8 ms·

Why are doctors wary of wearables?

33 points by NN88 2y ago

AIFounder 2y ago
[dead]
- FireBeyond 2y ago
  Yikes. I'm a paramedic. I have a history of diverticulitis and kidney stones. I inputted my symptoms from this weekend: left flank abdominal pain, 3/10 severity, episodic, just out of curiosity: > What you described are symptoms associated with hepatitis b, malaria, typhoid fever, Colon and rectal cancers I don't think this is going to improve hypochondria. I added in 'nausea', per the agent's request to expand on my symptoms: > Your symptoms are strongly associated with hepatitis b and malaria. Consider visiting a healthcare professional for further diagnostics. Oof.
  - hyeonwho4 2y ago
    Looks like neither of those conditions are in the database of recognized diseases: https://chatdoc-xi.vercel.app/disease https://chatdoc-xi.vercel.app/disease Which is probably a sign that further development is needed.
    - FireBeyond 2y ago
      When you first open the app: "Try this: generate a 7 day meal plan to support weight loss goals" Sure, let me try that... > What you described are symptoms associated with stomach ulcer Huh. Yeah, definitely further development needed! > Looks like neither of those conditions are in the database of recognized diseases I didn't even initially see this, as the menu by default doesn't have a "Diseases" option until you switch to text mode and then revisit the menu!
      - AIFounder 2y ago
        You switched to text mode immediately? You're supposed to click on the "wake up" button in order to interact with the AI assistant using your voice. Switching to text mode will only take you to the symptom checker, and it's clearly stated on there that "You are using ChatDoc's symptom checker. This is not a GPT." The reason the menu by default didn't have a diseases option is because at that point, you were using the AI assistant model, NOT the symptom checker. The symptom checker is the model which has the list of diseases in the database.
        FireBeyond 2y ago
        I can see that, and it makes sense. But could do with being more clear. While it does say "this is not a GPT", it doesn't particularly imply, especially to the less informed user, that the symptom checker is (I assume) a more straightforward tree-like search. As a healthcare provider, can I -strongly- suggest that the symptom checker doesn't make such ... provocative ... inferences, disclaimers or not, especially after only a round or two of questions. "I have left flank abdominal pain" shouldn't be met with "this is a symptom associated with ... [typhoid fever and cancers]". This is guaranteed to be fear-inducing. Ironically, if you're tuning this for "potentially serious conditions", it's amplified. Even though you are trying to do a positive thing - flag concerns for followup with a HCP - the more serious the shortlist of conditions, the more serious the shortlist of possibilities becomes, and the absence of milder or relatively benign conditions is going to alarm people. They're not going to think "Oh, I was thinking it might be [minor abdominal condition] but now this thing is telling me to be mindful of these life threats!" I'm always interested to see this kind of tooling, and it is clear that this is a work in progress. But I also wanted to give you "civilian" perspective (in my case, it was most likely a mild episode of diverticulitis, though my initial concern was a kidney stone). I have no idea of your medical qualifications, so please don't take this condescendingly - I mean it sincerely (to the point where I vouched for your comments, as you appear to be 'dead'). But at a bare minimum, consider the SAMPLE-OPQRST methodology for gleaning some insights, before looking at potentials. SAMPLE-OPQRST is taught to EMTs and paramedics (I myself teach it as an instructor and evaluator in EMS) as a baseline history-gathering tool. SAMPLE refers to Signs/Symptoms, Allergies, Medications, Pertinent medical history, Last oral intake, Events leading to present illness ("what prompted you to call 911?"). OPQRST allows you to delve more into each Symptom. Onset - did it come on quickly or gradually? Provocation - does anything make it better or worse? Quality - how would you describe the feeling of this symptom? Radiation - is the feeling (not "the pain", though it can include this) localized to one area, or does it spread? Severity - pain scale, 1-10. Time - how long have you had this symptom?
- nradov 2y ago
  Peter H Diamandis doesn't understand anything about AI or medicine beyond the most superficial stuff. We have had clinical decision support systems for decades that produce good accuracy for diagnosis. This doesn't particularly require ML or LLMs or neural networks or any of the recent AI hype technologies. Older, simpler statistical techniques work just fine. However, these existing CDS have never become part of the standard of care because there isn't much evidence that they improve patient outcomes. Most diagnoses are fairly straightforward and don't require a CDS to get it right. In order for a CDS to really shine in the rare "zebra" diagnoses it takes a lot of extra work for clinicians to do data entry, and they don't have time for that.
