In the news this week, Adam Engst examines Apple’s vehement denial of Bloomberg Businessweek’s claim that Chinese spies snuck malicious chips onto servers used by Apple and other tech companies. Plus, we share details of the minor iOS 12.0.1, watchOS 5.0.1, and tvOS 12.0.1 updates, and Glenn Fleishman explains how Wi-Fi is moving from unscrutable names like 802.11ac to simple generational numbering. Adam also looks at the new TidBITS News app and other app-based ways of reading TidBITS. Finally, Rich Mogull, who’s a paramedic as well as a security expert, spells out how the Apple Watch Series 4’s health monitoring features will and won’t save lives. Notable Mac app releases this week include macOS Server 5.7.1, BusyCal 3.4.4 and BusyContacts 1.2.17, and Little Snitch 4.2.1.
Color us confused. Last week, Bloomberg Businessweek published a long, detail-filled story alleging that Chinese spies had compromised America’s technology supply chain by inserting a malicious chip into servers used by as many as 30 major technology companies, including Apple.
It’s a bombshell of an article, but an odd one, simultaneously specific in places while vague about what these alleged chips actually did. Plus, all sources were anonymous, which isn’t unusual for an article that involves government-level industrial espionage and national security, but it’s surprising that the article doesn’t quote any outside experts on the record.
In response, Apple released a public statement, saying bluntly that everything the article claims about Apple is completely untrue:
On this we can be very clear: Apple has never found malicious chips, “hardware manipulations” or vulnerabilities purposely planted in any server. Apple never had any contact with the FBI or any other agency about such an incident. We are not aware of any investigation by the FBI, nor are our contacts in law enforcement.
Finally, in response to questions we have received from other news organizations since Businessweek published its story, we are not under any kind of gag order or other confidentiality obligations.
Apple’s statement has none of the tenor of a company trying to cover up untoward behavior, and if anything, it sounds as though the company is fed up with Bloomberg’s questions and allegations. Since then, both the US Department of Homeland Security and Britain’s National Cyber Security Center have said that they have no reason to doubt Apple’s statement. Plus, BuzzFeed’s John Paczkowski reported that multiple senior Apple executives “all denied and expressed confusion” with the report. And Apple has now sent a letter to Congress reiterating these denials.
In addition, Apple and Amazon, which also denied the article’s scenario, are both $1 trillion public companies that routinely face and sometimes lose lawsuits over product representations. Their statements are so specific, cover so much, and are so definitive that both companies would have an enormous liability should it come out that they were lying.
Although there have been some suggestions that such an attack is technically feasible, our contacts with hardware manufacturing experience are extremely dubious that this particular one could have taken place as described without anyone noticing, and our contacts in security reporting haven’t heard anything about this from their sources. So we are currently assuming that Apple is telling the truth about not having found malicious chips in its servers.
But Businessweek isn’t a fly-by-night publication, and there are too many sources quoted and details given for the reporters to just be confused. So unless it’s all an elaborate fiction that somehow snuck by the publication’s editors, we remain unable to explain why Businessweek published the piece in the face of such categorical denials.
Apple has released a trio of updates—iOS 12.0.1, watchOS 5.0.1, and tvOS 12.0.1—to fix a few minor issues in Apple’s latest operating systems. In general, we recommend waiting a few days to install these updates unless one of them addresses a specific issue you’re having. However, if you have an Apple Watch Series 4 that’s working fine, you may wish to hold off installing watchOS 5.0.1 for a bit longer.
iPad users rejoice: Apple has restored the placement of the “.?123” key in iOS 12.0.1. In iOS 12, Apple had swapped its place with the Emoji key. The update also addresses two iPhone XS issues: one that caused it to rejoin Wi-Fi networks at 2.4 GHz instead of 5 GHz and another that prevented it from charging immediately when connected to a Lightning cable. In miscellaneous fixes, iOS 12.0.1 solves a problem that kept subtitles from appearing in some video apps and another that could prevent Bluetooth from being available. iOS 12.0.1 also eliminates two Lock screen-related security vulnerabilities.
iOS 12.0.1 weighs in at 80.7 MB on the 10.5-inch iPad Pro and 106.8 MB on the iPhone X, and you can obtain it in Settings > General > Software Update or install it through iTunes.
