Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data.
Anytime you associate health with financial motivation, you end up with something twisted on the long run.
Sure, you can say that Apple, right now, is in the proper state to do that (although given they were part of PRISM, it's debatable).
But what about in 10 years? What if their executives decide that Apple Pay should lead to the creation of a bank? Then from a bank to an insurance company? Then they have a conflict of interest.
Simpler than that, what if they change their stance on user data, and decide to exploit it to understand their customers better? Or sell it? Or just partner it to labs, insurance companies, hospitals?
Like with facebook, it will of course all be "made anonymous", until it's not anymore.
Money and health data are not meant to be mixed IMO.
But even without all that, we are adding yet another tracking system on top of what is already a sensor packed pocket self-spying device.
It's hard to not worry that such concentration of power has a high potential for suffering.
The solution to this conundrum and similar potential problems with other 'smart' devices is to leave them on the (virtual) shelves. If your insurer starts to promote the use of such a device you change insurer. The same goes for car insurance which wants to have access to (live) tracking data on your car, home insurance who demand the installation of and access to 'security systems', the list gets longer and longer. The way things are going this new nosy technology is set to create a new class of Luddites, those who while not averse to technology in itself do not accept their lives to be steered by profit-seeking entities through the use of such.
Another interesting question is whether law enforcement will be allowed to access such data and whether it can be used as proof against the wearer. If your data indicates you were in a higher state of alert with a raised pulse, the gyroscope and position sensors indicate you were physically active, the location data puts you in a given area and the microphone picked up suspect sounds they won't need much more to convict you. Who is the legal owner of the data? Some countries give people the right to refuse to testify against themselves so if the data is owned by the wearer I'd expect it to be off-limits to the law.
The potential good uses of this type of technology are myriad, it just needs to be made big-brother-proof. That will be a hard task since there are situations where you'd want some of these easily-abused features to be used - e.g. call in emergency services if the device detects a life-threatening condition, etc.
That's easy today because this option is unpopular. But look back and see how many things we (as entire populations, not necessarily individuals) starting accepting that was unfathomable a couple of decades ago.
Without strong government intervention we may end up at the point where you can take it or forfeit the insurance.
This is what I see coming as the mega corps eat our society alongside software. Look at the regulatory capture the telcos have managed with their negotiated service area monopolies or duopolies. It’s easy to say “buy something else” until there’s nothing else to buy and the product is a requirement for functioning in society (insurance, internet connectivity, healthcare). We need trust busting candidates now.
I don't think trust busting can make the telco problem go away. You can punish someone for their past wrongdoings, but that doesn't necessarily incentivize anyone to become an ISP after the fact. You have to look at how we invest in infrastructure instead. In most of the country, ISPs are responsible for building their own infrastructure; they have to either dig up streets or beg the local power company for pole access. If they didn't have to do that, many more companies would be interested in being ISPs. As it stands right now, it's too expensive and too risky. Sure, being an ISP is 95% profit once you've paid for the infrastructure, but the payoff period is many decades. Nobody has that risk appetite anymore.
In Manhattan, under every street is a subway where you can put power cables, fiber optic cables, etc. The result is that there are a multitude of business ISPs around, because someone already dug a hole in the ground where their cables can go. The actual stringing of cables is a straightforward procedure; sure you need to buy trucks and cables, but that's a lot cheaper than saying "hey we're closing 5th Ave. for 3 months" and digging the whole thing up. The street was dug up once (in 1891!), and now nobody has to do it again. (OK, the tunnels are pretty full, but it's better than nothing.)
If every street were built like this, it is likely that there would be many more ISPs. The big risks are gone. (There is a secondary problem in that many people still like linear TV, and many TV networks are owned by companies that are also ISPs. AT&T owns HBO. Comcast owns NBC. So that would be the sticking point after there is infrastructure, and sure... have the government break them up. They'll probably be dead long before we have the infrastructure, though.)
The short term solution is probably to invest in better trenching techniques. I've heard of microtrenches, nanotrenches, and picotrenches. Maybe we need femototrenches where you just run a fiber to someone's house through their lawn and cover it up with tape where it crosses the sidewalk. It's better than nothing. But probably still too risky for anyone to attempt.
Here in the Netherlands I see a tracking device for cars becoming popular. It is being marketed as a device to get early insights in car breakdown oh and btw you get a 10-20% discount on the insurance fee. That could amount to €40 a month which is a big incentive for people. Sometimes there are even additional insurance discounts when the accelerator has detected a gentle driving style.
Why should a gentle driver subsidize aggressive drivers? Why should a person that has a healthy diet and does regular cardiovascular exercise subsidize someone who doesn’t? Should someone that drinks only water subsidize those who regularly drink carbonated sugary or alcoholic drinks?
With more data, it’s possible to see how much certain lifestyles subsidize others, so it will be interesting what society deems eligible for subsidies and not.
You just described exactly how insurance actually works. I don’t really want to live in a world where the higher risk people are MORE disincentivized from being able to secure insurance by eliminating “subsidies” because of their behavior. Insurers need more of lower risk people to subsidize higher risk people (or events) otherwise the whole thing simply doesn’t work.
As an insured, insurance is to protect yourself from an unknown randomly distributed loss that you can’t afford.
As an insurer, you can afford to insure if the losses occur within the assumed probability distribution and loss magnitude parameters.
In the case of auto (or driving) insurance, it is known that driving aggressively will cause more collisions hence more losses. Therefore, any insurance company not taking this knowledge into account will have uncompetitive premiums compared to another insurance company that is. Insurance only doesn’t work in this case for people who choose to drive aggressively.
A more contentious point would be people living in poor areas having to pay more for insurance due to more property crime in poorer areas. It’s easy to say someone who drives recklessly chooses to and should suffer the consequences, but what about someone who happened to be born to poorer parents?
In the case of healthcare, there are a few known factors that make many chronic health events not random, such as bad diet, lack of excercise, and bad genes. A broken arm might be a sufficiently random event, but what should society do about the non random health losses? What if you were born to poor parents and never had much of a chance to make it so you had a job schedule that allowed you a routine to workout regularly? Or time to cook healthy foods? Or you don’t make enough money to live near grocery stores that sell nutritious foods?
But then at least 70% of Americans are fat. And I see them voluntarily buying large containers of sugar water multiple times a week. Why should I have to pay for their diabetes? Same for a smoker or an alcohol drinker?