  - AIFounder 2y ago
    I think he might. He has an MD attached to his name after all. But I'm pretty sure the AI he's specifically referring to is something in relation to large language models, or he's simply just unaware that the technology you mentioned is being used at present.
- janniehater 2y ago
  [dead]
robertlagrant 2y ago
There is definitely a world in which various sensors send data somewhere and a thing crunches the numbers and figures out you have a trend to somewhere bad. It's just the doctors were trained in a world before sensors, and they're understandably wary of people googling symptoms, and sensors aren't that good, and the software is limited, and we as regular humans aren't used to understanding this sort of information about ourselves. The only question is: are we going to go back to a world without wearables, and the potential benefits and drawbacks they bring? Or are we going to improve them and adapt ourselves to them?
pie420 2y ago
the answer, as always, is hypochondria. i used to be a hypochondriac and it is crazy how much more im seeing my peers have hypochondria
- neom 2y ago
  I know a few folks who tend towards hypochondria, curious what changed for you? I feel like the people I know who I'd consider hypochondriacs^, are going to be like that forever. ^I'm not a doctor
  - wrp 2y ago
    Personal anecdote from knowing a few cases. It seemed to result from too much time alone and ruminating. Getting out and doing stuff with people made their hypochondria fade into the background.
NoPicklez 2y ago
The problem is people having devices monitor different metrics of their body without the knowledge to know what to do about what they see. As mentioned in the article, wearables monitoring heart rate variability do quite a good job of telling people ahead of time that your body might be trying to fight something. During covid devices monitoring HRV would spike before people started to present with the symptoms of COVID-19. Monitoring every aspect of your body and going to the hospital at any sign of "out of baseline" metrics is silly. There will always be a group of people that get a "high heart rate" notification and think its an emergency, or start to make generalised diagnosis of issues.
- smileysteve 2y ago
  This is the premise of the issue that the author assumes, that doctors are somehow gatekeeping a cure to the common cold/flu -- a premise which is generally untrue. But, as the author's example, a cold/flu; is not generally useful to doctors, because doctors can not fight a cold. At worst, they get more visits from people with colds in their waiting rooms, are pressured into over prescribing antibiotics - which impact the individual's gut biome and society's antibiotic resistance. What's extremely odd, is an article like this in the time of telemedicine; advantageous because it uses less of a provider's time, is typically lower cost, and reduces chance of office visit infections; and of which there are very few actionable outcomes.
  - NoPicklez 2y ago
    Humans are complex in their emotions, they might see a metric on their wearable device that alarms them that shouldn't and they visit a hospital out of concern. People who are more "hypochondriacs" might be more likely to buy wearables and hawk eye anything that becomes out of baseline. You can't likely help those people unless you address their underlying sensitivity to their health. At the end of the day, smart devices have made people more aware of their bodies particular vitals and therefore will create more people asking for help out of concern, of which for the majority isn't likely to cause anything of concern
- tzs 2y ago
  > As mentioned in the article, wearables monitoring heart rate variability do quite a good job of telling people ahead of time that your body might be trying to fight something. During covid devices monitoring HRV would spike before people started to present with the symptoms of COVID-19. I think the article was talking about changes in heart rate, e.g., increases or decreases in the beats per minute. It certainly makes sense from an English point of view to call that heart rate variability but it turns out there is an actual medical term "heart rate variability" (HRV) that means something a little different. Heart rate: count the number of beats in a minute. Heart rate variability: how the beat to beat interval changes. So say if you have a rate of 60 beats per minutes the average time between beats will be 1000 ms, but the actual times will vary around that. HRV is a measure of that variation. Some wearables do track both rate and HRV.
smileysteve 2y ago
> would the data from my wearable have helped healthcare professionals with my treatment? This presumes doctors practicing medicine 2.0 have any effective treatment. For the flu, sure there is tamiflu; or COVID, paxlovid; but absent those 2, for the short term interference; the best options are somewhere between zinc lazenges, creatine, water, and sleep. Both the flu and COVID now have vaccines, which are more effective and preventative than interfering treatments. Anti-biotics should, generally, rarely be given at early stage, unless there are significant factors, as they have both individual and population level side effects. Now, can a glucose monitor or testing cortisol or liver proteins more often tell you something? Yes, but not with much more actionable items than eat healthy, work out, sleep more, drink less (Yes, there is hrt, glp1s - but those are unlikely to be prescribed if the issue is not significant over a longer term)
