Monday, April 27, 2015

Dr. Siri is hiding on your wrist

The Apple Watch harbours undisclosed hardware capable of measuring blood oxygen content as revealed by iFixit's teardown. The hardware is not activated yet, but I don't understand how securely it has been made inaccessible by third party software. There is speculation that Apple is waiting upon FDA approval to enable the device for medical indications.
The currently inactive hardware is a pulse oximeter which, as previously mentioned, enables the noninvasive measurement of blood oxygen content. You may recognize a pulse oximeter as the red light that is clamped onto a patients finger in a hospital.
If the FDA approves the device for any medical application the implications would be interesting. The amount of health related data that could be collected would be enormous, and would likely reveal some interesting and unexpected correlations.
I'm somewhat unclear as to the range of potential applications for the individual user. The pulse oximeter seems to have applications in an acute medical setting, but I'm not clear on the usefulness in an everyday setting. It may have applications for analysis of sleeping disorders, chronic disease, or for serious athletes doing high altitude training, but otherwise I'm not sure of its utility. Could it be useful for alerting care givers to out-patient emergencies? Perhaps the use of the device will become apparent once deployed on a large scale and everyday activity data is collected.


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Monday, April 13, 2015

Time your next heart attack to conincide with national cardiology meetings

Surprisingly, high-risk patients with heart failure and cardiac arrest admitted to US teaching hospitals during dates of national cardiology meetings had lower 30-day mortality rates. The surprise is that outcomes improved despite the absence of the cardiologists who attended the meetings. While the cause of this correlation and the generalizability of the methodology are unclear, the finding is very significant. A Freakonomics podcast covering this study expressed the magnitude of this effect in a powerful comparison. While the combination of common interventions (beta-blockers, statins, aspirin, and blood thinners) reduce mortality risk by 2-3% in these patients, this effect reduced mortality risk by up to 10%. The Freakonomics podcast also entertainingly asks some cardiologists attending a cardiology meeting about the findings. The most compelling reason presented in the podcast to explain this effect is that the health professionals not attending national cardiology meetings use more conservative interventions during this time.


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Wednesday, April 08, 2015

The rising cost of cancer drugs

A recent research letter in JAMA oncology presented a quick analysis of the costs of cancer drugs. The article cites evidence that cancer drug prices are rising faster than prices of drugs in other therapeutic areas. The authors found no significant price difference between next-in-class drugs and novel drugs. Drugs that were granted US FDA approval based upon disease response rate were priced significantly higher than drugs approved based upon overall survival or progression- or disease free survival, however no significant relationship between cost and the percentage improvement in end point was found. The authors concluded that current pricing is "not rational but simply reflect what the market will bear." The price which the market will bear is indeed rational from the perspective of a business though I would think. There was also no consideration given to the costs of drug development but perhaps it is insignificant, I don't know. Nonetheless, an interesting analysis that makes me wonder about drugs in other therapeutic areas.


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