It’s a nuanced topic that makes me wonder what freedom is and how much freedom can cost. Am I restricting freedom by not wanting to pay for others’ actions known to cause certain losses? Should people be restricted from certain actions if they can’t afford the losses, therefore restricting their freedom? Can they even be restricted, logistically?
How do you know that more aggressive driving causes more collisions?
How do you know which accelerometer-measured[1] parameters correlate with aggressive driving? High speeds? Abrupt acceleration? Hard acceleration? Abrupt braking? Hard braking? Late braking (how do you know the difference?) High lateral cornering loads? How are these differentiated from abrupt lane changes? Does the dongle know if you used your signal or not?
Studies show that driving late at night is far riskier than driving during daytime; due to visibility, alcohol, etc. Lots of late night trips? Time to punish that graveyard shift ER doctor for driving her car at such risky times!
1. Presumably most of these OBD-II dongles really only use accelerometer data to report back, even though they have access to more data if they want it, and if they're programmed to understand every model of vehicle
> How do you know that more aggressive driving causes more collisions?
I don’t, but insurance companies employ some pretty smart people who can figure that out. If they offer discounts for certain driving characteristics, I’m willing to bet that they reduce the insurer’s expenses. Otherwise they won’t be in business for long.
Most insurers that offer a tracking-based discount also offer policies without. It seems to me, all that matters is, on average, they don't offer a discount to tracker users that is larger than those users, as a pool, save them in claims.
The only incentive to get it "right" is that, if they do a really poor job at this, they will lose business to insurance companies that do a better job at it -- again, to the extent that the differences between insurers are significant, that customers are price sensitive, aware enough to shop around and compare the actual rates they pay, etc.
We already know that your non-tracker-based insurance premiums may vary wildly from one insurer to another. One may penalize you heavily for being 18. One may offer a larger discount to those who complete driver's ed courses, or own a car with airbags.
Maybe you'll be penalized for that first accident or ticket, or maybe your insurance company will give you some leeway (and, presumably, double down on the surcharge after your second accident).
I don't see how it's inherently obvious that an insurer that gets their tracker-based metrics 'wrong' will go out of business in short order. Again, all they have to do is charge more than they pay out in claims and overhead.
> insurance is to protect yourself from an unknown randomly distributed loss
But when randomly distributed loss hits you'll surely expect to be subsidized by others who somehow weren't affected by this despite their aggressive driving, or bad diet, etc.
> bad diet, lack of excercise, and bad genes
Now imagine the fun times when your insurer decides which one they can use to screw you over and how badly.
Sure, I get your point but it's buried in a mountain of nuance that makes the "straight forward logic" meaningless. The insurance industry doesn't need yet more ways to screw people over, or give the people who need it most an even bigger middle finger and hang them out to dry.
>A more contentious point would be people living in poor areas having to pay more for insurance due to more property crime in poorer areas. It’s easy to say someone who drives recklessly chooses to and should suffer the consequences, but what about someone who happened to be born to poorer parents?
This already happens of course. Auto insurance (and I assume other property insurance) varies based on where your auto is garaged (by a lot).I live in an exurban town. I assume my insurance would be 2x-3x is I lived in Boston.
I’m more than willing to subsidize the more aggressive drivers in order to maintain my privacy. Joe Schmoe gets slightly cheaper car insurance than he “deserves” and my driving habits are known only to me. That’s a win-win for everyone except the insurance companies who want to collect data about our habits and monetize it to pad the bottom line.
When aggressive drivers pay more than gentle drivers, that creates an incentive for aggressive drivers to drive more gently. Some of them will, and that in turn will save lives, not just money.
I do agree with the possibility of uses for this kind of technology, however at least in the United States, health insurance is largely tied to ones employer which makes it impossible to switch insurance companies.
> Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data.
I have a hard time letting the state amass more data from people.
> Anytime you associate health with financial motivation, you end up with something twisted on the long run.
Well, the state is not some objective, incorruptible entity without any ulterior motives. You end up with something twisted even when you let the state handle health data. The key is for individuals to decide how, where, when and what they want to share and provide enough control and literacy on why this is important. Unfortunately, too many people get lost in who should or shouldn't get some data and miss the point of maintaining one's freedoms.
I don't disagree with you in general but I wanted to say why I feel comfortable enough with Apple's approach. I looked at the privacy statements for Apple's health apps and the 3rd party sleeping apps. It is my understanding that all data stays on my watch and iPhone unless it is encrypted. My understanding is that only I have access to this data.
I would like to share some data with my doctor and insurance but I want that under my control.
EDIT: just wanted to add that I am also in general deathly against IoT devices re: tracking. I read Surielance Capitalism and took the book seriously.
Apple is a for-profit organization that's free to alter their privacy terms any time they want. I don't trust that future modifications of those terms won't make all that data available to anyone who pays.
And even if they don't sell the data it will still be a huge attraction for all kinds of black-hats.
And the government is also free to change the rules depending on the administration in power. I can leave a corporation I don’t like much easier than a government.
That’s not necessarily true - realistically not using google or Facebook, for the average, non-tech person, is in many ways up there with moving from say, France to Germany (I chose the EU to make a specific point about ease of movement) in terms of difficulty.
Also, at least democracies have formal mechanisms for holding governments accountable, even if these mechanisms are often corrupted or flawed.
Living in a democracy means you have options beyond “voting with your feet”.
Even in the best case ignoring the effects of the electoral college, two senators per state regardless of the population and gerrymandering suppressing the will of the people. It’s fine when a democratic government having power is ruled by the majority as long as you are in the majority.
Look at the history of how the government treats minorities (racial, religious, non straight, etc)
I agree about gerrymandering, think the Electoral College is anti-democratic, and see you point about the way the Senate is set up (though that is maybe a bit trickier than the above 2 items).
But I feel like this is kind of outside scope of what we were talking about? The US is a flawed democracy, no doubt, and some political scientists argue it no longer functions as a democracy, but, it is still, both formally and somewhat in practice, a democracy.
Except when encryption becomes mandated by law to be backdoored. Having the data distributed over multiple disparate systems is at least a major inconvenience for any attacker.
Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data.
I wouldn’t trust the American Government with any more power than they have now. It’s not just contempt for the current government, but it wouldn’t matter which party were in power.