- thedrbrian 2y ago
  >This presumes doctors practicing medicine 2.0 have any effective treatment. For the flu, sure there is tamiflu; or COVID, paxlovid; don't know if you were being intentionally sarcastic when naming those two as effective treatments >How effective is Tamiflu? Unfortunately, the effectiveness of Tamiflu is marginal, as it cannot “cure” the illness. Most studies have shown that the medication will reduce the length of symptoms by only 12 to 24 hours, and if started after two days of symptoms, it does not help at all. It is important to keep effectiveness in mind, as expectations for Tamiflu are often very high and, frankly, overhyped. https://health.mountsinai.org/blog/is-it-worth-it-to-take-tamiflu/ https://health.mountsinai.org/blog/is-it-worth-it-to-take-ta... >Paxlovid does not significantly alleviate symptoms of COVID-19 compared with placebo among nonhospitalized adults, a new study published on April 3 in The New England Journal of Medicine found. The results suggest that the drug, a combination of nirmatrelvir and ritonavir, may not be particularly helpful for patients who are not at high risk for severe COVID-19. https://www.medscape.com/viewarticle/study-shows-nirmatrelvir-ritonavir-no-more-effective-than-2024a10006gb https://www.medscape.com/viewarticle/study-shows-nirmatrelvi... which links to https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 and this little nugget >CONCLUSIONS The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir–ritonavir and those who received placebo.
whoomp12342 2y ago
because they are gimmicks and its fair to be wary of gimmicks
- timrichard 2y ago
  I don't think so. I upgraded my Fitbit to a Fitbit 5 when I started getting arrhythmias a few years back. I used the ECG capture whenever I felt something was wrong. As the irregular beats graduated into episodes of what the medics identitied as SVT (due to a worsening thyroid, as as it transpired at a later point), I captured each trace. I brought the printout of the PDF to the GP, who ordered some blood tests and referred me to cardiology. The cardiologist wanted me to email the PDF traces too as a starting point. Nobody treated it as a gimmick; in the early stages it was the difference between data and no data, because the episodes had been unpredictable.
rapjr9 2y ago
I worked in research on wearables for more than a decade, including research with medical doctors. The number one reason we got from doctors about not using wearable data was that they didn't know what to do with it, what it meant. If blood pressure is too high when they've had you sit still for a while and taken a measurement in their office with their machine, they know how to interpret that. If you show them a continuous blood pressure trace from a persons whole day, they have no idea what to do with it. How much should your BP go up when you are doing something strenuous? How much should it go down when you sleep? They don't know. The volume of data also dismayed them. Present a years worth of heart rate data and who has time to look through it all and understand what it means? You need to know the context of the readings, what the person was doing, what was going on in the environment, even what the person was thinking, and wearable data comes with little context (mainly just accelerometer and gyro data, but it can't tell if you are eating dinner or watching tv or typing on a keyboard). The UI's for looking at the long term data are terrible, and it requires a lot of processing power to get a reasonable response time, and there is no ability to query the data, such as looking for time-offset correlations between one type of reading and another. The data just is not very usable without context. A person looking at their own data for the day remembers the context, what they did that day, but how about a month ago? A year ago? Sensor accuracy still needs improvement also (e.g., did your body temperature go up today because you're getting sick or because you spent the day outside when it was hot instead of staying inside in the air conditioning? If the sensor is affected by ambient temperature there is no way to tell.) Wearable health sensing is good enough to be somewhat useful to an individual, but it needs to be developed a lot more to be useful to a doctor (though it can provide clues that are useful sometimes). There need to be a lot of RCT's to understand just what the data means, what is normal for a person, what indicates a problem. There is also the fear that if the doctors help develop this technology it will replace a lot of their diagnostic function. That could be good, but it could also result in everyone trusting the machine's decisions rather than looking at what is actually happening with the person. To give an example, a wearable might indicate a sudden change in gait for an elderly person. Is that a sign of mental decline? Muscle deterioration due to age? A stroke? Or were they playing baseball two days ago with a grandchild and injured themselves? New shoes? It could be any of these and more besides. If the machine does not evaluate all the possibilities it can only choose from the ones it does implement, which raises the likelyhood it will be wrong.
