Jacob Tietelbaum is a medical doctor, bestselling author and regular contributor to the Huffington Post. His wife, Laurie, is a nutritionist. Together, they have developed Cures A-Z, one of the most popular smartphone health apps. The app, they say, is science-based and contains hundreds of cures, as well as a nutrition guide.
At a glance, the credentials of the app's creators look impressive. Scratch the surface, however, and Tietelbaum has been ordered by the US Food and Drug Administration to stop selling unproven treatments for chronic fatigue syndrome. Both Jacob and Laurie promote a treatment for allergies and autism that has been described by the medical journal Current Allergy & Clinical Immunology as "the most unsubstantiated allergy treatment proposed to date".
Can you really trust their health app?
Indeed, as the market for health apps – estimated to be worth about $26 billion (€24 billion) by 2017 – continues to grow, can you trust any of them?
Dr Steve Kerrigan is a senior lecturer in pharmacology at the Royal College of Surgeons Ireland (RCSI), which has recently developed the RCSI MyHealth App. “There has been an explosion in the number of health apps, and there may be up to half a million more released in the next short while,” he says. “Some of the apps are really good and useful. Couch to 5k, for example, has been transformative in terms of how people approach fitness, while a first aid app could be useful as an educational tool.”
Consumers of health apps need to ask themselves a number of questions, says Kerrigan. “Who is the developer? Are they reputable? Are they medically trained, or are they an 18-year-old sitting in their bedroom who is really good at designing apps? If they’re not a medical specialist, have they partnered with trained experts or a reputable institution?
“In particular, people should be very, very careful about trusting any app that claims to diagnose a medical condition: people go through college for six years or more to learn how to do this. An app that tells you, for example, that your blood sugar is fine based on what you ate today, should be treated with caution.”
A medical degree or background isn’t a requirement for a health app developer. In the US, the FDA regulates only a handful of medical apps, and most of those are for healthcare professionals to use with their patients, rather than the sort which can be casually downloaded at home.
In the EU, mobile apps are not regulated. Ceara Treacy, a postgraduate researcher in mobile medical apps at the Regulatory Software Research Centre in Dundalk IT says this is allowing room for innovation. She points out that any technology which claims to treat or diagnose a medical condition is considered a medical device and must go through a regulatory process. But manufacturers can easily get around this by stating that their product is for entertainment or information purposes only.
In a burgeoning body of academic research into health and fitness apps, opinion is divided as to how beneficial they are. Writing for the British Medical Journal, Iltifat Hussein, an assistant professor of emergency medicine at Wake Forest School of Medicine and editor of iMedicalApps.com, says these apps can help people take control of their health and in some cases improve their health outcomes.
About 40 per cent of apps are discarded after the novelty wears off. Some can be genuinely useful for patients with particular conditions or for those who want to improve their health and wellbeing. Others may be relatively useless: do you really need to know your oxygen level, pulse rate or a foetal heart rate, and what can you do with the information? Then there are apps that claim to have legitimate health benefits, where caution is advised.
All this, however, is before the privacy implications are even considered. Healthcare information is highly sensitive and worth up to 10 times more than stolen credit card details, as fraudsters can use the data to buy medicines and medical equipment.
Daragh O’Brien is the managing director of Castlebridge Associates, a strategic data-protection and information-management consultancy. He says data privacy laws apply to the sensitive data generated by health and fitness. “But you can have all the regulation in the world and nobody enforcing it. Bear in mind that snake-oil salesmen have always been a feature of the medical field; without effective regulation, that data can be abused.”
A popular and free app that is used by people to evaluate their health symptoms, iTriage, states on its site that it values the privacy of its users. But read the privacy policy and iTriage indicates that it can disclose your personal data to your employer, to third parties for marketing purposes, to any company they merge with, to any government anywhere in the world, to your family. O’Brien says this would put him off using the app and they should review the policy.
Read the privacy statement on health apps, says Kerrigan. “Your name, address, height, weight and date of birth are sensitive pieces of information, so be cautious of disclosing them. And never give away your address or date of birth.”