We somehow missed this one earlier—on 27 September 2018, Apple released watchOS 5.0.1 to fix a few minor issues. One caused an artificial increase in exercise minutes, another prevented users from receiving stand credit in the afternoon, and a third could prevent the Apple Watch from charging. watchOS 5.0.1 works on the Apple Watch Series 1 and newer, but not the original Series 0 Apple Watch.
We have heard from a TidBITS reader who installed watchOS 5.0.1 on her Apple Watch Series 4 and then had it go into a reboot loop. Apple recommended unpairing and re-pairing the watch, and the support rep told her that the problem was being fairly common. Unfortunately, when she restored from her backup, the problem returned, but setting it up from scratch eliminated the crashes. Her husband’s Apple Watch Series 3 had no such problem with watchOS 5.0.1.
Also, AppleInsider is now reporting that users of the Apple Watch Series 4 in Australia are complaining that a Daylight Saving Time bug is causing their watches to go into a reboot loop. The problem resolves itself after 24 hours but will likely cause Apple to release watchOS 5.0.2 before Daylight Saving Time occurs in other countries, such as 4 November 2018 in the US.
Those of you with an Apple Watch Series 4 that’s working fine should perhaps hold off installing watchOS 5.0.1. Anyone who does want to run the latest version can install the 37.3 MB watchOS 5.0.1 update using the iPhone’s Watch app (go to Watch > General > Software Update).
As is often the case, there isn’t much to say about the tvOS 12.0.1 update, which promises “general performance and stability improvements.” If automatic updates aren’t on, you can update your fourth-generation Apple TV or Apple TV 4K by going to Settings > System > Software Updates. We know of no reason not to update after waiting the requisite few days to see if any problems crop up.
Forget 802.11ax. Say hello to Wi-Fi 6. The Wi-Fi Alliance announced that it will add generation numbers to its trademarked Wi-Fi name, which indicates a device meets its compatibility tests, rather than relying on obscure protocol names set by a standards group.
In the new scheme, Wi-Fi’s numbering starts at what the Wi-Fi Alliance has decided is the 4th generation:
- 802.11n is Wi-Fi 4
- 802.11ac is Wi-Fi 5
- 802.11ax is Wi-Fi 6
This change is purely cosmetic, as it doesn’t affect the certification process or the industry standards group’s work.
The Wi-Fi Alliance wants operating system interfaces to modify their signal strength indicators to incorporate generational numbering that shows the active connection type. That sounds like a graphical headache, and I expect every operating system maker will take a different approach. Or they may just ignore the suggestion altogether, as it’s not mandatory.
A Protocol by Any Other Name Would Run as Fast
The reason for switching to numbers stems from a desire for an easier way to talk about Wi-Fi across versions. I’ve been writing about Wi-Fi since 2000, and it has always been a pain to explain what the letters and numbers mean because most people don’t really need—or want—to know anything but “this works with that at the highest speed of X Mbps.”
This explanatory nightmare worsened in the early 2000s, as the Wi-Fi trademark began to incorporate many different technical standards. Meanwhile, the Wi-Fi logo gained add-ons that referred almost exclusively to standards governing spectrum usage and bandwidth rates.
IEEE, an international standard organization, sets naming schemes by major and minor group, and then uses letters and other markers for standards within each group. The 802 LAN/MAN Standards Committee handles all “metropolitan” (large-scale) and local area network standards. Inside of that, the 802.11 Working Group creates task groups that develop lettered standards, like 802.11b and 802.11ac.