nextworddev 2y ago
Doctors are obsessed with job security
- nradov 2y ago
  Doctors don't worry much about job security. Unemployment rate for licensed physicians is ~0% and demand is growing faster than supply. Greater use of wearable devices will only create more work for them, not less.
  - nextworddev 2y ago
    Do you know doctors IRL?
    - nradov 2y ago
      Yes
snitzr 2y ago
While I'm sure a wearable could be occasionally useful or even save a life, most don't do much. It's telling that mainstream fitness wearables tout their data collection ability but never use this data in marketing to prove they make people healthier. I think most fitness wearables are cashing in on pseudo medical device branding as a way to charge hundreds of dollars for electronics that cost very little to manufacture. I'd be wary of those kinds of devices if I were a doctor.
- teitoklien 2y ago
  Both whoop band and Apple Watch + https://bevel.health https://bevel.health plus a bunch of other fitness apps, give awesome abilities to folks, to improve their sleep, balance their energy cycle, reduce injuries by knowing when to rest more for recovery. - Sleep - Properly recovering each day for Consistent Cardio - Stress minimisation with Tracking Triggers/Causes, Foods These things alone are monumentally impactful in increasing longevity and health, more than any current available medicine, or therapy. Just these 3 factors alone. And fitness bands combined with effective apps that make use of these metrics, do a pretty darn good job already to improve all these 3 critical factors that allow you to - Live a healthier day - Perform better at work - Identify and mitigate causes that hurt your sleep (bad sleep -> bad day) - Balance exercise with recovery - Managing stress levels and making healthier choices
  - tptacek 2y ago
    The sleep monitoring in particular is complicated: monitoring and especially alerting on sleep quality can exacerbate insomnia.
    - bobthepanda 2y ago
      strictly speaking, I think apnea monitoring as done on the Apple Watch is pretty non-invasive and not too bad. One thing that ended up being really noisy and irritating was a continuous glucose monitor. It turns out it's possible to stick those things in you in a way that can false alarm blood sugar drops during your sleep, at which point your CGM app freaks the hell out and wakes you up.
wavedynamics 2y ago
[dead]
int_19h 2y ago
Are they wary of wearables? Whenever I go to a specialist these days, I usually see an Apple Watch on their wrist.
- tptacek 2y ago
  The premise of the story is that doctors are worried that people are over-monitoring raw health details, not that doctors are worried that OLED screens are replacing jeweled watch movements.
lifeisstillgood 2y ago
So I have high blood pressure (middle age it seems sucks), and have been under a cardiologist for 18 months. The first thing he said was “this wearable is good”, so of course I bought it and it’s been on my wrist consistently. The company is legit but has made considerable effort not to allow the data out of their eco-system (exports only to pdf, no ability to send to Apple Health etc). So I notice that I send a quarters worth of pdfs to the doctor, whose secretary prints them out and he flips through them with a strange expression trying to work out what’s going on. I have taken a few frustrating lunchtimes to parse out the pdfs and have gotten to the point I can get the data and graph it - but what to usefully do with it is interesting Company: Aktiia - look for mikado-aktiia on github
- ewoodrich 2y ago
  Out of curiosity, what is the value in constant heart rate measurements your doctor sees? I have taken blood pressure meds for about a decade now and don't think that's ever been suggested for me but also my PCPs never acted particularly considered about my high BP readings given my age for a long time. I kinda had to self advocate for meds that (mostly) control it. I was hoping losing a lot of weight (now in the normal range) would help but still seem to need the meds and by all indications I have a consistently high heart rate which concerns me a bit as I get older.
  - lifeisstillgood 2y ago
    Agreed on the “how do I fix this” issue - I run about four miles a day which I hoped would help, and need to lose more weight but it seems mostly “middle age - cannot be fixed only managed” As for the constant monitoring - I don’t know. I think he would be happy with weekly manual blood pressure or something - because as someone points out downthread, that’s what is comparable ans what has decades of medical experience (research/ empirical experience) But one believes that monitoring more is going to lead to more effective or earlier decision making.
ashoeafoot 2y ago
Author should have induced a artificial ahead of time fever. Sauna, hot bath, insulation (bed rest well wrapped). Go all in, guns blazing before it goes all out.

