Take Two Aspirin And Download This App (At Your Own Risk)

Don’t be surprised if one day soon your doctor ends an appointment saying, “Here’s a prescription for a drug that will help, and download this app.”

Medical apps are turning our phones and tablets into exercise aides, blood pressure monitors and devices that transmit an EKG. But the proliferation of apps is way ahead of tests to determine which ones work.

Christine Porter is hooked on the My Fitness Pal app.

Christine Porter posts food, drink and exercise infofmation to her health app every day and says she's almost always honest. (Martha Bebinger/WBUR)

Christine Porter posts food, drink and exercise infofmation to her health app every day and says she’s almost always honest. (Martha Bebinger/WBUR)

In October, after deciding to lose 50 pounds, Porter started recording everything she eats or drinks and any type of exercise she does.

“It’s telling me I have about 1,200 calories remaining for the day,” Porter said. She took a long walk at lunch and built up some calorie credits so she wouldn’t have to skimp so much at dinner.

Porter heard about the app from her health coach at the Ambulatory Practice of the Future, a primary care clinic for Massachusetts General Hospital employees.

“I usually give patients a choice of several apps that might help them,” said health coach Ryan Sherman. “Some patients won’t even look at them and then others might say, ‘Oh, yeah, this could work for me.’ ”

Increasingly, Sherman says, patients are coming in, pulling out their phones and asking, “Hey, have you seen this one?” The options are both exciting and hard to manage.

“There’s a new one every day so it’s trying to keep up with that,” Sherman said. “And if there’s not one place to look that can be hard.”

Which is one reason doctors at this Mass General clinic are suggesting — but not prescribing — apps. It’s hard to know which of the roughly 40,000 choices work.

Experts who are trying to figure out which apps are safe and effective generally separate them into two categories: those that actually turn your phone into a medical device and everything else.

The FDA is revising regulations that would apply to medical device apps. For all the other ones, Happtique, a company based in New York, has just created a certification process. Co-founder Ben Chodor says Happtique will review apps and give the ones that perform as advertised a seal of approval .

For example, Chodor said, “If you’re looking at glucose monitoring apps and there’s 150 of them, but 20 have a seal on them, then you can make an educated decision about which of those 20 you want to use.”

Some patients prefer game-type apps, Chodor added. Others like apps with big icons or great graphics.

But right now apps are largely untested despite the claims of some direct marketing ads. So if you’re using one instead of going to the doctor, think twice.

“It does make sense that people who download these apps and use them really understand that they are doing so at their own risk,” said Dr. Laura Ferris, a dermatology professor at the University of Pittsburgh.

“The worst of [the apps] missed melanoma over 90 percent of the time.
– Dr. Laura Ferris, a dermatology professor

Ferris ran a study of apps that claim to detect cancer based on a picture of a mole. Only one of the apps sends the picture to a dermatologist. It was right in 98 percent percent of cases. Three others could be dangerously wrong.

“The best of them missed melanoma 30 percent of the time,” Ferris said. “The worst of them missed melanoma over 90 percent of the time.”

Still, some doctors say apps that work are transforming medicine. Dr. Eric Topol, chief academic officer at Scripps Health in San Diego, prescribes apps that monitor blood pressure and heart rates so that both he and his patients know when and why things aren’t going well.

“And that’s a whole lot better than giving them medicine that we don’t even know if it works, has side effects, has costs,” Topol said. “So I have a higher regard for ads [devices connected to a phone or tablet] and apps than I do for medication.”

Topol says apps that control blood pressure will help prevent strokes and heart attacks, and may mean doctors should prescribe phones and tablets in addition to apps.

Few doctors in Massachusetts are prescribing apps, but many are paying close attention and thinking about ways that apps could improve care.

“If a diabetic patient can use an app and help organize their individual blood sugar regime and improve their self-care, then they can spend less time in the doctor’s office, which is a win-win for both sides,” said Dr. Richard Parker, chief medical officer for Beth Israel Deaconess Care Organization.

Count Porter in the “win” category. The fitness app devotee has lost 35 pounds in seven months. “It’s crazy, I never thought I could do that and I feel great. I feel like a different person,” she said.

Still, there are many unresolved questions about health care apps:

  • Should all the information Porter uploads become part of her medical record, and if so, how?
  • Who analyzes all her numbers?
  • Will insurers cover the cost of apps?

Dr. Ben Crocker, who is with the MGH clinic that recommended Porter’s app, says those are questions doctors will have to answer because “this is what’s engaging patients. Patients are coming to their doctor for the first time saying, ‘I’ve been collecting some information,’ or, ‘I’ve been using this application.’ And that, I think, we can’t ignore, no matter where this is taking us, no matter how Wild West it feels.”

Have you had any positive or negative experiences with medical apps? Share your story in the comments.

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