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This is Apple's new iPhone XR

Apple unveiled a third, lower-end iPhone Wednesday -- the iPhone XR. It starts at $749, has a bright LCD screen, and comes in several colors.

Posted: Sep 14, 2018 4:34 AM
Updated: Sep 14, 2018 4:53 AM

Apple unveiled a medical device this week, complete with FDA approval. This device -- the Apple Watch Series 4 -- is unlikely to be reimbursable on your insurance plan, but maybe it should be. It could very well save lives.

The core advancement is a darling of a med tech smart set that touts the coming democratization of medicine. It's an electrocardiogram app. A company called AliveCor, backed by tens of millions in venture capital, is already marketing a similar ECG app that requires connecting peripheral sensors to your Apple Watch or iPhone. The sensors range in price from $99 to $199, followed by monthly or annual fees. AliveCor got excellent PR on its road to market when one of the country's most famous cardiologists, Dr. Eric Topol of Scripps Research, used the device to diagnose atrial fibrillation in a woman on a United Airlines flight.

Now Apple is incorporating ECGs into the Apple watch's native software and hardware, a move that must temper AliveCor's investors, but such usurpation is a known risk in an industry where platforms routinely push around, and push out, their developers. That said, AliveCor appears more clinically robust, producing ECG strips doctors can upload into electronic medical records, along with clinical worksheets doctors can use to interpret and sign off on, and even bill for their work.

With electrodes built into the watch's "digital crown" and its native ECG rhythm analyzer, the Apple Watch will now inform you if your heartbeat warrants medical attention. There are many abnormal rhythms Apple's watch can't detect, but most of the attention is on atrial fibrillation: it's common and potentially deadly.

Atrial fibrillation develops in 2%- 3% of us over the course of our lifetimes, sometimes without any symptoms or with very vague symptoms (like a touch of light-headedness). When the upper chambers of the heart (atria) beat irregularly, blood doesn't move through the heart in the manner it should. This can leave some blood moving slowly enough that it congeals into clots. When those clots move out of the heart and block one or more arteries in your brain, they can cause a debilitating stroke.

Your heart can go in and out of this rhythm, so an annual physical, including an ECG, can easily miss it. Of course, Apple's software only offers a single lead. A full ECG has 12 leads and is necessary to diagnose a whole host of other heart conditions.

I've seen this scenario dozens of times in my role as a neurorehabilitation physician, helping patients at the Shepherd Center in Atlanta recover as much brain function as possible after these types of strokes. In the vast majority of cases I've seen, my patients got no warning their heart had a bad rhythm (arrhythmia). Their first symptom wasn't heart palpitations; it was paralysis.

An editor at CBS' tech news site ZDNet managed to prevent such an outcome for himself by trying out an earlier version of Apple's heart app this year. After enrolling in a large Apple research and development study, Jason Perlow saw an alert pop up about his irregular heartbeat, leading to his diagnosis. He's now undergoing treatment for atrial fibrillation.

Such treatments can be serious, including the use of blood thinners and invasive heart procedures. And that's where the potential harm of all this new surveillance comes in: With screening on such a massive scale, will some people get diagnosed and treated for atrial fibrillation that may never have caused a stroke or other serious problem?

Doctors contemplating blood thinners will compute a patient's risk score, based on features like age and history of related health conditions, such as diabetes or high blood pleasure. But there's debate over what score equals what treatment. The "average" person with atrial fibrillation is five times more likely to suffer a stroke than someone without, but still most likely not to have a stroke in a given year. Meanwhile, treatments like blood thinners mean a person could die more quickly in a serious accident or a variety of medical scenarios that cause internal bleeding.

These are risks Apple and the FDA are willing to let consumers take.

Before you snap up the $399 Apple Watch Series 4, don't forget an even more valuable heart health device you can put on your wrist for under $50: a blood pressure monitor. High blood pressure is 10 to 15 times more common than atrial fibrillation and easily treatable.

But the ECG app integration isn't the only new feature. The new Apple Watch will deploy its internal movement and position sensors to detect a sudden hard fall, the kind where you lurch forward and fling your arms out. If after such a tumble the watch detects no movement, it will assume you're out cold and need help. This is even better than the old "I've fallen, and I can't get up" life alert systems, which require that you're awake and alert enough to push a button. Your super-smart Apple Watch will call while you're unconscious.

