eXtensions - Saturday 15 Jun 2019


Cassandra - Weekend Review: Health Monitoring with our Devices - Warn, Check, Confirm

By Graham K. Rogers


A brief hospital stay had me re-examining the ways in which we can use technology to monitor daily activities. There are several stories about how the Apple Watch has given early warning of problems, but other devices may also help users have a better picture of their health.

I have spent the last couple of days in hospital for scheduled minor surgery and it is interesting to see how technology is used. On the older ward I was booked into, not so much. The brief view I had of the operating theater was impressive as had been the new wing of the hospital where pre-admission testing was carried out. The last few years have seen a technological revolution in health care. There is a lot of money in this and it can benefit all stakeholders: patients, hospitals, medical staff and the companies who make the equipment. There are some familiar names such as Nikon who have had optical equipment available for several years, Hitachi, Philips and Siemens, as well as newcomers, such as Apple, with the Apple Watch and the Health app on the phone.

The Apple devices have allowed me to monitor my own state over the last couple of years, with my main priority being heart rate, blood pressure, weight and sleep. The latter is relatively new for me, although most people are aware that a good night’s sleep will be beneficial. Conversely, a lack of sleep, particularly over an extended period, can imply other conditions that need to be investigated. Awareness and warnings are first steps to fixing a problem.

When I interviewed Dr Milani of Ochner Health a couple of years back, one of the problem indicators in post-operative care he told me about was monitoring weight. If a patient is at home after an operation, a sudden increase in fluids will indicate a problem. This is detected initially by a weight increase. With the scales linked to an app that sends data to the hospital unusual changes set of alarms and the patient can be brought back in for necessary attention.

The Nokia (Withings) scales I have record data to an app that is shared to the Apple Health app on my iPhone. While most of the time my weight is depressingly normal, it is high and I am encouraged to bring it down. I am able to see unusual changes and a few months ago, after some chest pains and overnight sweating, I saw a massive drop in weight. When this continued over the following 24 hours (I lost several kilograms), I contacted a hospital and the problem was diagnosed. The surgery this week is as a direct result of that. Although the other symptoms would have had me eventually seeking advice, the huge drop in weight set off alarms for me (although I was never in any mortal danger).

Withings Scales Withings Scales

Withings Scales and Blood Pressure Measuring Device

I also have a Withings blood pressure device and I check my blood pressure almost every morning. It may be the wrong time of day as I am rushing about, preparing to go to work, but if there are initial high readings, I try again until I am satisfied with the reading. The app records only the last reading; or I can set it up to take the best of three. I also had a Qardio blood pressure meter which I gave to my mother in the UK, because the doctor’s surgery she attends monitors her blood pressure with a device like a band around the chest. When she has it removed, the clinic download data to a PC and check. When she suggested using her own device, the response was that they were not set up for this sort of thing. A year or so later, after she had mentioned this a couple of times, they agreed to check it against theirs and found that the Qardio device was as accurate as theirs, so they agreed to let her use that.

Qardio Blood Pressure Monitor GMate Blood glucose measuring device

Qardio Blood Pressure Monitor and GMate Blood glucose measuring device

When I show my doctors readings I have recorded for weight and other inputs, they look but do not appear to see. Although this week a keen medical student asked me about the background and I was able to show how my weight had changed over the last year. I noticed that several of the medical staff at the hospital were wearing the Apple Watch. I was talking to a colleague about then ECG function of the Apple Watch 4 which is only available in a few countries other than the USA because the authorities have not allowed its use. With the Thai medical profession, the fear, I was told, was not the potential of false positives - high readings - but false negatives: when a device does not warn the user when readings are too low.

This is absurd as there are millions of people without the Apple Watch who are unaware if their readings are unusually high or unusually low and rely on occasional monitoring by health care professionals. A high reading on the Apple Watch would indicate a potential problem, so the user would check with the doctor. A user with a low reading will simply be checked on the next health visit, like the rest of the population who do not have the Apple Watch.

Apple Watch 4 Apple Watch 4

Apple Watch 4 - Images courtesy of Apple

As for high readings, I experienced this with a blood-glucose monitor that I bought the same day I interviewed Dr Milani. In the interests of science, for 2 weeks I ate and drank nothing between 8pm and 6am. When I woke, the first thing I did was to take a small sample of blood and check with the device that connected via the 3.5mm headphone jack (on later iPhones with no jack, the device uses the Lightning-headphone adapter). The readings were higher than I wanted to see so I had my blood checked at a hospital. While slightly high, blood-glucose levels were acceptable. Other readings like cholesterol and lipids were also slightly high, so I changed my diet. Readings are still a little high, but the doctor is satisfied: warned, checked, confirmed.

The iPhone Health app is to be improved in the iOS 13 update, Evan Sellek (iDownloadBlog) writes, explaining how among the new updated features, new data points will be available for tracking. Trends will be monitored by the app and warnings will allow the user to make adjustments - something I do now (e.g. weight, blood pressure). Apple is pushing this app and its features more and additions will be welcome.

