[oflannabhra]

> The question is are they are going to create millions of unnecessary doctors’ visits from unnecessarily concerned users or are they going to save thousands of lives? My bet is both – until traditional healthcare catches up with the fact that in the next decade screening devices will be in everyone’s hands (or wrists.)

[mikekij]

True! But a similar debate has played out in the mammography space. While routine mammograms have undoubtedly saved thousands of lives, some researchers have concluded that the complications caused by false positives (e.g. infections after a biopsy) may make the net contribution of routine mammograms negative. In other words, any individual is more likely to be harmed by routine mammograms than helped.

I'm not saying that the healthcare features in the new Apple Watch are bad; just that it will be interesting to see what their net contribution to healthcare will be.

[JProthero]

Isn't there a meaningful difference in this case between the consequences of false positives from routine mammograms, or, say PSA testing, compared to detecting Atrial Fibrillation?

False positives will always cause undue distress, and that's a factor worth considering, but the consequences of a false positive from a mammogram or PSA test could be an invasive biopsy, as you point out, or even unnecessary treatment. Wouldn't the consequences of a false positive AF detection typically be much less serious though, such as some additional non-invasive tests? There's a financial and psychological cost to that, but is it really comparable to a false positive indication for cancer, which would be much more difficult to follow up, especially weighed against the benefits of detecting undiagnosed conditions?

When I saw the product launch I shared your concerns about emergency services being inundated with calls from watches detecting falls, but apparently the chief executive of the US National Emergency Number Association isn't concerned. He said this about it:

“These are the real beginnings of exciting innovation. I don’t see, at least initially, an overwhelming number of false positives coming in. But only time will tell.”

https://www.bbc.com/news/technology-45518040

[oflannabhra]

In your example, what is the measure for determining that routine mammography is net-negative? By what measure is "any individual more likely to be harmed" determined?

I totally understand the caution medical boards use when crafting their recommendations. However, I don't think consumer access to medical screening equipment is similar. In fact, I think that empowering consumers and patients to be more in control of their medical decisions is vastly net-positive, and as the article points out, the healthcare industry is going to need to adapt to it.

[DanBC]

> By what measure is "any individual more likely to be harmed" determined?

Do mammograms detect cancer? Yes.

Do mammograms lead to reductions in all cause mortality? Probably not, no.

There's a bunch of stuff where we use proxy measures when we should be using different measures (all cause mortality; days lost to disability; QALYs).

> However, I don't think consumer access to medical screening equipment is similar. In fact, I think that empowering consumers and patients to be more in control of their medical decisions is vastly net-positive, and as the article points out, the healthcare industry is going to need to adapt to it.

You get a scan. It shows a lump. What do you do? Most people say "get a biopsy", which is ok if we're saving lives or reducing days lost to disability, but if we're not doing those and we're causing harm then giving power to people really just means hurting them.

Here's a nice infographic: https://twitter.com/Jia_Luo/status/951985691772293120

18 deaths vs 21 deaths, and that's important, but look at the extra harm caused.