button, which didn't have a fingerprint sensor yet.
None of my options suggested above required not trusting them. Either Apple lies about cooperating, the FBI lies about having access, or the FBI has access without Apple's knowledge.
Anyway, their statements on the matter go much further than what a gag order would require.
@dang @saagarjha - Does this mean all my comments will keep getting banned? I just wrote a comment, and it is blocked again. Where can I read the rules/process on shadowbanning? I am committed to trying to tone down my replies and focus on being accepting of others' realities, and being constructive.
saagarjha and dang - please could you give an answer to my previous question?
Another interesting question is whether law enforcement will be allowed to access such data and whether it can be used as proof against the wearer. If your data indicates you were in a higher state of alert with a raised pulse, the gyroscope and position sensors indicate you were physically active, the location data puts you in a given area and the microphone picked up suspect sounds they won't need much more to convict you. Who is the legal owner of the data? Some countries give people the right to refuse to testify against themselves so if the data is owned by the wearer I'd expect it to be off-limits to the law.
The potential good uses of this type of technology are myriad, it just needs to be made big-brother-proof. That will be a hard task since there are situations where you'd want some of these easily-abused features to be used - e.g. call in emergency services if the device detects a life-threatening condition, etc.
That's easy today because this option is unpopular. But look back and see how many things we (as entire populations, not necessarily individuals) starting accepting that was unfathomable a couple of decades ago.
Without strong government intervention we may end up at the point where you can take it or forfeit the insurance.
In Manhattan, under every street is a subway where you can put power cables, fiber optic cables, etc. The result is that there are a multitude of business ISPs around, because someone already dug a hole in the ground where their cables can go. The actual stringing of cables is a straightforward procedure; sure you need to buy trucks and cables, but that's a lot cheaper than saying "hey we're closing 5th Ave. for 3 months" and digging the whole thing up. The street was dug up once (in 1891!), and now nobody has to do it again. (OK, the tunnels are pretty full, but it's better than nothing.)
If every street were built like this, it is likely that there would be many more ISPs. The big risks are gone. (There is a secondary problem in that many people still like linear TV, and many TV networks are owned by companies that are also ISPs. AT&T owns HBO. Comcast owns NBC. So that would be the sticking point after there is infrastructure, and sure... have the government break them up. They'll probably be dead long before we have the infrastructure, though.)
The short term solution is probably to invest in better trenching techniques. I've heard of microtrenches, nanotrenches, and picotrenches. Maybe we need femototrenches where you just run a fiber to someone's house through their lawn and cover it up with tape where it crosses the sidewalk. It's better than nothing. But probably still too risky for anyone to attempt.
With more data, it’s possible to see how much certain lifestyles subsidize others, so it will be interesting what society deems eligible for subsidies and not.
As an insurer, you can afford to insure if the losses occur within the assumed probability distribution and loss magnitude parameters.
In the case of auto (or driving) insurance, it is known that driving aggressively will cause more collisions hence more losses. Therefore, any insurance company not taking this knowledge into account will have uncompetitive premiums compared to another insurance company that is. Insurance only doesn’t work in this case for people who choose to drive aggressively.
A more contentious point would be people living in poor areas having to pay more for insurance due to more property crime in poorer areas. It’s easy to say someone who drives recklessly chooses to and should suffer the consequences, but what about someone who happened to be born to poorer parents?
In the case of healthcare, there are a few known factors that make many chronic health events not random, such as bad diet, lack of excercise, and bad genes. A broken arm might be a sufficiently random event, but what should society do about the non random health losses? What if you were born to poor parents and never had much of a chance to make it so you had a job schedule that allowed you a routine to workout regularly? Or time to cook healthy foods? Or you don’t make enough money to live near grocery stores that sell nutritious foods?
But then at least 70% of Americans are fat. And I see them voluntarily buying large containers of sugar water multiple times a week. Why should I have to pay for their diabetes? Same for a smoker or an alcohol drinker?
It’s a nuanced topic that makes me wonder what freedom is and how much freedom can cost. Am I restricting freedom by not wanting to pay for others’ actions known to cause certain losses? Should people be restricted from certain actions if they can’t afford the losses, therefore restricting their freedom? Can they even be restricted, logistically?
How do you know which accelerometer-measured[1] parameters correlate with aggressive driving? High speeds? Abrupt acceleration? Hard acceleration? Abrupt braking? Hard braking? Late braking (how do you know the difference?) High lateral cornering loads? How are these differentiated from abrupt lane changes? Does the dongle know if you used your signal or not?
