Health Apps: Get a Second Opinion

Health apps can seem like a wise tool to help us improve our well being. Now comes a harsh reminder from one of the nation’s top doctors: Not all apps are created equal. Some are not only a waste of time and money — they can also hinder your health.

“This is the digital snake oil of the early 21st century,” said the head of the American Medical Association.

The head of the American Medical Association  doesn’t think health apps are all they are cracked up to be. Dr. James L. Madara, executive vice president and CEO of the AMA, called health apps part of the “digital dystopia” facing the health field today.

At the organization’s recent annual meeting, he further likened apps to snake oil.

“Even those digital products that might be helpful often lack a way of enriching the relationship between the physician and the patient,” Madara said. “It’s like trying to squeeze a 10-gallon product idea into a 2-gallon health care knowledge base.”

“This is the digital snake oil of the early 21st century,” he added.

Are health apps really just hype?

Dr. Karandeep Singh, an assistant professor at the University of Michigan Medical School in Ann Arbor, Michigan, has studied them extensively. He said Madara is right in that it’s hard to separate good health apps apart from the poor ones.

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“I wouldn’t use the term ‘snake oil’ because that implies false claims are being made — I don’t think that apps are generally making false claims,” Singh told LifeZette. “Rather, it’s hard for consumers to find the right app for a given purpose when there are hundreds of apps similar in appearance and description in the face of relatively high turnover of apps on the app store.”

Medical societies haven’t helped — they haven’t specified a way to make searching easier, he said. Taking an active role in the curation of apps would likely improve relationships between medical professional societies and app developers, Singh added.

Rise of the App
The Food and Drug Administration has a policy on mobile medical apps, but regulation focuses mostly on apps that replace medical devices. The Federal Trade Commission also oversees apps and has given developers resources to see if laws apply to their tools, Singh said.

App developers are not subject to the Health Insurance Portability and Accountability Act (HIPAA), so personal data could be compromised.

Perhaps more oversight is needed: Health-related apps are the fastest growing sector in the marketplace, PricewaterhouseCoopers data indicates. Adoption of health apps doubled from 2013 to 2015. Another study showed that one-fifth of smartphone users had at least one health app installed in 2012; the same study, however, found privacy concerns with health data shared via the apps.

A 2015 study in the Journal of Medical Internet Research found that only three out of nine app-only interventions led to a statistically significant improvement for people to manage symptoms of chronic diseases.

An Institute for Healthcare Informatics report on some 43,000 mobile health apps found that more than 50 percent were downloaded less than 500 times. The same report found that only 23,682 were designated as having a legitimate function.

So What’s ‘App-licable’?
Singh said health apps are beneficial if they engage patients in a way that supports them in their care.

Tracking symptoms, weight, or blood sugar may be incredibly helpful for some patients; so might others that share that data with their doctors. Peer-to-peer support tools within apps can also support patients, as can creating games in the form of fitness competitions, he noted. Apps are also likely to be beneficial for telemedicine and population health management purposes.

Apps that claim to aid users in making a diagnosis or choosing a treatment pose a concern — but Singh said most don’t make unsupported claims. Last year, the FTC went after two apps that claimed to help people diagnose skin cancer, Mole Detective and MelApp.

Kaila Prins, of Mountain View, California, used an app to count calories when she started bodybuilding in 2009. She had been anorexic in the past, but said the technology made it easy to “get granular about calorie counting.” That caused her to get obsessed with counting calories, she claims.

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“It was encouraged as healthy,” she said. Prins soon became orthorexic, or fanatical about healthy eating.

In 2011, her company issued a wellness challenge using the Nike+ activity tracker. Employees were encouraged to compete against other corporate locations based on the miles they could run. She ran, injured herself, and kept running. Prins damaged her tendon and had three surgeries following the injury.

“I now suffer from chronic pain and nerve damage from a surgery gone wrong,” she said.

Prins knows she chose to use the app and acknowledges she could have stopped, but claimed she wasn’t sure how to, due to her own mental health issues. Some apps do serve a purpose, but many encourage people to overdo it to the point that it’s not healthy anymore, she said.

It’s All About Choice
Consumers should look at ratings and reviews to see if an app is right for them, said Singh. Stay away from “stale” apps that do not have recent updates. Remember that app developers are not subject to the Health Insurance Portability and Accountability Act (HIPAA) — so personal data could be compromised. Avoid apps that don’t have a privacy policy in terms of how information might be collected, he added.

“Consumers should also be wary about apps that make claims about making a diagnosis or treating a condition, just as they would be for such information obtained through other channels,” he said.