Health Policy Forum | By Rochelle Sharp*
With
about 9,000 consumer health apps currently available in the iTunes store, it
seems like almost all smart phone users can download their way to better health
these days.
The
store offers a mindboggling array of creative apps, including ones that
calculate calories burned during exercise, create soundtracks to help people
fall asleep, and display pictures that can elicit memories from Alzheimer’s
patients. If the store doesn’t offer something for what ails you now, it
probably will soon. The selections will proliferate within the next year, with
an additional 4,000 consumer apps expected by next summer, industry experts
say.
But
all this innovation creates a bewildering set of problems. It’s hard to figure
out what apps are available, let alone which work best. Health apps may have
the potential to dramatically improve people’s lives, but those based on
misleading or bogus information can cause serious harm.
“Apple
isn’t testing apps for their scientific validity,” said Dan Cohen, a social
worker who has reviewed apps for their effectiveness.
Given
the stakes, it’s no surprise that the government is starting to regulate these
smart phone applications. Just last month, the Federal Trade Commission brought
its first cases against the makers of two health apps. Each claimed to cure
acne with colored lights emitted from cell phones.
“Smart
phones make our lives easier in countless ways, but unfortunately when it comes
to curing acne, there’s no app for that,” the FTC chairman said, when
announcing the crackdown. The agency cited the makers of AcneApp, which had
sold about 11,600 downloads of its $1.99 app, and the developers of AcnePwner,
which sold 3,300 downloads of its 99 cent app.
The
Food and Drug Administration (FDA), meanwhile, proposed regulations this summer
for apps that could be considered medical devices. The agency, which is seeking
comments on its proposals until Oct. 19, may focus on apps that are accessories
to established medical devices used by doctors, such as smart phone apps that
can display X-rays.
It
could also regulate apps that transform smart phones into medical devices by
using sensors or other attachments. Already, the FDA has approved gadgets that
turn smart phones into blood pressure-monitoring cuffs and pocket ultrasound
machines.
Apps
that connect to consumer devices, such as blood glucose meters, may be
regulated, too, if the apps display or analyze the meters’ readings, the FDA
says.
The
majority of health apps will almost certainly not be considered medical devices
and will escape government scrutiny. But some app developers are voluntarily
going through the laborious FDA clearance process, in part, to convince the
medical community that their products have real clinical value.
WellDoc,
a Baltimore-based health care company, got FDA approval last year for its
DiabetesManager, which provides automated diabetes coaching for patients. The
app also was tested in a randomized clinical trial conducted by the University
of Maryland’s medical school, which found that patients had a statistically
significant improvement in their blood glucose levels after using the app for a
one-year period.
Scientists
have found flaws with other apps.
When
a George Washington University professor conducted the first content analysis
of behavior-modification apps, she discovered that few of the 47
smoking-cessation apps available in 2009 followed evidence-based health
guidelines. Lorien Abroms, a public health professor, concluded that the apps
had “serious weaknesses” because they did not link to quit lines or clinics or
suggest ways for smokers to get social support from family and friends.
She
argues that public health apps should be developed from evidence-based
guidelines and should offer users the chance to receive text messages. Studies
show that text messaging can help people change unhealthy behaviors.
Many
public health organizations have developed useful apps. The American Heart
Association has one to help people find walking paths, while the New York City
Department of Health, in its effort to help reduce the spread of sexually
transmitted diseases, lists places that give away free condoms.
Such
health apps are already popular and may soon be ubiquitous – with 500 million
consumers projected to be using them by 2015. Nine percent of smart phone
owners surveyed last year said they use health apps, Pew Research Center study
found. Younger people downloaded them most frequently, with 15 percent of smart
phone owners between the ages of 18 and 29 using them. Black owners also had
higher user rates, with 15 percent of those surveyed taking advantage of them,
compared to 11 percent of Hispanics and 7 percent of whites.
The
most popular types of consumer health apps focus on fitness and diet, according
to a report released last month by MobiHealthNews, which tracks mobile
health issues. About 16 percent of available apps in the iTunes store focus on
cardio fitness, with some running apps claiming millions of users,
MobiHealthNews says. Another 14 percent of apps are aimed at improving people’s
diets, while another 11 percent deal with stress and relaxation.
“Consumers
trying to keep up with the ever-changing app market may want to consult medical
societies, like the American Cancer Society,” says Cohen, who evaluates apps.
Alternatively, they could download Cohen’s own app, Healthful Apps, which highlights
some of the most effective, user-friendly health apps available. Cohen
said he spent more than a year perusing and testing apps before coming up with
his list. He focuses on apps in eight categories, including relaxation,
caregiving, memory improvement, and communication. Among
his favorites: iTriage, an app designed by two emergency room physicians that
helps patients understand their symptoms and provides information about the
closest clinics and hospitals – including wait times at some emergency rooms.
Cohen
says that he sometimes uses the Asleep app when he has insomnia, and also likes
sleep apps that send different sound tones to each ear, called binaural tones.
He is a fan of Panic Control, an app designed by a California psychiatrist that
helps people during panic attacks, as well as apps that test people’s hearing
and vision. He likes such testing apps, not because they can replace doctors,
but because they can serve an important public health function of encouraging
people to seek professional help when they need it.
For
caregivers of the elderly, Cohen likes Elder 411, an app designed by a
geriatric care manager filled with more than 500 pieces of advice, and
Alzheimer’s Cards, an app filled with pictures that can spark memories, based
on the book, “Simple Pleasures for Special Seniors.”
For
an app that has completely transformed the lifestyle of people with
disabilities, he picks Proloquo2Go, a text to speech app that allows people
with autism, cerebral palsy, and various brain injuries to communicate more
easily. Cohen
also endorses Pain Care, which recently won the “Project HealthDesign”
challenge sponsored by the Robert Wood Johnson Foundation and California
HealthCare Foundation. The app lets patients track pain symptoms and share data
with their doctors. It is designed to help people figure out what exacerbates
their pain and what treatments are most effective.
It’s
impossible to know how the next generation of consumer apps could change
patients’ lives. But almost everyone agrees with one statement made by FDA
deputy director William Maisel, when he spoke at the agency’s recent hearings
on apps and said.
“These
types of products will revolutionize the way we deliver health care.”
*Rochelle Sharpe is a Pulizter Prize-winning
journalist with more than 25 years of health writing experience.
