Health Apps for the Healthy: Useful or Useless?

Diana Swift

April 15, 2015

New health apps appear regularly, but their value remains unclear. Now two physicians on opposite sides of the Atlantic set out opposing views on the utility of such apps in a debate published online April 14 in the BMJ.

"Physicians Need to Get on Board Fast"

Taking the pro-useful side, Iltifat Husain, MD, an assistant professor of emergency medicine at Wake Forest School of Medicine, Winston-Salem, North Carolina, and editor of iMedicalApps.com, argues that because consulting room discussions of fitness and weight loss consume time and are largely ineffective, primary care doctors could instead recommend reliable health apps to deliver education and behavior-modifying techniques. He points to the success of Lose It, an app-based weight-loss plan that works as well as paper- or website-based programs, and he refers to two recent randomized trials showing that weight-loss apps on (now outmoded) personal digital assistants increased compliance and improved outcomes over traditional programs. App patients in one study lost an average of 3.9 kg (95% confidence interval, 2.2 - 5.5 kg) more than patients following a standard plan at each postbaseline point assessed.

In his view, apps for today's ubiquitous smartphones may work even better than personal digital assistants "because of their deeper integration with a patient's lifestyle...enabling a more intimate and frequent experience," he writes.

In addition, if health apps and devices can empower diagnosed patients to manage their medical conditions, improving satisfaction and compliance, perhaps they can also help healthy people stay healthy. But with thousands of the health conscious already using unproven apps to measure everything from physical activity and calories to blood pressure, sweat production, and time spent in various stages of sleep, physicians need to get on board fast.

"If we wait for scientific studies to prove the benefit of apps, we're going to get left behind — not only by our patients who are already using them but also by the industry dictating which tools people should use," Dr Husain warns.

Although there is no evidence that health apps are harmful, many are untested. The US Food and Drug Administration is regulating only those that turn smartphones into medical devices or accessories to these devices, leaving countless health apps on the market with no oversight.

Serious potential for harm lies in professional passivity, Dr Husain argues. Although healthy people may well benefit from health apps that encourage more physical activity and better diet, doctors need to be proactive about telling the public which metrics actually matter and which apps they should buy.

"Mostly Harmless and Likely Useless"

On the con side of the debate, Des Spence, a general practitioner in Glasgow, Scotland, argues that the tens of thousands of contemporary health apps are perhaps mostly harmless and likely useless. He took aim at the neurotic narcissism of today's Lycra-sporting health nuts and their fixation on wearable "health bling" and use of foods as pharmaceuticals.

Dr Spence argues that the growing mania for constant self-monitoring of all manner of vital signs will only promote uncertainty and anxiety in the young, asymptomatic ranks of the worried well. "We have an unhealthily health obsessed generation who will seize on these new health apps and devices," he writes.

And what will these believers actually learn? How common brief arrhythmias are in the normal population? How often our blood pressure might be high? And who benefits from such "health totalitarianism"? he asks. "Corporate medicine and the drug industry, that's who, whose joint commercial imperative is to make us all health neurotics."

Calling technology, medicine, and overdiagnosis "the new riders of the Apocalypse," Dr Spence opted to take his chances and live life medical app–free.

This commissioned opinion article was not externally peer-reviewed. The authors have disclosed no relevant financial relationships.

BMJ. Published online April 14, 2015. Full text

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