Not trusting the government doesn’t have to mean trusting companies.
I completely agree with you, but I also have my doubts about governments as well. This leaves only the option of my health data being controlled by myself.
So knowing is little solace for people that are affected. People who aren’t affected seem to always be the ones saying stuff like this.
See for example - “at least we now know that minorities are getting beat by the police now that it is getting filmed” ignoring the fact that it was happening for decades and no one believe it.
> I really have a hard time trusting anything else than the state to handle health data.
I would say I'm exactly the opposite. The less data the state has about me the better.
In reality it's probably more a concern about anyone having too much data. I don't mind different organisations having little bits but I get concerned when people want to bring it all together.
> The less data the state has about me the better.
This seems to me the wrong mentality. What you ultimately care about is the leverage you have over the entity holding your data. In most cases you have more leverage over the state via voting and lobbying.
> it's probably more a concern about anyone having too much data
I agree. The issue is what you give up when you let people have that data, and how to mitigate those downsides.
> I don't mind different organisations having little bits
Sure, but realistically that's not how it will work. The point of gathering all the health data is that it's valuable to provide your health information to other businesses. This is specifically called out in the article, with the example about the gym and your doctor.
> but I get concerned when people want to bring it all together.
Bringing it all together is the whole idea. Apple may not literally give the raw data to anyone, but they will do what is functionally equivalent. They'll provide an API for third parties to make business decisions about your individual health. There is no way to do this is a privacy-preserving way.
> This seems to me the wrong mentality. What you ultimately care about is the leverage you have over the entity holding your data. In most cases you have more leverage over the state via voting and lobbying.
I would argue the exact opposite. I've always found private companies to be far more responsive to my needs than government.
You realize the President won the election while losing the popular vote and more voters vote Democratic than Republican in both the House and the Senate bit because of both gerrymandering and the 2 Senators per state regardless of the population, Republicans have a disproportionate number of seats?
This isn’t meant to be a partisan statement, more to the point of how the voting system works in the US.
Besides that, people aren’t going to vote based on privacy. All a politician has to do is tell “terrorism” or “think about the children” and they can pass anything they want.
Not to mention that most regulations come via agencies run by unelected officials and judges are unelected and have a lifetime appointment.
No US president has won the popular vote, because no popular vote has been held. The rules of the contest influence the number of people who vote.
I do agree though, health care data handling is probably too niche to get people diselected, most voters are going to be more woried about other issues.
Which US President was elected by the population? As far as I know, they were all elected by the results submited by the electors of each state, or the selection of the house of representatives (or through succession after a vacancy of the office).
Pretending there was a popular vote when there wasn't is like claiming whichever team scored the most points during a series of games won the series dispite the fact that the series is decided based on which team won the most individual games (although some tournaments do include total points scored as a tiebreaker).
You are being overly obtuse. The term popular vote has a clear definition in US presidential politics and the meaning of “won” the popular vote has a clearly defined meaning. That this has no bearing on the outcome of the election is a separate issue but doesn’t diminish in the slightest the meaning of winning the popular vote.
The term may have a clear definition, but the value doesn't mean anything.
Without arguing if it's a good or a bad thing, we do not have a popular vote, and summing the votes of the individual contests is not a meaningful estimation of what the results would be if we did. If someone wants to take the time to make a nuanced estimate, with consideration of how turnout might change and what results we might see, that would make for an interesting discussion, and I'm sure we'd all have fun arguing over the details of the assumptions and the results.
There was a “popular vote”. We know the exact count of who voted, whether the popular vote decided the outcome is completely orthogonal to whether it had an impact doesn’t say that it didn’t exist.
The fact that the popular vote is ignored because of how the system is designed is the entire point.
> In most cases you have more leverage over the state via voting and lobbying.
How is this leverage at all? Apple doesn't have my health data. I have a device produced by Apple that allows me to store and share health data conveniently. The state has the unilateral authority to use violence against me. I have very very little leverage on the state vs a company that sells me a glorified filing cabinet.
> The point of gathering all the health data is that it's valuable to provide your health information to other businesses. . . They'll provide an API for third parties to make business decisions about your individual health. There is no way to do this is a privacy-preserving way.
The point is that's valuable to me, the person who the data is about. Apple already has a. privacy preserving model all they to do is follow their current model. Collect all that data for me, the person who the data is about, store it on my device, and allow me, the owner of said data to provide it to whoever I see fit. This allows me to get the best of all worlds. I have this amazing resource that tracks my activity, diet and environmental exposures and various clinical health metrics across many different information streams. If I want to share my workout routine with my insurance company to get a discount I can decide to do that, if I want to show only my doctor i can pull it up during a visit and show him. If I want to share my Xrays or medications with my personal trainer I can likewise make that decision. There is no reason for me to think that Apple will implement an API here for mass data exports because there is no reason too, I can send the data on a case by case basis. And if Apple changes their privacy policy, which I honestly find unlikely, I can delete and walk away.
I also feel the exact opposite, I have almost no personal control over the state. Not to mention the relentless incompetency and bureaucracy of state institutions, which often end up covering up their own mistakes.
Maybe it's the french in my talking, but I really have a hard time trusting anything else than the state to handle health data.
I'm not French, and also feel the same way. It can also due to the fact that is is the center of all the political focus and other stuff. In general US has worse data protection polices than other developed nations (of course still better than country like China).
And state doesn't care about money ? I've heard several places talking about bumping insurance for stuff the moralising politicians find easy to wilify - from stuff like dietary choices and whatever the diet fad seem to be popular (nutrition being the scam that it is basing mandatory public policy on it is ridiculous), over drinking to smoking, illegal drug use (recreational or performance enhancing) etc.
I don't want anyone collecting data on me - I should be in charge of disclosing the information - there is an adage in the PED community - if you mention steroid use to your physician and it gets on your record the next time you brake a bone or catch a cold it's going to be "steroid related". Probably the same shit for rec drugs or regulated nootropics.
> if you mention [X] to your physician and it gets on your record the next time you brake a bone or catch a cold it's going to be "[X] related"
Yeah, and likely they will treat you differently, and not consider that in outcome analysis. If you badger people about [negative health factor] every time they come in, they're not going to come in early, and you're going to blame the resulting poor outcome on the factor, not the behavior induced by the system. /rant.