Earlier this week the NYTimes made the decision to carry no more (political) cartoons in its international editions, which brought about some scathing comments concerning censorship. As the local cartoonist, Steph, was recently dropped as the Nation moved from print to web-only, it is often the cartoonist - the canary in the coal mine - that is one of the first to go. As I can testify, having been dropped twice by the Bangkok Post for “economic reasons”, the accountants talk loudest, even if they know nothing about news. In The Guardian, Martin Rowson writes, in a comment on the NYTimes decision, "When the accountants moved in on the US newspaper industry in the 2000s, the first employees to go were the cartoonists, just like most newspapers that get closed down aren’t shut by governments but by their proprietors."

I was somewhat nonplussed on Wednesday when I read an article by Ben Lovejoy (9th5Mac) on Apple and taxation. The idea of tax avoidance, which is substantially different from tax evasion, has come up from time to time, most notably when Senators McCain and Levin sanctimoniously fawned on Tim Cook who had come to give evidence to the committee (Patrick Temple-West, Reuters), then savaged Apple's cash hoard, earned from overseas sales. Due to the severity of laws on repatriation of cash, Apple kept all that money abroad, despite the suggestions of Wall Street on how to spend it and the ranting of politicians in America and other countries.

Money Out of the blue (as far as I can tell) Lovejoy, who once blocked me when I dared to respond to a Tweet of his, puts forward the idea that Apple should "do the right thing", which would ignore the responsibilities to its shareholders. As Tim Cook stated to the committee (this has been said several times before and since), Apple follows the tax laws of the countries it operates in: laws that were written by the same politicians who criticise particularly the high-earning tech companies who use (not abuse) those laws. When there was some easing of regulations on repatriation, Apple did bring back (and pay taxes on) some of the money that had been kept abroad, and then used some of it to buy back its own shares. That was also criticized by some, particularly some in Wall Street who itch to spend Apple's cash.

The idea that once Apple takes the first step, other companies will follow, seems a little naive to me. Other than goodwill, there is little else to motivate them. I would not expect Google, Facebook or Amazon to suddenly return billions of dollars to government coffers, especially when most is wasted by defense spending or support of irresponsible businesses (e.g. banks), and the current president has a reputation for unpredictability.

Lovejoy puts forward some interesting arguments, but even as someone who leans somewhat to the left, I do not see them as convincing or valid. Read the article and fill out the survey by all means.

I mentioned back in April that Apple had sent home all the Irish construction workers who were involved in the building of one of its data centers in Denmark. This was coincidentally in the same week that the Supreme Court in Dublin had allowed the granting of planning permission on the Irish site that Apple had already abandoned, partly as a result of the objections filed that the Court overruled. Now Benjamin Mayo (9to5 Mac) writes that Apple has officially abandoned construction on that Aabenraa data center site. This was apparently a “strategic decision” as Apple is to focus on the Aalborg site.

One of the new features that received an enthusiastic response at WWDC was the coming Apple sign-in feature that was unfavorably compared to those from companies like Google and Facebook. Russell Brandom (The Verge) has an interview with Google's login chief, Mark Risher who welcomes the Apple solution, but is at pains to point out that Google is not that bad. I have my doubts of course, but he insists they do not collect as much as some claim: "It's not used for any sort of re-targeting. It's not used for any sort of advertising. It's not distributed anywhere." It is an interesting read and Risher does question (rightly) how Apple's email spoofing will work in terms of data collection.

I have commented positively on the ways in which Microsoft is embracing the iTunes App Store more and more. I had thought of it as a late realization (much post-Ballmer) that both companies would benefit not from cooperation per se, but helping Windows users to increased options when they are using iPhones or iPads. MacRumors reports on a new Apple app in the Microsoft Store that will allow users to access their iCloud account when working in Windows. Juli Clover writes that, "The iCloud app for Windows includes iCloud Drive, iCloud Photos, Mail, Contacts, Calendar, Reminders, Safari Bookmarks, and more." Better than working in a browser; and proof that the two companies will work together for mutual interests.

It is therefore interesting to read a comment by Joe Rossignol (MacRumors) outlining the expansion of Apple's presence in Seattle. Although the company has been in the area for a while, it is apparently about to sign a lease for enough office space to house over 4,000 people

Qualcomm were adjudged to have bullied potential buyers of its chips and many companies think that the decision to fine the company and put it under supervision is about right. Qualcomm of course does not and is expected to appeal. In the meantime, perhaps knowing that Intel was about to throw in the towel on its modem business, in a separate case, Apple settled with Qualcomm and signed up for chips for a number of years.

It had already been rumored at that time that Apple was interested in Intel's modem chip unit but nothing seemed to happen until now. Signed up with Qualcomm as it is, the news (Juli Clover, MacRumors) that Apple is looking to buy at least some of the unit (and its engineers) shows how the company thinks for the long term. Apple would like to have everything in-house and this looks like a good move.

Graham K. Rogers teaches at the Faculty of Engineering, Mahidol University in Thailand. He wrote in the Bangkok Post, Database supplement on IT subjects. For the last seven years of Database he wrote a column on Apple and Macs. After 3 years writing a column in the Life supplement, he is now no longer associated with the Bangkok Post. He can be followed on Twitter (@extensions_th)



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