The health apps on your smart phone: science or snake oil?

At present, the app market for smart phones is a sprawling one, filled with the genuinely useful, the timesavers and the distractions. There is also a lot of dross available; essentially anyone with the right instructions can make an app; how useful and user-friendly that app will be is another matter. The same is true of the healthcare app market – there are many useful ones, intermingled with those of poor quality, returning poor results or information, which for physical and mental health issues can be deeply problematic. It is true that smartphone apps make the delivery and use of self-help tools much easier (Harrison et al., 2011). But are users too quick to take the information provided by apps to heart, and are the app developers marketing their products based on fake science?

Recently a brain training app Lumosity (Lumos Labs, 2007) was accused of doing just that. The creators, Lumos Labs, was fined by the United States Federal Trade Commission (FTC) for false advertising. The app claimed to help with brain function and cognition, as well as helping with degenerative conditions such as Alzheimer’s. The FTC accused Lumos Labs of preying “on consumers’ fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer’s disease” despite not being able to back up these claims scientifically (Hufford, 2016).

Lumosity is only the tip of the iceberg. There are a huge number of health and mental health applications available for smart phones (Kamel Boulos et al., 2014), most of which market themselves on the basis of improvement to physical or mental health. A quick search of Google Play (other app stores are also available) retrieved apps for depression, schizophrenia, anxiety and bipolar disorders. For physical disorders, there were apps to track blood sugar levels, apps to look up and evaluate symptoms and apps to check your blood pressure. The convenience of carrying this information around in your pocket is appealing. But there seems to be a lack of control and professional evaluation around health applications. Not only that, but users are likely to rate health apps using different criteria from health professionals – when investigating the creation of a mental health app, Goodwin et al. (2016) found that participants identified useful apps primarily by how easy they were to use, above the usefulness of the content.

Many apps make impressive claims that appear to be based in science, but quite often these are not backed up. The iCare Blood Pressure Monitor publishers (iCare Fit Studio, 2016), for example, list several statements about their app in quotation marks, e.g. “The world’s first blood pressure measurement APP” or “The world’s most functional examination APP” but the sources of these statements are not indicated. Eng & Lee (2013) evaluated diabetes apps and noted that the vast majority of tracking apps had not been evaluated by a medical body. Equally, they found that relying on app data to calculate insulin dosage could have potentially harmful consequences for the user.

Mental health and mindfulness apps tend to market themselves along similar lines, describing the value of use to the user, and backing it up with scientific-sounding information. Using the keyword depression retrieved 100 apps ranging from symptom checkers, mood trackers, wellness and self-help apps to yoga, home remedies, a CBT diary, mood logs and Suicide Test app (Archi Casual, 2015) whose avatar is a silhouette of a hanging female, and whose blurb namechecks the World Health Organisation and promises to “try to measure your depression level and will check your coping ability…you will find out whether you are suicidal or not”. MoodTools (2015) says that its app contains “several different research-supported tools” and that it was created in collaboration with multiple mental health professionals. This may well be true. However, very few of these apps are explicit about their sources and as Harrison & Goozee (2014) note, there appears to be a gap in “evidence-based app technology”. In terms of the structure of health apps, a study by Lister et al. (2014) found that there was an overall “lack of following any clear industry standard of effective gaming, gamification, or behavioral theory in health and fitness apps”. In an open marketplace where you can download an app claiming to help you self-diagnose bipolar disorder, it is worrying that app users may well take the information they receive as gospel without also getting input from a mental health professional.

Another key issue with smart phone apps is that they will produce data according to the formulae used to build them, and the information which is fed to it by the user (whether this is statistical, numerical or keyword analysis). The app, however, is unable to tailor advice based on body language or individual body chemistry and so risks causing harm where a user may have complex health issues or multiple diagnoses. Wykes & Brown (2016) also point out that using apps to treat mental disorders risks self-absorption on the part of the patient, instead of concentrating on interactions with the outside world as is often encouraged with face to face psychological treatment. It also seems that some downloaders will not research apps prior to use. For example, Finger Blood Pressure Checking from Mobile Creatives is a prank app; however from the user reviews, many users did not realise it was not serious.

Smart phone use has exploded globally over the past 10 years and the reality is that health advice, diagnosis and calculation is readily available for their users. The appeal of apps is the gamification nature of them (plug in your numbers, get a response in eye-catching graphics) and the fact that the majority of the population travel with their phones and use them in moments of downtime (e.g. commuting or queuing), which used not to be possible when Google was the main source of information. This being the case, should health apps be evaluated and given some sort of blue seal of approval by governing bodies so that they can be used with confidence? Medical devices in the UK have to be registered with the MHRA, but guidance on which smartphone apps are medical devices and which are not is unclear (McCartney, 2013). Buijink et al. (2013) suggested a more rigorous approach to the regulation of apps with a range of healthcare stakeholders contributing to a robust set of guidelines. But can smartphone apps be peer-reviewed in the same manner as academic health output? Or, with the overstuffed app market, would attempts at regulation be fruitless?

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.