As a Dane I don’t trust the government with my health data, but I don’t have a choice. Don’t get me wrong, it mostly perfectly safe and well managed, but then a government organisation mail CD-Roms with health data (unencrypted) on 5 million people to the Chinese embassy by mistake. Or the politicians decides that I can have medical help, but I lose all control of any tissue samples taken in the process, they will now be stored forever. I also have to accept that my daughters DNA is now stored by the government, and that’s not comforting in a country where xenophobes have to much power.
I think you're right about all of this! And to add another point, I worry the only people who will have access to this are those who can afford a bunch of health gadgets and a premium primary care provider.
But, at the same time, it's impossible to imagine our government creating such a thing :(
Totally, but in order to benefit from this system you'd probably also need a connected mattress, watch, maybe a continuous glucose monitor, some sort of workout device, etc.
It adds up. This is a country where half the population earns $40k or less a year.
Which is peanuts in the overall costs of healthcare. At what point are you given one as part of your welcome kit? There are already health plans in the US that offer fitbits or will subsidize their cost.
The game becomes encouraging a healthier lifestyle to help people avoid getting sick or hurt which costs alot less than treating someone once they have developed a full blown disease. It's one place where both the patients' and the insurer's and hospitals' interests are all in line with each other.
I don't, but I already have to. They run my life, and in France, my health. And they are not for profit.
I'm all for putting a better system in place, but meanwhile, I'd rather have my health data being in state own institutions that I feed from time to time with my visits, than having an always on monitor that streams directly my life to a for profit company.
But to be honest, I don't want to stream my life to any entity.
On the other hand, I also have a hard time trusting the government with the health data. I would actually prefer a federation of foundations under public law.
As for most things, we probably would be better of with a lot of separated institutions instead of a big centralized governement: one in charge of police, one in charge of health, on in charge of education, one in charge or budget, all of them separated and not governed by one entity at the top.
But that's what we got now, so If I have to chose, I chose the gouvernement. At least in my country: they are paying for health already.
> At least in my country: they are paying for health already.
Assuming that you pay taxes it will be you paying for health care services, albeit indirectly. If you live on government subsidies it is others who pay for your health services. The government is the intermediator between tax payers and beneficiaries.
Yeah well, that's maybe an over active imagination.
The best healthcare systems in the world (with respect to quality, and quantity of people getting it) are public health systems.
So I dunno, I'd rather have the (functioning democratic) government, a body I actually have a stake in be in charge of health as opposed to a body that it's only duty is to it's share holders.
As I see it, a governmental body is (should be) something we all have equal share in independent of our financial situation. I'm quite aware to the ways this body could malfunction. But at least we have a moral footing to work against these malfunctions. With a public/private company as long as it makes money, I have no moral grounds to oppose it ruining my and our lives.
A for-profit company will sell or hand-over data at the government's request anyway.
Apple's stance on encryption of phones is nice, but once health data is on a server, nothing matters.
Anything cloud is government property, just like all financial data. Now, if your health data starts in state owned DBs, like say in Germany, there is a fighting chance the data will stay in Germany.
Once it is in a global cloud like AWS, GC, Azure?
Any major government has access.
China bought so much data already, and with recent enforcement of their Cybersecurity laws, all data touching their citizens is fair game. Oracle pulled out of China, other like AWS go the route of joint ventures to continue operating.
Apple Health data is stored on the phone only. It would end up in encrypted iCloud backups of the phone, which would put it in the government requesting all your data with a warrant situation. It’s not an easily accessible thing.
That concern immediately screams for an "in perpetuity" agreement that can perhaps only be amended (like a constitution or other open source licenses; amended for updating technology etc.) within certain pre-established limits that are hard to circumvent, such as a limitation on the use of health data for profit via insurance. As long as the company agrees to stick to such an agreement for every customer forever, I don't see the problem (unless, of course, they are secretly selling data that you never find out about and can thus never sue them for -- I don't know how likely that is).
I’m conflicted as we are having this exact debate with contract tracing: Apple And Google came with a solution and the french gov chose a completely different one.
TBH can we trust the current gov. to do the right thing:
- In terms of competency: it took how many weeks to come up with an online form to generate a PDF ?. Then their contact tracing app hits all the limitations that motivated Apple and Google to work on an integrated solution, which then again means its effect will be super limited and people just don’t bother installing it.
- in terms of legitimacy: a lot of messaging and decisions caused litteraly hundreds of death for stupid or corrupted reasons. Like delaying lockdown because there wasn’t enough contaminated people. I mean, even at this point wearing a mask in public is still officially touted as some “perhaps you do perhaps you don’t” kind of behavior.
I really wonder if at this point the gov. is as motivated to keep people alive as some of the global companies.
> you can say that Apple, right now, is in the proper state to do that
I wonder why you say that. Is it because apple has been pushing the "privacy is a right" dialog and that somehow makes apple more trustworthy, right now?
Because I think apple is, right now, playing both sides of the privacy game.
for instance, all the blockers they allow are opt-out rather than opt-in.
Actually all their data choices are opt-out. I think they know statistically that nobody would willingly opt-in, so for business advantage (and fear?) that's what they do.
IHMO any data collected, whether "anonymized" or not, can be used against people and the human race so it should be opt-in. And opt-in should not be cleverly engineered into a faustian bargain.
This is one of the reasons why it’s nice that Apple currently has no access to health data. They might change this is the future, but you can always stop sharing then. (Rather than them saying they’re cool, having your data, and doing something malicious with it later.)
Because their software is not open source and they are very secretive, you have no way to verify that.
No to mention it assumes you would know about their change of heart, which you may not.
Apple said they were not part of any spying program, until it was revealed they were part of PRISM.
They also said their home button had a hardware problem and you had to buy a new phone, when it's been later demonstrated it could be fixed with software.
Everything a company says must be considered marketting until proven otherwise.
It's not specific to Apple, and it's not a moral stand. It's a practical approach to have with every companies since their driver is being profitable.
> Apple also said they were not part of any spying program, until it was revealed they were part of PRISM.
This does not seem like an accurate statement. After the PRISM revelations, which named Apple, Apple said they were unaware of the program and were not giving them access. As far as I know, this is the way things still stand today. The leaks claim access to Apple, Apple says they are not providing access. This may be explained through either party lying, or by the FBI being able to access Apple without their cooperation.