In the early days of 802.11a and 802.11b (both approved in 1999), the standards included a combination of wireless encoding (how to turn bits into radio waves), security, and network interactions. That was too much for a single task group and quickly became infeasible. (Task groups are made up of academics, researchers, and competing commercial interests, so the fewer things they have to agree on to move a standard forward, the better.)
The working group divided different kinds of work into separate lettered standards, like 802.11e for quality of service (prioritizing different kinds of data, so video isn’t choppy and voice calls are crisp), 802.11i for advanced security (to move away from the weak WEP standard found in 802.11b), and 802.11r (improving handoffs for devices as they move among base stations in a large network).
Meanwhile, the Wi-Fi Alliance mostly focused on the standards that related to improvements in bandwidth and throughput: 802.11g, 802.11n, 802.11ac, and 802.11ax. Occasionally, the trade group would add another term, like WMM for QoS (802.11e), which further muddied the waters.
Some manufacturers also added their own spin, with marketing terms like Wireless-N plastered on boxes. But consumers generally had to look for standard names on the packaging or in the interface to determine a product’s capabilities, so a Wi-Fi router might support <deep breath> 802.11a, b, e, g, h, i, j, n, y, and ac.
The Wi-Fi Alliance’s new numbering system focuses on generations of speed improvements but looks back only to 802.11n, which is a decade old. Given that 802.11a and 802.11b were approved at the same time, implicitly calling them Wi-Fi 1 and Wi-Fi 2, and extending Wi-Fi 3 to 802.11g, isn’t quite right. But we anticipate people will do it anyway.
Simplifying device compatibility through better naming seems like a clever idea that’s long overdue, and one that should help people who have no interest in technical standards arcana. The next time someone asks me what Wi-Fi router they should buy, I look forward to saying, “Wi-Fi 6. Look for it on the box.”
And now, if you’ll excuse me, I have to go run some search-and-replace passes in my book Take Control of Wi-Fi Networking and Security so the next update can account for these new names.
In the early days of TidBITS, we were proud of the fact that you could find us on commercial online services like AppleLink, BIX, CompuServe, Delphi, and GEnie, along with the open Internet. Today, you can come to the canonical source of all things TidBITS—our Web site at tidbits.com—and you can sign up to receive TidBITS in email or use an RSS reader with our feed (TidBITS members get a full-text feed).
If you prefer, however, you can read TidBITS in a variety of other places. Here’s the latest news on the TidBITS News app, Apple News, Google News, and Flipboard.
Matt Neuburg’s TidBITS News app for iOS has recently been having troubles that turned out to be our fault. We keep tweaking our RSS feeds to work better with certain services or readers, and one change we made to the app’s custom feed rendered the feed invalid and confused the app. That’s now fixed, so if you like the app, give it a try again.
You’ll also want to see what’s new because Matt has released an update that uses our current logo and headline font. Other changes include updating it for iOS 12, restoring offline mode, and modernizing the interface.
One note: if you want larger text on the headline screen, go to Settings > General > Accessibility > Larger Text and move the slider at the bottom of the screen to the right. You can also add a Text Size button to Control Center in Settings > Control Center > Customize Controls and then increase the size of the text in Control Center.
Apple News in Mojave
A few months ago, I asked TidBITS readers to “Please Follow TidBITS in Apple News!” (30 July 2018). Nearly 1,400 people did, which was hugely helpful for kickstarting the Apple News algorithm into recommending our articles to new readers. In that article, I published a graph showing that 4,645 unique users saw our headlines or viewed our articles for roughly the month of July. For the last 28 days, that number has skyrocketed to 88,258, so thank you for helping expose our articles to more people. (The total views during the last 28 days were 13,238, up from 1,104 in that period in July, so Apple News traffic still pales in comparison with the 202,444 page views on our Web site.)
Regardless, if you have a minute and want to check out the new Mac version of News in Mojave (and you’re in the US, UK, or Australia, the only countries Apple News supports), additional follows would help. Mojave has been out for only a few weeks now, but it already accounts for 5% of our views in Apple News. I suspect that’s more because reading on the Mac is more convenient for many people than because News is a particularly well-done app.
