The British Medical Journal has staged a debate on the topic “Can healthy people benefit from health apps?”
The debate seems to your correspondent to be a draw.
Iltifat Husain, editor, iMedicalApps.com, and assistant professor of emergency medicine at Wake Forest School of Medicine, North Carolina, USA, argued the “Yes” case and cited studies showing that users of weight loss apps lose more weight than those who don't adopt software-assisted weight loss regimes.
Of devices like Fitbit and Jawbones, he said there is “no current evidence that these fitness devices improve outcomes or exercise compliance; likewise, there is no evidence that they cause harm.”
Hussain also noted that “absence of evidence isn’t necessarily evidence of absence” and said: “We can’t rely on Apple or Google to regulate the apps in their stores and to guide consumers away from those that have no basis in evidence or may be dangerous.”
Nor will US regulators help.
His conclusion is that “... healthy people may well benefit from using some health apps, such as those that encourage more physical activity and better diet, but doctors need to be proactive about telling the public which metrics matter and which apps they should buy.”
Arguing the “No” case was Des Spence, a general practitioner from Glasgow, UK.
Spence reckons apps and wearables will be used by those he calls the “worried well”.
“Health 'bling' is everywhere: all things Lycra, T shirts from exotic charity half marathons, the chatter of personal trainers and training programmes, and bikes that cost more than cars. Even food is no longer to be enjoyed: it has become a pharmacopoeia of blended pulses, green leaves, and nuts.”
Spence reckons owners of this bling will over-diagnose themselves.
“Most medical research and diagnoses are based on isolated readings taken in medical clinics in symptomatic, older, high risk individuals, by doctors who can interpret results—not by young, asymptomatic, middle class neurotics continuously monitoring their vital signs while they sleep,” he wrote, adding:
The truth is that these apps and devices are untested and unscientific, and they will open the door of uncertainty. Make no mistake: diagnostic uncertainty ignites extreme anxiety in people. We must reflect on what we might lose here, rather than what we might gain. Will apps simply empower patients to overdiagnosis and anxiety?
Spence is also suspicious of who benefits from apps and wearables, suggesting the winners are “corporate medicine and the drug industry … whose joint commercial imperative is to make us all health neurotics.”
“War, pestilence, and famine are all out to grass; technology, medicine, and overdiagnosis are the new riders of the Apocalypse,” he concluded. “Humanity is wasting its time on monitoring life rather than getting on and living it.”
The full debate is available here. It may, however, be redundant: Apple today launched its HealthKit medical research service. If anyone ever gets their hands on an Apple Watch, perhaps boffins will be able to provide us with better data with which to inform a future replay of the BMJ's effort. ®