33 points by NN88 2y ago

AIFounder 2y ago

[dead]

FireBeyond 2y ago
Yikes. I'm a paramedic. I have a history of diverticulitis and kidney stones. I inputted my symptoms from this weekend: left flank abdominal pain, 3/10 severity, episodic, just out of curiosity: > What you described are symptoms associated with hepatitis b, malaria, typhoid fever, Colon and rectal cancers I don't think this is going to improve hypochondria. I added in 'nausea', per the agent's request to expand on my symptoms: > Your symptoms are strongly associated with hepatitis b and malaria. Consider visiting a healthcare professional for further diagnostics. Oof.
- hyeonwho4 2y ago
  Looks like neither of those conditions are in the database of recognized diseases: https://chatdoc-xi.vercel.app/disease https://chatdoc-xi.vercel.app/disease Which is probably a sign that further development is needed.
  - FireBeyond 2y ago
    When you first open the app: "Try this: generate a 7 day meal plan to support weight loss goals" Sure, let me try that... > What you described are symptoms associated with stomach ulcer Huh. Yeah, definitely further development needed! > Looks like neither of those conditions are in the database of recognized diseases I didn't even initially see this, as the menu by default doesn't have a "Diseases" option until you switch to text mode and then revisit the menu!
    - AIFounder 2y ago
      You switched to text mode immediately? You're supposed to click on the "wake up" button in order to interact with the AI assistant using your voice. Switching to text mode will only take you to the symptom checker, and it's clearly stated on there that "You are using ChatDoc's symptom checker. This is not a GPT." The reason the menu by default didn't have a diseases option is because at that point, you were using the AI assistant model, NOT the symptom checker. The symptom checker is the model which has the list of diseases in the database.
      - FireBeyond 2y ago
        I can see that, and it makes sense. But could do with being more clear. While it does say "this is not a GPT", it doesn't particularly imply, especially to the less informed user, that the symptom checker is (I assume) a more straightforward tree-like search. As a healthcare provider, can I -strongly- suggest that the symptom checker doesn't make such ... provocative ... inferences, disclaimers or not, especially after only a round or two of questions. "I have left flank abdominal pain" shouldn't be met with "this is a symptom associated with ... [typhoid fever and cancers]". This is guaranteed to be fear-inducing. Ironically, if you're tuning this for "potentially serious conditions", it's amplified. Even though you are trying to do a positive thing - flag concerns for followup with a HCP - the more serious the shortlist of conditions, the more serious the shortlist of possibilities becomes, and the absence of milder or relatively benign conditions is going to alarm people. They're not going to think "Oh, I was thinking it might be [minor abdominal condition] but now this thing is telling me to be mindful of these life threats!" I'm always interested to see this kind of tooling, and it is clear that this is a work in progress. But I also wanted to give you "civilian" perspective (in my case, it was most likely a mild episode of diverticulitis, though my initial concern was a kidney stone). I have no idea of your medical qualifications, so please don't take this condescendingly - I mean it sincerely (to the point where I vouched for your comments, as you appear to be 'dead'). But at a bare minimum, consider the SAMPLE-OPQRST methodology for gleaning some insights, before looking at potentials. SAMPLE-OPQRST is taught to EMTs and paramedics (I myself teach it as an instructor and evaluator in EMS) as a baseline history-gathering tool. SAMPLE refers to Signs/Symptoms, Allergies, Medications, Pertinent medical history, Last oral intake, Events leading to present illness ("what prompted you to call 911?"). OPQRST allows you to delve more into each Symptom. Onset - did it come on quickly or gradually? Provocation - does anything make it better or worse? Quality - how would you describe the feeling of this symptom? Radiation - is the feeling (not "the pain", though it can include this) localized to one area, or does it spread? Severity - pain scale, 1-10. Time - how long have you had this symptom?
nradov 2y ago
Peter H Diamandis doesn't understand anything about AI or medicine beyond the most superficial stuff. We have had clinical decision support systems for decades that produce good accuracy for diagnosis. This doesn't particularly require ML or LLMs or neural networks or any of the recent AI hype technologies. Older, simpler statistical techniques work just fine. However, these existing CDS have never become part of the standard of care because there isn't much evidence that they improve patient outcomes. Most diagnoses are fairly straightforward and don't require a CDS to get it right. In order for a CDS to really shine in the rare "zebra" diagnoses it takes a lot of extra work for clinicians to do data entry, and they don't have time for that.
- AIFounder 2y ago
  I think he might. He has an MD attached to his name after all. But I'm pretty sure the AI he's specifically referring to is something in relation to large language models, or he's simply just unaware that the technology you mentioned is being used at present.
janniehater 2y ago
[dead]