The best health apps on the market
RCSI MyHealth
App Store and Google Play, free, developed by RCSI in conjunction with 16 health charities
Easily the standout health app for Irish users, this is a new service developed by researchers at the Royal College of Surgeons Ireland, in conjunction with the Irish Cancer Society, the Irish Heart Foundation, Diabetes Ireland, the Alzheimer Society of Ireland and 12 other organisations.
It contains health information about more than 800 specific conditions; a list of health services in Ireland ranging from emergency contact numbers to support organisations and hospital details; links to the latest health news from credible sources; and the ability to work out your body mass index.
Can you trust it? Leading clinicians from the RCSI, as well as medical health professionals from a range of health charities, have worked on it.
Privacy policy? Excellent: The app doesn't demand any specific personal details or anything that could identify you. Your anonymised information may be gathered into statistics on usage of the app and also shared with the Irish Cancer Society.
Lloyds Online Doctor
All platforms, €25, developed by Lloyds Pharmacy
Not strictly an app, this is the most widely available service that allows patients to have a remote consultation. Browse your condition, start an online consultation with an Irish-registered doctor and receive your prescription through the post three to five days later. It’s been particularly popular for the contraceptive pill and for erectile dysfunction tablets.
Can you trust it? Opinions differ here, and both sides have a vested interest. Lloyds treat only patients for whom a physical exam (beyond blood pressure and BMI, which can be checked at a pharmacy) are not necessary. A spokesperson for the Lloyds group says about 10 per cent of patients are turned away when its doctors believe the patient would benefit from a face-to-face consultation.
The Irish Medical Organisation says such services are “not medical consultations in any real meaning of the word” and GPs work best “when there is personalised continuity of care between doctor and patient”.
Privacy policy? The company is compliant with all data protection requirements in Ireland and the UK. Sexually transmitted infections are "notifiable diseases" and Lloyds is obliged to report them to medical authorities.
Couch to 5k
App Store, Google Play and Windows Apps, free, various developers
Probably the most popular and well-known of all the fitness apps, Couch to 5K nonetheless warrants a mention because it has played a major role in encouraging physical activity. It works incrementally: users start off with a brisk walk, then a short run, then a longer one until, nine weeks later, they’re running 5km.
There’s a proliferation of these C25K apps; they’re more or less the same but some offer slightly different features. Start with the free ones, see how they work for you and then buy it if you like it.
Can you trust them? They aren't claiming to diagnose, cure or treat any particular illness or ailment, but are all about getting you fitter. Doctors say it works, although people with a family history of heart or lung conditions, as well as those who are out of breath after walking up a flight of stairs, might want to see their doctor first.
Privacy policies? There are too many apps to list all the policies here, but check the privacy policy on the app's details page before you download; if you're not comfortable with it, there are plenty more you can try.
Headspace
App Store, Google Play, Windows Apps, 10 free sessions with year-long subscriptions available, developed by Headspace Meditation
Meditation has gone mainstream. Too mainstream, too popular, too faddish? Possibly, but unlike other popular trends, such as the story that gluten is bad for almost everyone’s health, solid evidence shows meditation works.
Free and paid-for meditation apps are abundant, but Headspace’s offering is particularly strong.
Headspace focuses on mindfulness, a practice that helps people to focus on the present moment by simply observing their thoughts and emotion without judgement; when the mind’s focus wanders – as it inevitably will – just bring it back.
Can you trust it? Meditation has been heavily researched and, by now, the clinical evidence is clear: it decreases anxiety, depression and stress, and may play a part in preventing mental illness in the first place. It's good for general wellbeing, concentration, memory and creativity. Even empathy levels can be boosted by meditation. It's not the overall panacea, though: it can't cure cancer and it won't make you a millionaire.
Headspace meditations have been well reviewed by users and several clinic trials have suggested the app is an effective tool.
Privacy policy? Headspace has a long set of terms and conditions. Buried in there, the privacy policy explains that it collects your name, address and contact details. It doesn't share personal information with advertisers but may share aggregate information about its overall user base.