> They also said their home button had a hardware problem and you had to buy a new phone, when it's been later demonstrated it could be fixed with software.
This also seems inaccurate. Apple has never claimed you need to buy a new phone if the home button breaks. The actual issue is that the home button is part of the security system of the phone, runs its own fingerprint detection and is paired with the mainboard, and thus cannot be replaced without updating this pairing, otherwise there would be a trivial security break for the fingerprint protection. As a result, only Apple have the required access to replace the button, and thus third-party replacements are impossible.
> This does not seem like an accurate statement. After the PRISM revelations, which named Apple, Apple said they were unaware of the program and were not giving them access. As far as I know, this is the way things still stand today. The leaks claim access to Apple, Apple says they are not providing access. This may be explained through either party lying, or by the FBI being able to access Apple without their cooperation
Of course, gag orders (and PR common sense), prevent them from giving you this information.
But given what we know about the NSA and the context around it, I'm enclined to trust The Guardian and Snowden about it.
> This also seems inaccurate. Apple has never claimed you need to buy a new phone if the home button breaks. The actual issue is that the home button is part of the security system of the phone, runs its own fingerprint detection and is paired with the mainboard, and thus cannot be replaced without updating this pairing, otherwise there would be a trivial security break for the fingerprint protection. As a result, only Apple have the required access to replace the button, and thus third-party replacements are impossible.
No, the failure I'm refering to is of the iPhone 4 home button, which didn't have a fingerprint sensor yet.
> But given what we know about the NSA and the context around it, I'm enclined to trust The Guardian and Snowden about it.
None of my options suggested above required not trusting them. Either Apple lies about cooperating, the FBI lies about having access, or the FBI has access without Apple's knowledge.
Anyway, their statements on the matter go much further than what a gag order would require.
Dang, I'm keen to understand the process here on HN because I can see my reply is hidden, not flagged. It is only visible to me when I am logged in. Where can I read about your framework that you use to make decisions like this?
You're shadowbanned, usually because people have flagged your comments as nonconstructive in the past, and although I would personally think your other one is a bit ranty it's probably not worth being flagged, so I vouched for that one and this. If you're seeing this consistently I would email the moderators at hn@ycombinator.com; they'll be able to help.
@dang @saagarjha - Does this mean all my comments will keep getting banned? I just wrote a comment, and it is blocked again. Where can I read the rules/process on shadowbanning? I am committed to trying to tone down my replies and focus on being accepting of others' realities, and being constructive.
> and thus cannot be replaced without updating this pairing
Congrats, you've successfully swallowed both the marketing of Apple the corporation, and the marketing of the 'benevolent' rentier hacker empire that is America! [1]
I believe PRISM, Crypto AG, Dual_EC_DRBG, Intel Management Engine, etc. are just the tip of the iceberg. I think we're only just now starting to understand the massive impacts of the continued existence of these backdoors. The immense covert power the NSA has had since the beginning of the digital age (and in the case of the CIA-owned Crypto AG, even long before [2]), most of these powers it has actually been able to keep post-Snowden. Have you heard of the United States Foreign Intelligence Surveillance Court, which Snowden revealed is used extensively by the NSA [3]? If yes, then you know that it is undemocratic, yes? We cannot have courts that are closed, and at the same time call ourselves a democratic country. That is Doublespeak.
Is it strange that many are starting to see the US as essentially the biggest propaganda machine in our new hyperconnected digital world? That it is selling the wasteful consumerist nuclear family way of life, plundering the commons, while at the same time being a militant (military industrial complex) hypocritical rogue agent through parasitical corporate neo-colonial practices [4]?
How many times do these things need to happen for us to start believing it?
Fuck Captain America. Fuck Hollywood. Fuck the NSA powered US empire. Fuck the corporate charter.
I am talking about the power we humans have given to these ideas. I mean the people in them no harm. I am campaigning for us to collectively transcend these ideas and to stop destroying our earth's capacity to support humanity. The idea of America, the NSA etc. are in actual fact metaphysical power systems that do violence to hundreds of millions of people, daily [5]. The sooner we dismantle the current racist systems [6], especially black-box surveillance apparatus, and shift away from Platform Surveillance Capitalism and move towards Protocol Cooperativism, the better. We can do this using technologies like Ceptr and the Holographic chain pattern/framework by the MetaCurrency Project (an agent-centric Ruby on Rails-type framework for distributed networking applications, built using ideas from Git and BitTorrent)[7].
I believe Commons based peer production (instead of firm production) has to be our future. For beautiful visions I often turn to the works of Kevin Carson, Arthur Brock and Eric Harris-Braun.
Mentions in the middle Google also doing this a much bigger instl base then just ignores it. Also more specialist devices justs asks for all data that Apple or Google has in the health apps so how is this a moat?
All valid complaints. However when you look at how doctors deal with data and information tech they seem unable to innovate in that space. No medical establishment has the capability to make something like what Apple is doing. It just doesn't exist in that intellectual DNA. Furthermore, in my experience doctors are terrified of tech. They fear being replaced for some reason. I've seen it over and over.
(full disclosure, I've been working the the health sector for a while making new applications using Apple's HealthKit.)
The question is, will all these data aggregated together actually give us any actionable data that we can and will act on? If there's one thing Google Analytics has taught me, it's that it's quite possible to have a lot of detailed data at your fingertips, but still not be able to answer any valuable questions with it.
I’m using the Watch and with my iPhone. The Health and Activity apps work great together.
The visualizations are clear and understandable. For example, I’m significantly less active this spring than last spring—average of 2.2 miles walking per day in 2019 vs. about 1 mile in 2020.
That’s mostly due to stay at home orders due to COVID-19 the past 3 months. Once the weather got better and the number of cases subsided, I started taking walks in my neighborhood due to the actionable data I had.
Remember, the Watch and the iPhone can do machine learning on the device.
What’s missing is an easy way to do more advanced health data processing on my Mac if I wanted to.
I’d like my public health department release an app for COVID-19 exposure notification, using the Apple/Google API.
You could also envision broad clinical trials of treatments for COVID-19 using these components.