To follow TidBITS in Apple News, search for “TidBITS” in the search field at the top of the sidebar and then click the heart icon either next to TidBITS in the results, or, once you click TidBITS in the results, at the upper right.
Google News is, of course, Google’s algorithmically driven news site at news.google.com, but the search giant also provides a Google News app for iOS and Android. As with Apple News, I’d really appreciate it if you could visit our official TidBITS channel in any Web browser and click the Follow button in the upper-right corner. I hope additional follows will increase the visibility of our articles in Google News too, since it can drive a vast amount of traffic.
(Many years ago, we once published a short article about how Google had created a winter Easter egg for its search page (see “Type “Let It Snow” into Google,” 21 December 2011). If you typed that phrase into Google’s search field, snow started to fall from the top of the screen. The Google News algorithm somehow put that article on the front page, and we received over 100,000 visits that day alone.)
While Apple and Google are the 800-pound gorillas of our news ecosystem, and Matt Neuburg’s TidBITS News app is the homebrew favorite, the best reading experience may come from the Flipboard app for iPhone and iPad. If you’re using Flipboard now, search for TidBITS in the search field and tap the Follow button next the search result (you may have to scroll down a lot to find the right TidBITS; look for my name under it). You can also find TidBITS on Flipboard’s Web site.
For those who haven’t used it, Flipboard relies on an elegant page-flipping interface that makes it easy to scan through article headlines. On the iPhone, you flip up and down, whereas, on the iPad, you flip left and right. In either app, tapping displays the full article in an in-app browser. And since our Web site is now fully responsive, it’s a good reading experience.
We have only 48 followers and 542 viewers on Flipboard right now, so any increased traffic will undoubtedly help Flipboard recommend our articles to new readers there as well.
However you decide to read TidBITS, we appreciate it! If there’s some other spot where you’d like to see TidBITS included, let me know, and I’ll see what I can do.
I saw my first dead body in the fall of 1990. I was in Emergency Medical Technician school a couple of nights each week and on my first ride with a real ambulance crew in Boulder, Colorado. The guy’s neighbors were worried and called 9-1-1. We came and left. We didn’t know why or how this man died, just that he appeared to have fallen down due to whatever killed him, and there wasn’t anything we could do.
Later on, I finished EMT school, volunteered with a local fire department and ambulance, moved on to Paramedic school, and spent a couple of years working full-time in emergency medical services. Eventually, I scaled back to finish college and spent more time with mountain rescue and ski patrol, and on a disaster response team, which I still do today.
I’ve seen strokes from atrial fibrillation (AFib), slip and falls, mountain biking mishaps, and the usual menagerie of human frailty and stupidity. While I worked full-time for only a few years, I’ve been a part of the EMS system in one form or another for over 25 years.
Thanks to its health monitoring features, the new Apple Watch Series 4 will save lives, probably within weeks of launch. I’ve been on real calls that might have had happier endings had the person been wearing one. I don’t know if wearing one would have saved that first victim—probably not—but Apple should get full credit for building a mainstream device that will save some lives.
That doesn’t mean it’s perfect. The Apple Watch Series 4 is far from a comprehensive life-saving device. It suffers from some serious limitations and faces some very real obstacles, especially cost and battery life, but in the end, some people will live longer because they wear one. Over time these features will become more reliable, more affordable, and more comprehensive, especially as Apple’s competitors catch up.
The Apple Watch Series 4’s three key health-related features are fall detection, atrial fibrillation detection, and a simplified electrocardiogram (ECG). Here’s how they might help, the limitations they face, and where Apple might go next.
I responded to countless “slip and fall” calls over the years. These are one of the most common calls for paramedics. Particularly for the elderly, the consequences of a fall can be fatal even when there’s a quick response. Head injuries are frequent and serious, but hip fractures are even more common and can lead down a path from which it’s very difficult to recover.