robertlagrant 2y ago

There is definitely a world in which various sensors send data somewhere and a thing crunches the numbers and figures out you have a trend to somewhere bad. It's just the doctors were trained in a world before sensors, and they're understandably wary of people googling symptoms, and sensors aren't that good, and the software is limited, and we as regular humans aren't used to understanding this sort of information about ourselves. The only question is: are we going to go back to a world without wearables, and the potential benefits and drawbacks they bring? Or are we going to improve them and adapt ourselves to them?

pie420 2y ago

the answer, as always, is hypochondria. i used to be a hypochondriac and it is crazy how much more im seeing my peers have hypochondria

neom 2y ago
I know a few folks who tend towards hypochondria, curious what changed for you? I feel like the people I know who I'd consider hypochondriacs^, are going to be like that forever. ^I'm not a doctor
- wrp 2y ago
  Personal anecdote from knowing a few cases. It seemed to result from too much time alone and ruminating. Getting out and doing stuff with people made their hypochondria fade into the background.

NoPicklez 2y ago

The problem is people having devices monitor different metrics of their body without the knowledge to know what to do about what they see. As mentioned in the article, wearables monitoring heart rate variability do quite a good job of telling people ahead of time that your body might be trying to fight something. During covid devices monitoring HRV would spike before people started to present with the symptoms of COVID-19. Monitoring every aspect of your body and going to the hospital at any sign of "out of baseline" metrics is silly. There will always be a group of people that get a "high heart rate" notification and think its an emergency, or start to make generalised diagnosis of issues.

smileysteve 2y ago
This is the premise of the issue that the author assumes, that doctors are somehow gatekeeping a cure to the common cold/flu -- a premise which is generally untrue. But, as the author's example, a cold/flu; is not generally useful to doctors, because doctors can not fight a cold. At worst, they get more visits from people with colds in their waiting rooms, are pressured into over prescribing antibiotics - which impact the individual's gut biome and society's antibiotic resistance. What's extremely odd, is an article like this in the time of telemedicine; advantageous because it uses less of a provider's time, is typically lower cost, and reduces chance of office visit infections; and of which there are very few actionable outcomes.
- NoPicklez 2y ago
  Humans are complex in their emotions, they might see a metric on their wearable device that alarms them that shouldn't and they visit a hospital out of concern. People who are more "hypochondriacs" might be more likely to buy wearables and hawk eye anything that becomes out of baseline. You can't likely help those people unless you address their underlying sensitivity to their health. At the end of the day, smart devices have made people more aware of their bodies particular vitals and therefore will create more people asking for help out of concern, of which for the majority isn't likely to cause anything of concern
tzs 2y ago
> As mentioned in the article, wearables monitoring heart rate variability do quite a good job of telling people ahead of time that your body might be trying to fight something. During covid devices monitoring HRV would spike before people started to present with the symptoms of COVID-19. I think the article was talking about changes in heart rate, e.g., increases or decreases in the beats per minute. It certainly makes sense from an English point of view to call that heart rate variability but it turns out there is an actual medical term "heart rate variability" (HRV) that means something a little different. Heart rate: count the number of beats in a minute. Heart rate variability: how the beat to beat interval changes. So say if you have a rate of 60 beats per minutes the average time between beats will be 1000 ms, but the actual times will vary around that. HRV is a measure of that variation. Some wearables do track both rate and HRV.

smileysteve 2y ago

> would the data from my wearable have helped healthcare professionals with my treatment? This presumes doctors practicing medicine 2.0 have any effective treatment. For the flu, sure there is tamiflu; or COVID, paxlovid; but absent those 2, for the short term interference; the best options are somewhere between zinc lazenges, creatine, water, and sleep. Both the flu and COVID now have vaccines, which are more effective and preventative than interfering treatments. Anti-biotics should, generally, rarely be given at early stage, unless there are significant factors, as they have both individual and population level side effects. Now, can a glucose monitor or testing cortisol or liver proteins more often tell you something? Yes, but not with much more actionable items than eat healthy, work out, sleep more, drink less (Yes, there is hrt, glp1s - but those are unlikely to be prescribed if the issue is not significant over a longer term)