It’s not just the amount of walking; it was also calories burned, heart rate not getting into an aerobic range, my VO2 max and other data that I’d have no idea about if I didn’t have a device monitory this during my waking hours.
you should never have stopped walking. the chances of covid infection outside on a walk are essentially zero.
this is one of the many little harms of blanket stay home orders rather than just distancing (with masks only when you can’t), where you get nearly all of the benefits with nearly none of the downsides.
I live in New England; in addition to the stay at-home orders, it was also cold and rainy much of the spring, in addition to living in a state with the third most infections and deaths from COVID-19 in the country during March–May.
As of today, we’ve had 8,860 confirmed cases of COVID-19 in my county alone.
I have pre-existing conditions and live with a septuagenarian that clearly made it not worth the risk to be out and about.
i completely sympathize with the need to be cautious in the face of elevated risk, but taking a walk outside doesn't by itself present additional risk. the virus doesn't exist ambiently in the air. you need an infected person breathing into your face for some period of time for the risks to accumulate enough to successfully transmit the disease.
Totally agree! It's going to take a whole new sub-specialty of ML to make any sense of it. But I think there's a positive feedback loop where more data → better algorithms → more data, because more people opt into the system in order to get access to the algorithms.
I think there might be an even bigger problem in coming up with any kind of response that we didn't already know. E.g. the advice "Don't smoke, stop eating before you're full, eat more vegetables, eat less bread and pasta, drink less alcohol, prefer water instead of drinks like juice, milk or soda, stop eating processed sugar, avoid saturated fats, get regular cardio, avoid stress, get enough sleep and do so at roughly the same time every night" is likely to be correct for the vast majority of people. Having top-of-the-line ML crunch a bunch of data only to spit out the exact same recommendation to everyone doesn't really accomplish much. Maybe more specific recommendations would be possible in a decade or two if we start having detailed data to look at, but considering how hard a time we've had just answering simple questions like 'are eggs good or bad for you?' in general, I'm not really all that optimistic about our ability to make precise individual recommendations that are not already obvious.
Generally I think you're right. But also I think there are a ton of edge cases we could discover based on complex interactions of genetics, environmental factors, disease history, etc.
Also there's a lot more urgency when an algorithm detects an anomaly and asks you to schedule a blood test!
Many studies show that modern machine learning could revolutionize healthcare. However, many hospitals and governments are extremely protective of patient data. And many hospitals don't even know how to exploit their data through deep learning. Enter Apple and Google and others with big machine learning departments. They are finding new ways of collecting health-relevant data. For example:
Through Apple Heart Study, Stanford Medicine researchers show wearable technology can help detect atrial fibrillation
Apple's privacy marketing seems like just that. All of their proprietary software is highly suspect. And remember, the COVID-19 contact tracing APIs were built by both _Google_ and Apple. If Apple was so concerned about privacy they would have implemented the tracing APIs themselves for the iPhone and released the source code.
I hate Apple's approach of doing 70% of the work all the time. If they truly cared about health, they'd make it incredibly easy for any company to add health data in to their ecosystem and not just try to sell more Apple Watches. As a Whoop user, it's so much more beneficial than their basic Apple Watch stats (which btw are fine for most people, I just want more/better HRV data)
It is easy to add data to Apple health though. You can even do it programatically yourself with the Shortcuts app. There are thousands of apps that integrate with Apple Health.
If Whoop doesn’t, that is surely a choice Whoop made.
Well Apple Health is an open API that anyone can integrate with. So I'd assume Whoop either A) doesn't want to be modularized, or B) has a data format that doesn't fit with Apple's specification for some good reason.
You can actually integrate with Health while still also showing it in your app. Health is like a database of sorts which you can choose to add your data to or access from yoUr app. (Similar to HomeKit, actually.)
Right, what I'm saying is that Whoop should, but doesn't. I don't really want to export my data, transform it for Apple's Health APIs and then re-import it. I want Whoop to do that for me. I'd use their App and Apple Health.
You should reach out to Whoop and request they sync their data with Apple Health. This isn't an Apple issue, this is a Whoop issue. The more users who request it, hopefully, the more they'll see the need.
Also, to counter one of your arguments above, Apple Health doesn't do a lot of analysis on third party data short of showing it in charts, so there is still value to using Whoops app for that aspect of it.
As an example, my scale is Whithings, my bed had a Beautyrest Sleeptracker both of these services consume and contribute to Apple Health.
This is definitely a common complaint with WHOOP! Looking into the reviews for the WHOOP 3.0 the biggest piece of negative feedback I could find is the lack of integration with Apple Health. Seems like this is a bridge they'll have to cross eventually.
Or probably people have become vary of companies like Apple and Amazon who are very focused on vertical integration at the cost of killing off the business of their partners. Spotify had to spend decade to reach critical mass of users for it to reach profitability. Apple Music got their much sooner because Apple was able to push it as the default music app.
Companies used to serve multiple stakeholders that included, employees who worked for them, communities they were present in, customers they served, etc. in addition to stock holders. Slowly, slowly, the definition of stakeholders has been shrunk and reduced to stock holders and responsibilities reduced to maximizing profit. Of course these stakeholders and responsibilities are being further reduced slowly slowly to where companies only exist to benefit large shareholders and corporate executives.
I am guessing you might be young and may not be aware of history of corporations.
Apple Health is one of those products that's useless until it suddenly isn't. We're reaching that point for some folks and I only expect that group to expand rapidly in the coming years.
Ever since I heard Mary Lou Jepsen (OLPC/Oculus Rift) talk about her work on a revolutionary holographic medical imaging system, I've been expecting Apple to buy her Openwater startup, add resources and introduce cheap, safe MRI-like body/brain scanners for the masses. If it works, it could be bigger than the iPhone.
https://www.openwater.cc/technology
What happened to Palantir handling NHS data in UK? There was some privacy concern there but it happened anyways. Call me a pessimist and this a rant but it seems like the public doesn't really control what their governments decide to do with their data. The best the tech firms do is issue an apology for infringing on privacy or pay a light fine while they get to keep majority of their profits.
Its not much of a rant. Its taken centuries of hard work for the average person's body to mostly not be the owned property of other people or governments.
The battle's barely been started for self determination and self ownership of our data.
Apple has a talent for putting themselves right at the center of important technologies. I wonder if this strategy plays out as integrated medical devices and a full-blown healthcare platform. Their reputation for top-notch hardware, good UX, and their shift towards in-house SoCs gives them a serious edge there. Everything about their brand feels well suited for healthcare, and IMO they still don't have a killer enterprise app. This could be what Watson was promising to be.
