March 12, 2014
The lure of wearable technology and its application to health is tremendous- so tremendous that even the richest company on the planet-Apple, can’t resist it apparently. And so goes the recent insider news that has captured the attention of people worldwide “Apple is developing software and sensors that can predict heart attacks”. Not so fast Apple, not so fast….
As a cardiologist dealing in prevention and clinical research for the better part of the last decade, I will acknowledge that the concept of acoustic devices for measuring flow is not new (ultrasound imaging of the carotid arteries, aorta, peripheral arteries). The coronary artery is however a low pressure flow zone with intervening soft tissue, muscle and the rib cage. Also, it is critical to remember that not all severe blockages cause heart attacks, and many, so-called mild blockages can progress quickly to causing a heart attack from various mechanisms. Scientists have spent the last three decades attempting to identify the holy grail of heart attack prevention, the “vulnerable plaque”, with limited success.
The last few years have seen non-traditional big data players make forays into the healthcare segment. Google with its Google glass and extended applications such as Google helpout, IBM partnering with academic centers and insurance companies to leverage big data and Apple attempting to redefine mobile health monitoring with an A team of fashion designers, medical sensor gurus, sleep researchers, exercise physiologists, and fitness experts working on smart wearables.
I am by no means a pessimist or one to shy away from cutting-edge technology. I use the Alivecor on my phone for EKG screening as appropriate to provide information regarding cardiac rhythm, I encourage our trainees to use handheld echocardiographic devices to supplement their stethoscopes, and many such applications of modern technology to ‘assist’ the practice of good medicine. I might even get the Samsung S5 with its built –in heart rate monitor. I would love for wearable technology such as the iwatch or something similar on the wrist to magically predict heart attacks. Only, I find it hard to make the leap from surrogate information such as heart rate and peripheral resistance, captured from the wrist, to thrombotic occlusion of a coronary artery in the chest! The closest I have seen any technology come to this issue is the CADence device from AUM cardiovascular, which is currently undergoing clinical studies. My worry is that these devices will only swell the ranks of the worried well, increase unnecessary million dollar work ups, lead to unnecessary procedures and add cost to an already overburdened healthcare system.
And finally, a plug for my ilk. Technology has its place and pushes human limits. In medicine however, I firmly believe that it will never be able to fully replace the role played by a flesh-and bones doctor, with years of accumulated experience and judgment, and patients will never cease to want the ‘human touch’ element. That to me is half the battle in managing disease and prevention.
-Dr Sameer Bansilal, Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai and an Attending Physician in the Mount Sinai Cardiovascular Institute.