thedrbrian 2y ago
>This presumes doctors practicing medicine 2.0 have any effective treatment. For the flu, sure there is tamiflu; or COVID, paxlovid; don't know if you were being intentionally sarcastic when naming those two as effective treatments >How effective is Tamiflu? Unfortunately, the effectiveness of Tamiflu is marginal, as it cannot “cure” the illness. Most studies have shown that the medication will reduce the length of symptoms by only 12 to 24 hours, and if started after two days of symptoms, it does not help at all. It is important to keep effectiveness in mind, as expectations for Tamiflu are often very high and, frankly, overhyped. https://health.mountsinai.org/blog/is-it-worth-it-to-take-tamiflu/ https://health.mountsinai.org/blog/is-it-worth-it-to-take-ta... >Paxlovid does not significantly alleviate symptoms of COVID-19 compared with placebo among nonhospitalized adults, a new study published on April 3 in The New England Journal of Medicine found. The results suggest that the drug, a combination of nirmatrelvir and ritonavir, may not be particularly helpful for patients who are not at high risk for severe COVID-19. https://www.medscape.com/viewarticle/study-shows-nirmatrelvir-ritonavir-no-more-effective-than-2024a10006gb https://www.medscape.com/viewarticle/study-shows-nirmatrelvi... which links to https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 https://www.nejm.org/doi/full/10.1056/NEJMoa2309003 and this little nugget >CONCLUSIONS The time to sustained alleviation of all signs and symptoms of Covid-19 did not differ significantly between participants who received nirmatrelvir–ritonavir and those who received placebo.

whoomp12342 2y ago

because they are gimmicks and its fair to be wary of gimmicks

timrichard 2y ago
I don't think so. I upgraded my Fitbit to a Fitbit 5 when I started getting arrhythmias a few years back. I used the ECG capture whenever I felt something was wrong. As the irregular beats graduated into episodes of what the medics identitied as SVT (due to a worsening thyroid, as as it transpired at a later point), I captured each trace. I brought the printout of the PDF to the GP, who ordered some blood tests and referred me to cardiology. The cardiologist wanted me to email the PDF traces too as a starting point. Nobody treated it as a gimmick; in the early stages it was the difference between data and no data, because the episodes had been unpredictable.

rapjr9 2y ago

I worked in research on wearables for more than a decade, including research with medical doctors. The number one reason we got from doctors about not using wearable data was that they didn't know what to do with it, what it meant. If blood pressure is too high when they've had you sit still for a while and taken a measurement in their office with their machine, they know how to interpret that. If you show them a continuous blood pressure trace from a persons whole day, they have no idea what to do with it. How much should your BP go up when you are doing something strenuous? How much should it go down when you sleep? They don't know. The volume of data also dismayed them. Present a years worth of heart rate data and who has time to look through it all and understand what it means? You need to know the context of the readings, what the person was doing, what was going on in the environment, even what the person was thinking, and wearable data comes with little context (mainly just accelerometer and gyro data, but it can't tell if you are eating dinner or watching tv or typing on a keyboard). The UI's for looking at the long term data are terrible, and it requires a lot of processing power to get a reasonable response time, and there is no ability to query the data, such as looking for time-offset correlations between one type of reading and another. The data just is not very usable without context. A person looking at their own data for the day remembers the context, what they did that day, but how about a month ago? A year ago? Sensor accuracy still needs improvement also (e.g., did your body temperature go up today because you're getting sick or because you spent the day outside when it was hot instead of staying inside in the air conditioning? If the sensor is affected by ambient temperature there is no way to tell.) Wearable health sensing is good enough to be somewhat useful to an individual, but it needs to be developed a lot more to be useful to a doctor (though it can provide clues that are useful sometimes). There need to be a lot of RCT's to understand just what the data means, what is normal for a person, what indicates a problem. There is also the fear that if the doctors help develop this technology it will replace a lot of their diagnostic function. That could be good, but it could also result in everyone trusting the machine's decisions rather than looking at what is actually happening with the person. To give an example, a wearable might indicate a sudden change in gait for an elderly person. Is that a sign of mental decline? Muscle deterioration due to age? A stroke? Or were they playing baseball two days ago with a grandchild and injured themselves? New shoes? It could be any of these and more besides. If the machine does not evaluate all the possibilities it can only choose from the ones it does implement, which raises the likelyhood it will be wrong.