Studies show that driving late at night is far riskier than driving during daytime; due to visibility, alcohol, etc. Lots of late night trips? Time to punish that graveyard shift ER doctor for driving her car at such risky times!
1. Presumably most of these OBD-II dongles really only use accelerometer data to report back, even though they have access to more data if they want it, and if they're programmed to understand every model of vehicle
I don’t, but insurance companies employ some pretty smart people who can figure that out. If they offer discounts for certain driving characteristics, I’m willing to bet that they reduce the insurer’s expenses. Otherwise they won’t be in business for long.
The only incentive to get it "right" is that, if they do a really poor job at this, they will lose business to insurance companies that do a better job at it -- again, to the extent that the differences between insurers are significant, that customers are price sensitive, aware enough to shop around and compare the actual rates they pay, etc.
We already know that your non-tracker-based insurance premiums may vary wildly from one insurer to another. One may penalize you heavily for being 18. One may offer a larger discount to those who complete driver's ed courses, or own a car with airbags.
Maybe you'll be penalized for that first accident or ticket, or maybe your insurance company will give you some leeway (and, presumably, double down on the surcharge after your second accident).
I don't see how it's inherently obvious that an insurer that gets their tracker-based metrics 'wrong' will go out of business in short order. Again, all they have to do is charge more than they pay out in claims and overhead.
This already happens of course. Auto insurance (and I assume other property insurance) varies based on where your auto is garaged (by a lot).I live in an exurban town. I assume my insurance would be 2x-3x is I lived in Boston.
But when randomly distributed loss hits you'll surely expect to be subsidized by others who somehow weren't affected by this despite their aggressive driving, or bad diet, etc.
> bad diet, lack of excercise, and bad genes
Now imagine the fun times when your insurer decides which one they can use to screw you over and how badly.
Sure, I get your point but it's buried in a mountain of nuance that makes the "straight forward logic" meaningless. The insurance industry doesn't need yet more ways to screw people over, or give the people who need it most an even bigger middle finger and hang them out to dry.
I would say I'm exactly the opposite. The less data the state has about me the better.
In reality it's probably more a concern about anyone having too much data. I don't mind different organisations having little bits but I get concerned when people want to bring it all together.
This seems to me the wrong mentality. What you ultimately care about is the leverage you have over the entity holding your data. In most cases you have more leverage over the state via voting and lobbying.
> it's probably more a concern about anyone having too much data
I agree. The issue is what you give up when you let people have that data, and how to mitigate those downsides.
> I don't mind different organisations having little bits
Sure, but realistically that's not how it will work. The point of gathering all the health data is that it's valuable to provide your health information to other businesses. This is specifically called out in the article, with the example about the gym and your doctor.
> but I get concerned when people want to bring it all together.
Bringing it all together is the whole idea. Apple may not literally give the raw data to anyone, but they will do what is functionally equivalent. They'll provide an API for third parties to make business decisions about your individual health. There is no way to do this is a privacy-preserving way.
I would argue the exact opposite. I've always found private companies to be far more responsive to my needs than government.
This isn’t meant to be a partisan statement, more to the point of how the voting system works in the US.
Besides that, people aren’t going to vote based on privacy. All a politician has to do is tell “terrorism” or “think about the children” and they can pass anything they want.
Not to mention that most regulations come via agencies run by unelected officials and judges are unelected and have a lifetime appointment.
I do agree though, health care data handling is probably too niche to get people diselected, most voters are going to be more woried about other issues.
Pretending there was a popular vote when there wasn't is like claiming whichever team scored the most points during a series of games won the series dispite the fact that the series is decided based on which team won the most individual games (although some tournaments do include total points scored as a tiebreaker).
The fact that the popular vote is ignored because of how the system is designed is the entire point.
Without arguing if it's a good or a bad thing, we do not have a popular vote, and summing the votes of the individual contests is not a meaningful estimation of what the results would be if we did. If someone wants to take the time to make a nuanced estimate, with consideration of how turnout might change and what results we might see, that would make for an interesting discussion, and I'm sure we'd all have fun arguing over the details of the assumptions and the results.
How is this leverage at all? Apple doesn't have my health data. I have a device produced by Apple that allows me to store and share health data conveniently. The state has the unilateral authority to use violence against me. I have very very little leverage on the state vs a company that sells me a glorified filing cabinet.
> The point of gathering all the health data is that it's valuable to provide your health information to other businesses. . . They'll provide an API for third parties to make business decisions about your individual health. There is no way to do this is a privacy-preserving way.