You can purchase medical devices that monitor elderly family members while still giving them personal freedom. Anyone of a certain age remembers those “Help, I’ve fallen, and I can’t get up!” commercials. Typically, the patient needs to activate the device by pressing a button. Many of these devices are restricted to home use since they tie into a landline.
The Apple Watch Series 4 works similarly, detecting falls with its integrated accelerometer and gyroscope—see Joanna Stern’s Wall Street Journal video with a Hollywood stunt double for examples. It will then call for help if the wearer doesn’t respond to an alert within 1 minute. Since the Apple Watch knows when it’s on your wrist, there shouldn’t be any false alarms triggered by dropping it on your nightstand. It won’t detect all fall scenarios, and certainly not non-slip situations like slumping after a stroke, but the subset of what it can detect will likely rack up immediate saves. It can also work anywhere, not just in the home, like previous landline-tied solutions.
If you buy an Apple Watch Series 4 for a family member, make sure they wear it in the shower, when they’re most likely to have an accident. Yes, it’s sufficiently waterproof.
I’m not worried about there being too many false positives. First, it’s on by default only if the user has identified themselves as being over 65 in the Medical ID screen of the Health app; otherwise you turn it on in the Watch app. Second, there is a subset of falling patterns that is pretty distinct, and the combination of a fall, no movement for 1 minute, no response to an audible alert, and no response when 9-1-1 calls back should filter most of those out. False positives are a fact of the job, and EMTs deploy all the time on faulty fire alarms and injury-free car accidents. It bothered me only when I had just sat down to dinner.
Unfortunately, not every detected fall will result in a positive outcome. But it’s better to have someone respond right away than days later.
There are three significant inhibitors to the fall-detection feature. The first is cost, especially since all Apple Watches need an iPhone companion. That first inhibitor leads into the second, which is the complexity of both an iPhone and the Apple Watch in a demographic where the primary users may also be battling mental degradation. And this second issue ties to the third, which is the effort of keeping the Apple Watch charged and wearing it consistently. Again, this is likely a challenge for the most vulnerable population.
None of these is Apple’s fault; they’re just real-world limitations of the technology. The only thing Apple could change would be to remove the requirement that the Apple Watch be associated with an iPhone.
On the whole, I’m incredibly excited about this feature because it will save lives. Sometimes hyperbole is reality.
A Primer on Cardiology and Atrial Fibrillation
Before I discuss the next two features, it will help to understand the basics of how the human heart works. I’m oversimplifying intentionally—any cardiologists reading this article should skip this part to avoid increased blood pressure.
The heart has two halves and four chambers. The right side pumps blood to the lungs, and the left side serves the rest of the body. The top chambers on each side, the atria, are the “staging pumps” that load up the lower chambers, the ventricles, that do the real work. Without the atria, the ventricles can still move blood, but not as efficiently.
Heart cells are pretty wild and have something called automaticity. That means they can generate their own electrical signals and contract on their own without relying on nerve cells, as do most other muscles. Heart cells will beat on their own without external influence. They also work like a mesh network and influence the other cells around them. To keep everything coordinated, the heart has two pacemakers, bundles of cells that send out strong electrical signals so all the cells work together and squeeze when they are supposed to: the SA node (sinoatrial) in the atria, and the AV node (atrioventricular) for the ventricles.
The SA node fires and triggers the atria like the drummer in a band keeping time. This signal then shoots down special conductive pathways to the AV node, which sends a signal out and around the ventricles on different pathways to trigger the bigger contraction that moves the blood around the body.
Many things can mess up this process, and one of the more common is when something happens to the SA node, or the cells in the atria stop cooperating and get out of sync. That can lead to atrial fibrillation (AFib), where the cells of the atria stop working together and start contracting randomly. That causes the atria to stop pumping blood, leaving the ventricles on their own. While the ventricles can keep things moving by working harder—which also isn’t good—the worst issue is that blood can pool around and coagulate in the atria or the less-filled ventricles. This coagulated blood creates a clot, which the ventricles will happily shoot off to other parts of the body. If it blocks blood to the brain, that’s a stroke.
