By Tom Stibolt, MD, Mobile Musings Column Editor

An article in the British Medical Journal last month asks important questions: With nearly 100,000 health apps available for mobile devices, are any of these of actual value to patients; and what is their value in people who are already interested and involved in their personal health? The article is in the form of a pro/con debate and makes a number of interesting points. I believe these are worth sharing with our patients.

The debaters note that there are several categories of health apps. Some of these are for patients with specific diagnoses and offer services such as instruction on using an asthma inhaler or a place to track and share blood pressure readings from a home monitor. Others are intended for people with no specific disease. These track calories, steps, or even attempt to monitor sleep patterns.

On the pro app side, it is noted that many of the nonspecific apps are designed for dieting and exercise. It is noted that physician discussions of this topic are typically limited by time constraints related to an office visit. The apps may reinforce and elaborate on topics not well covered in provider-patient interactions. Mobile apps for weight loss in particular has been prospectively studied with two randomized trials demonstrating that mobile strategies using apps on personal digital assistants (PDAs) increased compliance and led to better patient outcomes than traditional programs.

However, data on apps specific to smartphones are few because of the novelty of these devices to researchers, even though they are not novel to the public. Studies have been done of fitness devices worn on the wrist such as FitBit. They demonstrate that the devices measure accurately but no studies have been done to demonstrate improved exercise compliance or other outcomes. Unfortunately, devices measuring other physiologic parameters have often not had their accuracy studied or in some cases, they have even been shown to be misleading. It is noted that there is also no evidence that they cause any harm.

The pro arguer ends with the observation and advice that Apple and Google won’t keep harmful apps out of their app stores and that the FDA clearly doesn’t have the bandwidth to keep up with the thousands of health apps out there. If we choose to be passive about explaining the metrics that matter to us and why, there is potential for great harm. So yes, healthy people may well benefit from using some health apps, such as those that encourage more physical activity and better diet, but we need to be proactive about telling the public which metrics matter and which apps they should use.

The con argument begins by noting that apps are currently offered that supposedly promote mental health; aid sleep; cause weight loss; control food allergy; aid self-diagnosis; manage pain; and help in every other conceivable medical condition. These apps are perhaps mostly harmless (and likely useless). However, these apps are now beginning to do something different. When used alongside wearable gizmos, the apps offer continuous physical monitoring of things such as fetal heartbeat in pregnancy, blood pressure, heart rate, and even pulse oximetry. The unanswered question is: are these wearable devices and apps a medical revolution of disease monitoring and early diagnosis?

Unfortunately, medical research and diagnoses are currently based on isolated readings taken in medical clinics in symptomatic, older, high risk individuals, by doctors who can interpret results. These same measurements in young, asymptomatic, middle class individuals will likely simply demonstrate how common brief arrhythmias are in the normal population, how often our blood pressure might be high, how widely normal oxygen saturations can vary, or the variation in the heart rate of an intrauterine baby.

For the worried well, this will not only be surprising information but will cause concern. Worse, what happens when these devices malfunction or are placed in the wrong position? How will it change our management? Who can interpret the results? What if parents want to start monitoring their children? The reality is that these devices are untested, especially in the setting where they are being used. Will apps simply empower patients to overdiagnosis and anxiety? Further, will patients believe that all of this close monitoring will prevent heart disease or cancer?

We, as health care providers need to help our patients understand the risks, uncertainties and limitations of self-monitoring. The number of these applications, however, will simply increase.

Editor’s note: The ATS does not endorse any of the programs or products mentioned in this column.