nextworddev 2y ago

Doctors are obsessed with job security

nradov 2y ago
Doctors don't worry much about job security. Unemployment rate for licensed physicians is ~0% and demand is growing faster than supply. Greater use of wearable devices will only create more work for them, not less.
- nextworddev 2y ago
  Do you know doctors IRL?
  - nradov 2y ago
    Yes

snitzr 2y ago

While I'm sure a wearable could be occasionally useful or even save a life, most don't do much. It's telling that mainstream fitness wearables tout their data collection ability but never use this data in marketing to prove they make people healthier. I think most fitness wearables are cashing in on pseudo medical device branding as a way to charge hundreds of dollars for electronics that cost very little to manufacture. I'd be wary of those kinds of devices if I were a doctor.

teitoklien 2y ago
Both whoop band and Apple Watch + https://bevel.health https://bevel.health plus a bunch of other fitness apps, give awesome abilities to folks, to improve their sleep, balance their energy cycle, reduce injuries by knowing when to rest more for recovery. - Sleep - Properly recovering each day for Consistent Cardio - Stress minimisation with Tracking Triggers/Causes, Foods These things alone are monumentally impactful in increasing longevity and health, more than any current available medicine, or therapy. Just these 3 factors alone. And fitness bands combined with effective apps that make use of these metrics, do a pretty darn good job already to improve all these 3 critical factors that allow you to - Live a healthier day - Perform better at work - Identify and mitigate causes that hurt your sleep (bad sleep -> bad day) - Balance exercise with recovery - Managing stress levels and making healthier choices
- tptacek 2y ago
  The sleep monitoring in particular is complicated: monitoring and especially alerting on sleep quality can exacerbate insomnia.
  - bobthepanda 2y ago
    strictly speaking, I think apnea monitoring as done on the Apple Watch is pretty non-invasive and not too bad. One thing that ended up being really noisy and irritating was a continuous glucose monitor. It turns out it's possible to stick those things in you in a way that can false alarm blood sugar drops during your sleep, at which point your CGM app freaks the hell out and wakes you up.

wavedynamics 2y ago

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int_19h 2y ago

Are they wary of wearables? Whenever I go to a specialist these days, I usually see an Apple Watch on their wrist.

tptacek 2y ago
The premise of the story is that doctors are worried that people are over-monitoring raw health details, not that doctors are worried that OLED screens are replacing jeweled watch movements.

lifeisstillgood 2y ago

So I have high blood pressure (middle age it seems sucks), and have been under a cardiologist for 18 months. The first thing he said was “this wearable is good”, so of course I bought it and it’s been on my wrist consistently. The company is legit but has made considerable effort not to allow the data out of their eco-system (exports only to pdf, no ability to send to Apple Health etc). So I notice that I send a quarters worth of pdfs to the doctor, whose secretary prints them out and he flips through them with a strange expression trying to work out what’s going on. I have taken a few frustrating lunchtimes to parse out the pdfs and have gotten to the point I can get the data and graph it - but what to usefully do with it is interesting Company: Aktiia - look for mikado-aktiia on github

ewoodrich 2y ago
Out of curiosity, what is the value in constant heart rate measurements your doctor sees? I have taken blood pressure meds for about a decade now and don't think that's ever been suggested for me but also my PCPs never acted particularly considered about my high BP readings given my age for a long time. I kinda had to self advocate for meds that (mostly) control it. I was hoping losing a lot of weight (now in the normal range) would help but still seem to need the meds and by all indications I have a consistently high heart rate which concerns me a bit as I get older.
- lifeisstillgood 2y ago
  Agreed on the “how do I fix this” issue - I run about four miles a day which I hoped would help, and need to lose more weight but it seems mostly “middle age - cannot be fixed only managed” As for the constant monitoring - I don’t know. I think he would be happy with weekly manual blood pressure or something - because as someone points out downthread, that’s what is comparable ans what has decades of medical experience (research/ empirical experience) But one believes that monitoring more is going to lead to more effective or earlier decision making.

ashoeafoot 2y ago

Author should have induced a artificial ahead of time fever. Sauna, hot bath, insulation (bed rest well wrapped). Go all in, guns blazing before it goes all out.