MEDICAL INNOVATIONS
PRN: Take as Needed
On Wearables, Health Care and Predictive AI By David Alex Schulz, CHP
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alloween, 1957: A Minneapolis child dies because an ACpowered pacemaker failed in a power outage. Before a month is out, local engineer Earl E. Bakken prototypes the world’s first battery-operated, transistorized, external pacemaker. The founder of Medtronic has ushered in a new paradigm for health care: portable wearable electronic devices. Before his death in 2018, Bakken saw Medtronic and other companies shrink devices, standardize them and interconnect them. From ‘fitness’ watches to devices monitoring blood pressure, electromyography, glucose, temperature and oxygen levels, portable wearable devices are ubiquitous. A similar revolution in implantable devices brought about infusion pumps, neurostimulators and cardioverter defibrillators (ICDs) to join the implanted pacemaker. All are members of the “IoT,” the Internet of Things, accessible to a network through either wifi or Bluetooth. Connectivity permits noninvasive monitoring and control of the device, but the collection and sharing of data is only barely secondary in importance. The question with new tech, as always: Just because we can do something, does it mean we should? Hazards are present such as Bakken and his successors never considered. It will take extraordinary strategic planning and deployment of equipment and its data to lower the risk to acceptable. Most obvious is the question of digital security, not only in the theft of data, but breaching the device controls themselves. Upon taking office, Vice President Dick Cheney insisted on disabling his pacemaker’s connectivity, fearful of assassination by hacking. In 2019, the Department of Homeland Security warned that hackers could wirelessly access implanted pacemakers made by Medtronic. Three months later, the company recalled some of its insulin pumps for similar reasons. The healthcare industry needs to address remote device security or it will be less prepared than it was for ransomware. The pandemic supercharged home health care, tele-medicine and Remote Patient Monitoring with an 20
SAN ANTONIO MEDICINE • May 2022
uptake in patients adopting pulse oximeters, digital thermometers, otoscopes, personal ECG and others. All carry inherent cyber-risk. Less obvious are problems due to peoples’ whims and personalities – call it the microcosm of medical anthropology. While generally thought that patients should take greater ownership of their own health care, we live in an age of extremes. Take Bill, whose lifelong tendency for anxiety led him to buy a Fitbit Sense in late 2020 during lockdown. CNET reporter Lisa Eadicicco relates the story, “He thought it would reassure him that he was healthy if he was able to take an electrocardiogram reading when he felt something abnormal, such as heartburn or an accelerated heartbeat.” Yet Bill only grew more anxious after receiving inconclusive ECG results his device, not unusual in casual, uncontrolled circumstances, where the device couldn't get a reliable reading. He began taking up to 20 ECGs a day because of his anxiety around springtime. Realizing he was hypering himself into a frenzy, he finally abandoned the device and his anxiety lessened. The industry is in its adolescence, and while data collection of consumer devices is continually more refined, companies are still figuring out the best ways to deploy wearables, and make sense
