What is the point of health apps when we are healthy?

What is the harm in health apps - none, right? And surely they can only be good at enhancing healthy behaviors? Or are there too many apps of too little value, and lots of potential for otherwise healthy people to get unhealthily worried - obsessed even - about their normal health?

Health apps have given us access to information about our bodies in a way that was once unimaginable, but has this change been good or bad?

Such questions form a debate in the latest issue of The BMJ, which pitches an emergency doctor and editor of a website that reviews health apps against a general practitioner who argues, no, healthy people cannot benefit from them.

First, a few points from the "yes" argument - healthy people can benefit - and whether we like it or not, digital health is part of a technological revolution:

• In the USA, smartphones and apps are now within most people's reach
• Health apps on smartphones are "here to stay"
• This has developed from a point more than 10 years ago, when apps were on PDAs.

Researchers at the Wake Forest School of Medicine, NC, conclude:

"They can help people to correlate personal decisions with health outcomes, and they can help doctors to hold patients accountable for their behavior."

One of the central points is that "tens of thousands of health apps are perhaps mostly harmless (and likely useless)" - and that too much technology in medicine already results in "medical harm and overdiagnosis" so we should be skeptical of embracing more.

"A Wild West approach to development is playing out and will use the advertising classic - fear - to sell product. War, pestilence, and famine are all out to grass; technology, medicine and overdiagnosis are the new riders of the Apocalypse.

Humanity is wasting its time on monitoring life rather than getting on and living it."

We are the ones choosing to self-monitor, or not to self-monitor, so the debate lies in how much choice we really are able to exercise, who really benefits, and whether there are any harms that outweigh benefits.

That last question falls to medicine and doctors, and is in the realm of regulators such as the Food and Drug Administration (FDA), which has just announced its position on the regulation of health apps. 

In addition, the FDA stated in February that it would have oversight only over those mobile medical apps that are intended to be used as medical devices, or accessories to the medical devices it would ordinarily regulate. The FDA sets out what this means:

"When the intended use of a mobile app is for the diagnosis of disease or other conditions, or the cure, mitigation, treatment, or prevention of disease, or is intended to affect the structure or any function of the body of man, the mobile app is a device."

Health or disease?

The journal debate centers on the question of apps used by healthy people, but both sides of the argument cannot help themselves responding to the unavoidable question of when health becomes disease. When does a health app become a medical app? When does an app prevent disease, or help create or mismanage it?

In fact, the benefit of personal digital technologies in people already at risk of disease, whereas society is increasingly seeing the body as a "simple machine" and that this gives rise to the false belief that it can be adjusted easily by the technology - when "cancer, dementia, heart disease and the rest" cannot.

Some everyday common sense is brought to the debate by several articles, for example one from Sylvia Warman, a UK office-based worker in London who became aware of her need to take more steps. She simply describes her own case, specifically to do with health monitoring through the use of FitBit One, a wireless activity and sleep tracker.

"For me, the encouragement to take more steps when approaching the daily goal was helpful. The praising phrases can be a bit cheesy, as are the virtual badges that FitBit awards to users.

But the weekly update I receive by email is a useful guide to progress and helps to identify patterns in terms of the days of the week I'm particularly active or inactive."

References:

1.  Can healthy people benefit from health apps?, Iltifat Husain and Des Spence, BMJ, doi: 10.1136/bmj.h1887, published online 14 April 2015.
2.  How I use health apps (commentary), Sylvia Warman, BMJ, doi: 10.1136/bmj.h1896, published online 14 April 2015.