AFib can also cause weird effects like a dangerously high heart rate. Some of those random signals can, in turn, confuse the AV node, which is what causes the irregular beating of the ventricles, and thus an irregular pulse. If the ventricles beat too quickly, that becomes a medical emergency since your heart can only go so fast for so long. The high heart rate is also less efficient and further increases the chance of stroke.
Ventricles can also fibrillate. But if that happens, blood stops circulating, and you’ll die quickly. If you’re lucky, you get to wake up after someone yells “Clear!”
Detecting AFib with an Apple Watch
Apple worked with Stanford University on a study to refine the Apple Watch’s atrial fibrillation detection. AFib characteristically causes an irregular heart rate as those random signals hit the AV node or other parts of the ventricle. If the atria just stop working at all (it happens) or the random signals are blocked, those are different arrhythmia (electrical problems), and the AV node and ventricles will keep firing their signals at a regular, albeit inherently slower, rate.
All versions of the Apple Watch can detect your heart rate using special lights on the back of the watch that shine into the skin on your wrists. Other sensors detect subtle changes in the light coming back and measure differences in blood flow which directly correlate to your heartbeat. If this approach seems a little sketchy, it is—wrist-based heart rate monitors aren’t known for being highly accurate.
However, to detect atrial fibrillation, the exact pulse rate isn’t important. Instead, the Apple Watch looks for an irregular pulse, taking into account inherent noise due to the watch moving on the wrist or changing light conditions. If it detects a pattern of irregularity that matches AFib enough times, it alerts the wearer.
Atrial fibrillation is one of the most common cardiac issues, especially as we age, and a leading cause of stroke. Unless you go into rapid AFib (technically, AFib with rapid ventricular response), you might not know you ever have it. Early notification of asymptomatic AFib is a major deal since it is a manageable condition. Far more manageable than a stroke.
The Value of an ECG on the Wrist
Because the heart sends out strong, coordinated electrical signals, they can be detected fairly easily using an electrocardiogram, which produces a graph like the one below. The basics are easy to read. The first bump is the SA node firing—it’s called the P-wave. Then there’s a pause as the signal goes to the AV node, where you see a spike for the QRS complex, which shows the AV node firing and the signal triggering the ventricles to contract. The last bump is the T-wave, which shows the ventricles recharging to beat again.
A traditional ECG measures all this activity with electrodes attached to your skin that detect those voltage changes. When I first started as a paramedic, we used 3-lead ECGs in the field, which let us detect only the most obvious arrhythmias. Attaching one lead on the right arm, another on the left, and one on the left leg creates something known as Einthoven’s Triangle and provides multiple views of how the signal moves around. These days we use 12-lead ECGs that offer a lot more angles and let us potentially detect things like heart attacks.
The Apple Watch Series 4 includes a Lead I ECG, invoked by holding your finger on the Digital Crown. It gives a decent view of the heart, but Lead II’s data is usually cleaner since it captures a better angle that’s more aligned with the heart’s conduction path and thus shows the strongest signal. Given the inherent limitations of the Apple Watch’s sensors, or any single lead ECG, the Apple Watch Series 4 will only be able to detect basic arrhythmias and perhaps some interesting fitness data.
It should be possible to identify AFib because it shows up quite obviously on an ECG as a missing P-wave and a bunch of squiggly lines as the uncoordinated cells all fire on their own. Being able to identify AFib on demand will give doctors a much better view than the optical detection that sees only an irregular pulse.
However, a Lead I ECG can’t detect a heart attack. It can detect some other issues, but many of those require knowing things like the exact timing of the distance between the P-wave and the QRS complex. I suspect Apple won’t be providing warnings of such conditions anytime soon, since even experienced medical professionals can miss those issues, especially with only a single lead.