One caveat: The Apple Watch is still a power hog. With light use, it only lasts 18 hours -- and far less if you're tapping away at its cool features all day. You'll need to plug it in nightly, so in the middle of the night, when most people could use a fall monitor, you won't be wearing it. Instead, the watch will be charging on your nightstand when you're crawling out of bed on your way to the bathroom.

The Apple Watch's health features will probably cause a few headaches, but I think the saved lives will be worth it on the whole. If you've got money left over after buying your blood pressure monitor, it may just be worth the investment.

Minnesota Coronavirus Cases

Data is updated nightly.

Cases: 453808

Reported Deaths: 6131
CountyCasesDeaths
Hennepin941381495
Ramsey40509748
Dakota33463350
Anoka31283368
Washington20471234
Stearns18051190
St. Louis13916247
Scott1213098
Wright11756107
Olmsted1073975
Sherburne827868
Carver703139
Clay657684
Rice621170
Kandiyohi556772
Blue Earth546833
Crow Wing489178
Otter Tail463167
Chisago458138
Benton423288
Winona394248
Douglas378466
Nobles374447
Mower372129
Goodhue355362
Polk330660
McLeod327947
Beltrami315048
Morrison314145
Lyon304738
Becker288839
Itasca287143
Isanti284842
Carlton283543
Steele278510
Pine269614
Freeborn253623
Todd233130
Nicollet227938
Brown217434
Mille Lacs215045
Le Sueur213516
Cass210524
Meeker201233
Waseca192816
Wabasha17413
Martin171726
Roseau166317
Hubbard150238
Redwood141027
Houston139814
Dodge13864
Renville138040
Chippewa132332
Cottonwood128918
Fillmore12646
Wadena120218
Rock111912
Aitkin111233
Sibley10947
Faribault108816
Watonwan10688
Pennington101016
Kanabec99318
Pipestone96423
Yellow Medicine94916
Murray9096
Jackson87310
Swift84418
Pope7465
Stevens7078
Marshall70315
Clearwater68714
Lake66315
Lac qui Parle66016
Wilkin6349
Koochiching60310
Lincoln4892
Big Stone4693
Unassigned44568
Grant4388
Norman4258
Mahnomen4147
Kittson37320
Red Lake3204
Traverse2613
Lake of the Woods1961
Cook1150

Iowa Coronavirus Cases

Data is updated nightly.

Cases: 310915

Reported Deaths: 4432
CountyCasesDeaths
Polk46760465
Linn18037279
Scott15838172
Black Hawk14076243
Woodbury13111181
Johnson1228552
Dubuque11615159
Pottawattamie9146115
Dallas907772
Story879438
Cerro Gordo472572
Webster472077
Sioux459657
Warren458039
Clinton457768
Marshall430762
Buena Vista396230
Muscatine395878
Des Moines394943
Plymouth352870
Wapello349898
Jasper331659
Lee324132
Marion308953
Jones274650
Henry267331
Carroll258234
Bremer249848
Crawford234324
Washington222933
Boone222717
Benton213050
Mahaska197637
Jackson194932
Tama190159
Dickinson188329
Kossuth178544
Delaware176036
Clay172021
Wright166624
Fayette165924
Hamilton162230
Buchanan162024
Winneshiek160820
Harrison158162
Hardin156931
Cedar155519
Clayton153849
Butler150924
Page146415
Floyd141436
Cherokee140027
Mills138517
Lyon137533
Poweshiek134924
Hancock131524
Allamakee130930
Iowa127722
Madison123610
Calhoun12349
Grundy122528
Jefferson122125
Winnebago121729
Mitchell116837
Louisa116230
Cass114843
Chickasaw113712
Appanoose112440
Sac112015
Emmet111232
Union111023
Humboldt106619
Shelby105427
Guthrie104224
Franklin103318
Unassigned10110
Palo Alto91711
Montgomery88324
Keokuk86326
Howard85519
Monroe82220
Clarke8108
Pocahontas78111
Ida75930
Davis70121
Greene6977
Adair69620
Monona67018
Lucas66610
Osceola64711
Worth6184
Taylor5999
Fremont5246
Van Buren50215
Decatur4964
Ringgold44811
Audubon4218
Wayne41921
Adams2993
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