No, not like their recent keyboards. But exactly like almost every model of their laptops, most of their desktops, their servers, their phones, tablets, watches, NAS/routers and set-top boxes. Every year, for >30 years.
Which laptops? The ones that could be made to repeatedly kernel panic due to GPU issues, that Apple denied was an issue until shown otherwise? Or the ones with the logic board issues? Or the ones with battery issues that caused burns? Or the SSD failures? Or the T2 issues that cause repeated kernel panics?
> their servers
As novel as the Xserver might have been, let's not pretend it was anything more than an unimaginably small surface area for a product
Apple makes well-designed products, mostly. But let's pump the brakes on the idea that everything that comes out of Cupertino is flawless, as you seem to imply.
Apple's got a lot of surface area, and a pretty damn good track record.
Who else is doing what they're doing? No other consumer hardware company goes top-to-bottom from the software to the chip, and no other company has such a cohesive ecosystem. Google EOLs a product once a week, Microsoft is making some nice stuff these days, but is nowhere near the same experience ("Windows is like a bundle of drivers", as in the article).
There is value to being prescriptive over their platform. It gives them skin in the game to make things good; they are much less willing to just blame a vendor.
I've owned 4 of their laptops in the past 5 years (not my choice) and all of them ended in the trash for different reasons that did not depend on me. Maybe the phones are better, I have never owned one.
Ok most companies make some bad products and most companies have some top notch products. Is Apple any different?
How?? I'm on a macbook air from 2011 and an iphone SE from 2012. Do you just pour soda all over them? Or has their laptop quality dipped in the last four years? I know that the butterfly keyboards were having all kinds of issues, but I wouldn't trash a computer over that, they would probably replace the keyboard.
One failed motherboard or smth like that, one because of display issues + keyboard, 2 because of keyboard become unusable. All MacBook Pros. A couple could not be serviced (>2 years old), one could not be fixed, one I changed job (to be fair, I don't know what happened with that one, they may have fixed it).
In comparison, the cheapest laptop I have ever owned (EEEPC) lasted more than 10 years.
The reputation for enforced obsolescence and extremely high prices will be an issue for all but the richest hospitals.
The biggest area of improvement in health care is at the cheaper end. Many people die annually from being unable to afford the $2.50 it costs for malaria treatment, or life saving vaccines.
The side dish problem is vaccines are insanely profitable; every dollar spent in the US on vaccines supposedly saves fifteen bucks of health care expense. I've seen numbers as low as $10 and as high as $15000. The problem is some very populous political and economic regimes worldwide are so unstable that even 1500% rate of return investments, which would seem a no brainer to fund in the west, are impossible without massive external western involvement. In a system that dysfunctional, malaria might not be the biggest problem, nor incredibly expensive and short lived apple iHealth devices.
We've tried allowing infinite immigration from failed states into western states; that didn't help either. Just brain drain's the failed states while exploding welfare expenses in the western states.
or... as with many other technologies, Apple leading the way will subsidize the proof of concept for everyone else. The iPhone didn’t stop people in poorer countries from getting mobile service and smartphones for pennies on the dollar. In fact, it did the exact opposite. 3rd world countries went and built better mobile networks than we had in the US at the time.
Moreover, if the existing medical industry is evidence of anything, prices are jacked up in developed countries to foot the bill of R&D, and the same medications are sold elsewhere for next to nothing.
Apple giving away health technology to disadvantaged communities seems like a good next step. Perhaps existing medical companies aren’t as incentivized to do that because they don’t have the shiny brand to advertise.
The notion that the industry isn’t exposing any data is patently false. FHIR and HL7 have been around for years now and I’ve connected many data sources into both Apple and other services that use those APIs.
FHIR helps quotes a bit, but I think the challenge is that HL7 is expensive to work with and that integrations are point to point.
I’ve also connected sources using HL7, but it’s hard to scale because it’s like everyone creating import/export interfaces to their system.
I think the benefit of Apple health is that it’s a common, trusted intermediary. Me, the patient.
I think it’s easier for me to pull data from multiple sources and show it to my doctor than for all those medical systems to share with each other so my doctor can see data. If I have 5 health services, it requires 5 export to Apple interfaces for me to collect my data, securely store it, and show it to my doc or to any one of those 5 providers.
To have provider interoperability it requires 30 interfaces (maybe my math is off 2^5-2).
There is stuff like Project Blue Button [0] that tries to make a standard interface to export data.
The complaint that it’s easy to export data is only true if you want to pay some consultant to make an interface. In the US, there’s a report on information blocking [1] that called out areas in healthcare with blocking and proposed some changes to lessen it.
I really welcome the Health Kit or Google Fit approach for sharing data among health app, I actually want to use that for health research. The main problem is that as soon as you mention the fact that patients data is going to be shared with a company (besides in the US) doctors shy away because of data protection, regulations etc. We need the data to be on the device and possibly outside of the control of one (or 2) companies.
I know Apple says that data is encrypted end to end, and I wish Google did the same, but even so it is still problematic. When you add the fact that every manufacturers of wearables obliges users to share data on their dodgy platforms... I don't see a solution to this. At least not until the mindset changed completely.
Just heard an interview with author of recent paper about global risk of increased mortality due to climate change. (Radio, no cite, sorry.) Research team has clarified impact of "wet bulb", which is somehow combo of both ambient temperature and humidity, and prevalence of heat related deaths.
Not just the Middle East, but also provided examples from Europe, Toronto, Louisiana.
While wet bulb temp of 35 °C is life threatening, paper shows that with higher humidity even 27 °C can be dangerous for at-risk persons and has led to greater mortality.
While the risk will certainly get worse, people have no intuition for it. Especially for outdoor work and activities.
Any way.
My immediate thought was my watch can alert me to wet bulb risks, a combination of weather and health monitoring.
What is all this "health data" people are talking about? When I go to a new doctor that has none of this apparently super complicated, dense health data, they give me a single page form to fill out where just about 90% of people below the age of 50 will tick every box with "no" or leave the field empty.
Lets say they want to raise premium revenue by 25%. The solution will be to increase premiums on smokers, because everyone hates smokers, by 25%.