I think the most significant immediate value to the Apple Watch Series 4’s ECG capability will come in refining AFib detection and letting doctors better monitor known AFib patients. Over time, I’m sure more studies will look for additional issues that can be detected with the Apple Watch’s Lead I ECG, but they will always be limited to a few well-known and major arrhythmias that are both detectable and actionable. Ventricular fibrillation, for example, is easy to detect but you probably wouldn’t be capable of holding your finger on the Digital Crown because you’d be busy dying.
Nonetheless, I find the Apple Watch Series 4’s ECG promising. It will be of most value to physicians keeping track of patients with known issues, especially since the optical AFib detection is more likely to find a previously undiagnosed instance of AFib. Many AFib patients today have small sensors implanted into their chests to track their issue and call doctors if it gets worse, so clearly there is a medical need. It may also be useful in helping patients with heart conditions record ECGs during specific events and then share those ECGs with cardiologists—most heart events don’t take place in the doctor’s office. Over time I’ll be very interested to see if Apple can expand the technology to detect other arrhythmias, but I wouldn’t expect that anytime soon.
A New Healthcare Horizon
The Apple Watch Series 4 is a big deal. Fall detection will save lives nearly immediately. AFib detection will help reduce the rate of strokes. And the ECG feature will enable doctors to better monitor and communicate with their patients. Even young, healthy, active people will see benefits ranging from immediate help after crashing on a bike to early detection of congenital or random AFib.
Unfortunately, these features are available only to people with the financial means to afford an Apple Watch and iPhone, who are cognitively capable of using the devices, and who can wear the watch reliably and keep it charged. These are serious inhibitors for broad adoption among the most vulnerable populations.
However, none of this should detract from what Apple has done here. Even if the Apple Watch Series 4’s health-monitoring features are imperfect, even if they detect only a subset of issues and incidents, wearing one will allow some people to live longer and healthier lives.
Now that Apple has put its stake in the ground, I expect a few advancements moving forward.
First, it is likely that more insurance companies will start subsidizing or providing Apple Watches to customers. Some companies, like Aetna, John Hancock, and UnitedHealth Group, already do this to get people moving more with the health tracking. This should help reduce some of the financial overhead. Also, the price will go down over time as Apple introduces new versions of the Apple Watch and keeps older versions around at a reduced cost. It will also take a little time for physicians to hook into the ecosystem and start using its features with patients.
Regarding technology advancements, it’s best to look at the vital signs that we healthcare professionals always want: pulse, respiratory rate, oxygen saturation, blood pressure, and blood sugar (glucose) levels.
Apple has already nailed pulse. Respiratory rate can be detected electrically, but probably not on the wrist. There have been numerous rumors about solutions for the last three, and the latest devices from Garmin claim to be able to detect oxygen saturation. When combined with pulse detection, low oxygen saturation readings could help identify sleep apnea, which is another major indicator of long-term health issues. Like AFib detection, detecting sleep apnea has the potential for large quality of life improvements. I wouldn’t be surprised to see something along those lines within the next two revisions of the Apple Watch.
Blood pressure is also a key indicator of a wide range of health issues, especially stroke. Despite all the rumors, I haven’t seen enough science to indicate we are close to being able to detect it without inflatable cuffs. That’s a big tech problem that Apple is probably working on, but one that may not have a wrist-based solution.
The same goes for glucose levels, which are critical for managing diabetes. Right now, the only reliable measurement techniques require small blood samples. Accurate detection with a watch would be a massive scientific breakthrough with lasting social impact. But again, it’s not something we can predict.
Even without these additional features, the Apple Watch Series 4 encourages a more active lifestyle, can detect the early onset of a potentially debilitating heart disease, and can call for help during certain life-threatening accidents. These are huge advancements that will improve and extend lives. Even in my limited personal experience, I know of real-life incidents that might have had a far better outcome had the individuals involved worn Apple Watches. I’ll be buying some for certain family members this year, and even knowing the limitations of the device, I’ll sleep better for it.