The point is that's valuable to me, the person who the data is about. Apple already has a. privacy preserving model all they to do is follow their current model. Collect all that data for me, the person who the data is about, store it on my device, and allow me, the owner of said data to provide it to whoever I see fit. This allows me to get the best of all worlds. I have this amazing resource that tracks my activity, diet and environmental exposures and various clinical health metrics across many different information streams. If I want to share my workout routine with my insurance company to get a discount I can decide to do that, if I want to show only my doctor i can pull it up during a visit and show him. If I want to share my Xrays or medications with my personal trainer I can likewise make that decision. There is no reason for me to think that Apple will implement an API here for mass data exports because there is no reason too, I can send the data on a case by case basis. And if Apple changes their privacy policy, which I honestly find unlikely, I can delete and walk away.
Why would you trust the state with anything? Didn't the UK govt sell health data to a Google owned company?
The 'Google owned company' was given access to more sensitive health records than they should have with a NHS trust and was found to be illegal. [0]
[0] https://www.newscientist.com/article/2139395-google-deepmind...
I'm all for putting a better system in place, but meanwhile, I'd rather have my health data being in state own institutions that I feed from time to time with my visits, than having an always on monitor that streams directly my life to a for profit company.
But to be honest, I don't want to stream my life to any entity.
I don't want anyone collecting data on me - I should be in charge of disclosing the information - there is an adage in the PED community - if you mention steroid use to your physician and it gets on your record the next time you brake a bone or catch a cold it's going to be "steroid related". Probably the same shit for rec drugs or regulated nootropics.
Yeah, and likely they will treat you differently, and not consider that in outcome analysis. If you badger people about [negative health factor] every time they come in, they're not going to come in early, and you're going to blame the resulting poor outcome on the factor, not the behavior induced by the system. /rant.
I'm not French, and also feel the same way. It can also due to the fact that is is the center of all the political focus and other stuff. In general US has worse data protection polices than other developed nations (of course still better than country like China).
But they are not meant to be connected to a home base.
I don't carry them with me all the time, while they are measuring and streaming metrics about my life.
TBH can we trust the current gov. to do the right thing:
- In terms of competency: it took how many weeks to come up with an online form to generate a PDF ?. Then their contact tracing app hits all the limitations that motivated Apple and Google to work on an integrated solution, which then again means its effect will be super limited and people just don’t bother installing it.
- in terms of legitimacy: a lot of messaging and decisions caused litteraly hundreds of death for stupid or corrupted reasons. Like delaying lockdown because there wasn’t enough contaminated people. I mean, even at this point wearing a mask in public is still officially touted as some “perhaps you do perhaps you don’t” kind of behavior.
I really wonder if at this point the gov. is as motivated to keep people alive as some of the global companies.
(full disclosure, I've been working the the health sector for a while making new applications using Apple's HealthKit.)
I would like to share some data with my doctor and insurance but I want that under my control.
EDIT: just wanted to add that I am also in general deathly against IoT devices re: tracking. I read Surielance Capitalism and took the book seriously.
And even if they don't sell the data it will still be a huge attraction for all kinds of black-hats.
Also, at least democracies have formal mechanisms for holding governments accountable, even if these mechanisms are often corrupted or flawed.
Living in a democracy means you have options beyond “voting with your feet”.
Look at the history of how the government treats minorities (racial, religious, non straight, etc)
But I feel like this is kind of outside scope of what we were talking about? The US is a flawed democracy, no doubt, and some political scientists argue it no longer functions as a democracy, but, it is still, both formally and somewhat in practice, a democracy.
I wouldn’t trust the American Government with any more power than they have now. It’s not just contempt for the current government, but it wouldn’t matter which party were in power.
There's no price transparency and there's no recourse for abuse or selective targeting.
https://www.nytimes.com/2020/06/12/us/politics/trump-transge...
What's the recourse when that action is hidden away behind some algorithm by a private corporation?
See for example - “at least we now know that minorities are getting beat by the police now that it is getting filmed” ignoring the fact that it was happening for decades and no one believe it.
I completely agree with you, but I also have my doubts about governments as well. This leaves only the option of my health data being controlled by myself.
That's a very April 1940 French perspective
I have a hard time letting the state amass more data from people.
> Anytime you associate health with financial motivation, you end up with something twisted on the long run.
Well, the state is not some objective, incorruptible entity without any ulterior motives. You end up with something twisted even when you let the state handle health data. The key is for individuals to decide how, where, when and what they want to share and provide enough control and literacy on why this is important. Unfortunately, too many people get lost in who should or shouldn't get some data and miss the point of maintaining one's freedoms.