First Aid by the Irish Red Cross
App Store and Google Play, free, developed by the 3 Sided Cube
Most accidents that require first aid, including cuts, falls, burns and choking, happen in the home. This app from the Irish Red Cross has tips for more than 20 common scenarios, as well as some safety advice. First aid apps are understandably popular, but they should be primarily used as an educational tool, says Dr Steve Kerrigan of the RCSI.
“If you need to deliver CPR or stop a serious bleed, the last thing you want to do is to open an app, click on the relevant link and then learn how to administer it: the patient could be gone by that stage. Look at the app long before you need to use it.”
The Red Cross app has preloaded content so it can be used without an internet connection or phone coverage.
Can you trust it? Internationally, the Red Cross is a hugely respected charity providing medical help to people all over the world. The Irish Red Cross and an army of volunteers provide ambulance services and first-aid courses throughout Ireland, and the app was made in association with its first-aid and medical experts. Similar apps have been developed by other Red Cross branches.
Privacy policy? This isn't clear in either the App Store on Google Play. But, as it's primarily an educational tool, it's not gathering sensitive information.
Headache Diary Pro
Google Play, €2.49, developed by froggyware
If you suffer from headaches or migraine, it can be hard to pinpoint the triggers or identify any patterns. This is a useful app that helps you to track the triggers, pain, symptoms and treatments, creating statistics that can help you manage your headache.
Can you trust it? This is precisely the type of app where users are vulnerable to inaccurate information. And there's so many headache diary apps. But this Google Play app has been clinically reviewed and is featured in the UK's NHS Health Apps Library, which is a reliable certification.
Nonetheless, headache apps are not perfect and shouldn’t substitute for a proper discussion of your headaches with a GP, particularly if they’re severe or if you haven’t tended to suffer from them before, but it can help on a day-to-day basis.
If you’re looking at headache diary apps for other platforms, check the developer: do they have a record of making medical apps and who have they worked with?
Privacy policy? Another app without a clearly stated privacy policy. This is a place where your medical information could potentially be valuable, so if you have concerns, either request their privacy policy before downloading or choose another app; it's a question of offsetting the NHS recommendation against privacy concerns.
Health Mapper
App Store, free, developed by DesignAndProsper
An all-purpose health app that helps with the daily management of a wide range of health conditions including diabetes, asthma, anxiety, Parkinson’s disease, eczema, multiple sclerosis and irritable bowel syndrome. It helps monitor symptoms, make appointments, and renew prescriptions. It’s also useful for medication reminders, but batteries die and apps crash, so it can be useful to have a back-up.
Can I trust it? Yes. It is recommended by clinicians who reviewed it for the NHS Health Apps Library.
Privacy policy: Not wonderful, but not awful either. You're not just giving basic details such as your IP address; it gathers your most sensitive and financially valuable medical information. This data is gathered for compiling statistics about the app, although it is anonymised. The reason it's free is that your data may also be used to "inform you about products and services from carefully selected suppliers"; this means your data will be given to other companies who will market their services towards you, although you can opt out here.
Drugs Meter
App Store, free, developed by Global Drugs Survey
Alcohol and drugs aren’t always the big bad monster: studies show about 80-90 per cent of drug users are nonproblematic and don’t become addicted. Recreational drug use isn’t going away. This is a useful app for monitoring whether the amount of drugs or alcohol you are consuming is dangerous, whether you should be cutting down and how your usage compares. The app’s creator, Dr Adam Winstock, a consultant addiction psychiatrist and founder of the Global Drugs Survey, says conventional advice to simply not take drugs fails to reach those who just want advice on harm avoidance.
Can you trust it? Yes. It's recommended by the NHS, Winstock has an excellent academic record and the Global Drugs Survey is gathering very important information against the background of a growing debate about the global war on drugs.
Privacy policy: Very good. The app doesn't ask for any of your personal details and it doesn't store trackable data. Your anonymised information forms part of a database on comparative drug use.