How does that math work, you're asking? Right now you and I can check "non-smokers" on medical documents. And that's true, at least for me, medically speaking.
However after we fuse all sources of data we can punish everyone. I bought two packs of cigars in the 90s when I was a dumb young kid. Medically speaking a quarter century later I'm a non-smoker from a health perspective. However, from a revenue generation perspective...
Big brother is not going to fund this out of the goodness of their heart to be revenue neutral or (gasp) positive for the public. The only purpose for this expensive initiative will be to screw over the general population even more to increase income inequality a little more and make the rich just a little richer.
Apple could be planning to make an EHR system, like Epic and Cerner. Google is supposedly working on one, too. (I don’t think the article really arrives on that possibility)
Most electronic health record systems are really terrible software, and they’re also very profitable pieces of software. Google, Apple, and Microsoft are probably the only companies with enough money and software engineering talent to start from scratch and disrupt that space.
Rather than go through the trouble of entering a new complicated market building an EHR to unseat some very entrenched players and force retraining of millions of healthcare workers, which would be relatively antithetical to Apple’s consumer-not-enterprise approach, they could focus behind the scenes efforts on data portability and interoperability via EHR customers (hospitals) so that those EHRs worked better with Apple Health.
You really don’t want to build an EHR if you can avoid it.
If you want to learn more about where research in this area is headed:
Santosh Kumar has been heading a large NSF research center investigating wearable medical sensing and how to turn sensor data into actionable health advice:
I really wish Apple would get on with it - the process for trying to upload medical records was super broken for me (plus as an American, I can't even find most of my medical records since they're in different doctors offices across the 4 states and many cities I've lived in). That said, I am nervous about just how much data they'll own. Does anyone know if there are government backed open systems that someone from another country could use? I know that Estonia for instance has an okay patient health portal where you can see all your info but it's not useful unless you live there.
Just last night I read an essay by Galloway where he pointed out that the really huge companies (Apple, Google, etc) have a hard time maintaining growth so have to move into different sectors where there are huge pools of money. Health is the most obvious one.
In the immediate human sense recall that this was the health app that launched with no way to record your menstrual cycle (a very important aspect of health for about half of humanity, the half that makes new humans I should add.)
In the deeper sense, we might encode "humors" into the design of our system. Our knowledge is incomplete. (E.g. the microbiome, or the "interstitium" which has been called "a new organ" https://www.livescience.com/62128-interstitium-organ.html )
> Buber's main proposition is that we may address existence in two ways:
> The attitude of the "I" towards an "It", towards an object that is separate in itself, which we either use or experience.
> The attitude of the "I" towards "Thou", in a relationship in which the other is not separated by discrete bounds.
There is a subtle trap in thinking of the body as "it" (and also a trap in thinking of the body as "thou", and another as "I"). It behooves us to be careful what we automate.
I would be happy if they would still support older machines with macOS. A macmini of 2010 that is still working good can't be left without security updates!
This is seen as desirable for more than one purpose, including allowing people to move their medical records to a new doctor or hospital easily, and for doing research on what makes for the best care, as well as giving doctors the ability to look at case histories similar to that of a patient they are treating.
Computerization of medicine has been resisted by doctors for a long time, which has meant that all the data and observations and diagnosis made over the years has essentially been lost when it could have been informing doctors decisions and being used in research. There are definitely privacy and abuse problems with putting everyone's health data in a central database run by the government, and it is very difficult to de-identify health data (how many people have your height, weight, age, and diseases?), but without some way to gather all the knowledge and experience and data from the practice of medicine we have been missing important correlations and creating harm due to each doctor making their own decisions instead of having a set of best practices informed by hard data. Whether the police, FBI, NSA, courts, and politicians should have access to this data are difficult questions and hard to implement so they are not subject to abuse. The police already can make some kinds of queries at hospitals for medical data.
The UK has started a large scale Precision Medicine project that is collecting health data on 500,000 people:
and I'm sure there are others, in many countries. A lot of this is part of the move towards Precision Medicine, medicine based on data and personalized to an individual, rather than treating all people as being identical and letting each doctor make their own guess on how to treat a patient (I've been in meetings where doctors say that 80% of the time they are guessing, though guesses get better as they see what works and what doesn't for any one patient):
The space Apple is aiming to dominate is currently one small part of all this. One big question is what do doctors do with all this data? It's too much to look at it all. They have no experience with such detailed info also. What is normal for the way your blood pressure changes as you go about your day? Your doctor doesn't know and hence even if she had continuous blood pressure measurements from you 24/7 wouldn't know what to do with it. What is a reasonable blood pressure while having sex? When climbing stairs? The only measurements like this that we've had historically are from astronauts.
Machine Learning may help, but what do you do with an opaque message from an algorithm that there is a 75% chance you have some abnormality in some obscure biological parameter? The chance of 25% of those notifications being wrong means you can't use it as the basis of a diagnosis. Maybe it suggests something you can investigate further, but then how much time will you waste following up on those 25% of notifications that are in error? Was the ML trained for your age, weight, and specific set of health conditions or will it fail to detect anything for people outside the scope of the training data, yet be used to evaluate your health (incorrectly) anyway? And using ML also creates yet another path for bad actors to steal and tamper with your data.
There are a lot of complicated questions surrounding medical data.
I don't see why I'd need Apple to tell my personal trainer I have a herniated disk. I can tell them myself, and I'm looking to be less locked into the Apple ecosystem, not more.
If that's what they're doing (which I bet it's not), I'd consider it as a good sign that Apple has run out of good ideas.
Anytime you associate health with financial motivation, you end up with something twisted on the long run.
Sure, you can say that Apple, right now, is in the proper state to do that (although given they were part of PRISM, it's debatable).
But what about in 10 years? What if their executives decide that Apple Pay should lead to the creation of a bank? Then from a bank to an insurance company? Then they have a conflict of interest.
Simpler than that, what if they change their stance on user data, and decide to exploit it to understand their customers better? Or sell it? Or just partner it to labs, insurance companies, hospitals?
Like with facebook, it will of course all be "made anonymous", until it's not anymore.
Money and health data are not meant to be mixed IMO.
But even without all that, we are adding yet another tracking system on top of what is already a sensor packed pocket self-spying device.
It's hard to not worry that such concentration of power has a high potential for suffering.