Anything cloud is government property, just like all financial data. Now, if your health data starts in state owned DBs, like say in Germany, there is a fighting chance the data will stay in Germany.
Once it is in a global cloud like AWS, GC, Azure? Any major government has access.
China bought so much data already, and with recent enforcement of their Cybersecurity laws, all data touching their citizens is fair game. Oracle pulled out of China, other like AWS go the route of joint ventures to continue operating.
I wonder why you say that. Is it because apple has been pushing the "privacy is a right" dialog and that somehow makes apple more trustworthy, right now?
Because I think apple is, right now, playing both sides of the privacy game.
for instance, all the blockers they allow are opt-out rather than opt-in.
Actually all their data choices are opt-out. I think they know statistically that nobody would willingly opt-in, so for business advantage (and fear?) that's what they do.
IHMO any data collected, whether "anonymized" or not, can be used against people and the human race so it should be opt-in. And opt-in should not be cleverly engineered into a faustian bargain.
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-atria...
Also there's a lot more urgency when an algorithm detects an anomaly and asks you to schedule a blood test!
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.
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.
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.
> Remember, the Watch and the iPhone can do machine learning on the device.
Great, what is the machine learning?
Regarding on device machine learning: https://developer.apple.com/machine-learning/
1. What valuable question was this data answering?
2. What is the machine learning?
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...
https://www.apple.com/healthcare/docs/site/Apple_Watch_Arrhy...
An OS with a focus on health seems to make a lot of sense.
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.
Also, to counter one of your arguments above, Apple Health doesn't do a lot of analysis on third party data short of showing it in charts, so there is still value to using Whoops app for that aspect of it.
As an example, my scale is Whithings, my bed had a Beautyrest Sleeptracker both of these services consume and contribute to Apple Health.
It's a company, it doesn't and cannot care about anything other than profit.
It can care about whatever those people choose to care about.
I am guessing you might be young and may not be aware of history of corporations.
If Whoop doesn’t, that is surely a choice Whoop made.
http://longnow.org/seminars/02018/oct/29/toward-practical-te...
Traditionally, these data sets have lived in silos.
But what could happen if it all was aggregated safely
in one place?
The battle's barely been started for self determination and self ownership of our data.
> their servers
As novel as the Xserver might have been, let's not pretend it was anything more than an unimaginably small surface area for a product
Apple makes well-designed products, mostly. But let's pump the brakes on the idea that everything that comes out of Cupertino is flawless, as you seem to imply.
Who else is doing what they're doing? No other consumer hardware company goes top-to-bottom from the software to the chip, and no other company has such a cohesive ecosystem. Google EOLs a product once a week, Microsoft is making some nice stuff these days, but is nowhere near the same experience ("Windows is like a bundle of drivers", as in the article).
There is value to being prescriptive over their platform. It gives them skin in the game to make things good; they are much less willing to just blame a vendor.
The biggest area of improvement in health care is at the cheaper end. Many people die annually from being unable to afford the $2.50 it costs for malaria treatment, or life saving vaccines.
The side dish problem is vaccines are insanely profitable; every dollar spent in the US on vaccines supposedly saves fifteen bucks of health care expense. I've seen numbers as low as $10 and as high as $15000. The problem is some very populous political and economic regimes worldwide are so unstable that even 1500% rate of return investments, which would seem a no brainer to fund in the west, are impossible without massive external western involvement. In a system that dysfunctional, malaria might not be the biggest problem, nor incredibly expensive and short lived apple iHealth devices. We've tried allowing infinite immigration from failed states into western states; that didn't help either. Just brain drain's the failed states while exploding welfare expenses in the western states.
Moreover, if the existing medical industry is evidence of anything, prices are jacked up in developed countries to foot the bill of R&D, and the same medications are sold elsewhere for next to nothing.
Apple giving away health technology to disadvantaged communities seems like a good next step. Perhaps existing medical companies aren’t as incentivized to do that because they don’t have the shiny brand to advertise.
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-bu... [1] https://www.healthit.gov/topic/information-blocking
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_...
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.
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-f...
You really don’t want to build an EHR if you can avoid it.
Santosh Kumar has been heading a large NSF research center investigating wearable medical sensing and how to turn sensor data into actionable health advice:
Tanzeem Choudhury has been doing some work at the intersection of AI and sensing and health:
Deborah Estrin's Small Data Lab is doing some interesting work too:
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 )
It's important that our data systems handle open-world rather than closed-world data, eh? 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
> 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.
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
There are other ongoing large scale projects collecting health data also:
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
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.
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.