Sunday January 6, 2013
Can an app keep the doctor away?
By AUDREY EDWARDS
Health apps can help promote a healthy lifestyle but it is important to check the expertise behind them.
SO many apps, so little time. In this age of technological indulgence, those with smart devices are offered a gargantuan host of apps to choose from.
If it isn't the social media ones, you have the games to fiddle with. And, of course, there are those catered to your special interests like news, arts and the sciences.
In health alone, there are over 6,000 apps available worldwide, among them apps that help you monitor weight loss, fitness, and ailments like diabetes and heart conditions. And there's even one that tracks your sleep patterns.
Malaysians are beginning to latch on to these apps as well.
Sheila (not her real name) has been using an app to manage her weight. It helps her log in what she has eaten and charts her exercise routine. It then plots a graph to let her know how much weight she has lost within a specified period.
The app caters for Asian and local food when it comes to counting calories and there is a barcode scanner that one can use to work out the nutritional content of food.
“I have lost 15kg in four months,” says the 32-year-old project coordinator, who stands at 165cm and used to weigh 99kg.
The app keeps her motivated to become healthier along with her group of friends.
Sheila admits she was “disgusted” after finding out the high calorie content of fast foods.
“Do you know how much you have to exercise after (consuming) that many calories?” she says.
Since she started using the app, Sheila has made changes to her diet, including cutting down on rice and sweet food. She also goes online to find out more about keeping healthy and has noticed an improvement in her asthma.
“I've never really bothered. I was always chubby and cute,” she quips but adds seriously that she intends to lose another 20kg.
Choosing the right app
Malaysian Dieticians' Association president Indra Balaratnam says health apps can motivate people to become more conscious of what they eat and drink and the progress they make in their pursuit of wellness because they are committed to keying in the information.
“This makes you a mindful eater,” she says, adding that apps in Malaysia that would be helpful would be those that educate people on the calorie content of foods and drinks or those that help keep track of weight management.
However, Indra is quick to point out that one cannot really be certain of the expertise behind the development of an app.
“These apps are usually developed by software entities,” she points out, adding that there are some which are developed by university institutions, hospitals, associations, government ministries and bodies.
“At least you know who the sources are but, essentially, we will never be able to fully tell how effective the app is,” she stresses.
“It's like buying a diet book at your book store. Not all diet books work; some can be very gimmicky.”
She therefore advises users to read reviews by others who have used the app and also show it to their dietician who can see how it can be used for one's specific dietary goal.
“Make sure that it is developed using reputable food databases such as the USDA (US Department of Agriculture) food database,” she says.
“The app should not take over from actual medical attention by a healthcare professional.”
Indra's concern about the effectiveness of apps is not unfounded.
In November last year, the New England Center for Investigative Reporting based at Boston University highlighted that the US Food and Drug Administration has been mired in a debate over how to oversee these high-tech products since they started coming out in the market.
The centre did an examination of 1,500 health apps that cost money and have been available since June 2011, and found that more than one out of five claims to treat or cure medical problems exactly the sorts of apps that FDA-proposed guidelines suggest need regulation, according to a report (http://necir-bu.org/investigations/medical-apps/). The probe also found that out of the 331 therapeutic apps, nearly 43% relied on smartphone sound for treatments.
“Another dozen used the light of the cellphone, and two others used phone vibrations. Scientists say none of these methods could possibly work for the conditions in question,” the report adds.
Indra says that regulating apps can prove tricky “as it is with anything on the Internet”.
“But my opinion is that the Malaysian Government should have an avenue for people to raise complaints about apps or any similar web-based content on nutrition and health that can be harmful,” she says. “This then gives the market a means to self-regulate.”
University Malaya Medical Centre consultant endocrinologist Dr Alexander Tan advises patients to use such apps if it helps them to understand and better manage their diabetes.
“I tell many of my patients that they only see me for 15 to 20 minutes at a time. The rest of the time, their diabetes control is in their hands, making education and self-monitoring an important part of managing their glucose,” he says.
He adds that the benefit of the app depends on how much the patients uses it and reminds that diabetics still needed to check and record their blood glucose levels, a task that can sometimes prove difficult and time-consuming.
“Just having the app alone is not useful if minimal data is entered,” he points out.
“The data also needs to be analysed and acted upon if abnormalities are detected.”
A problem that may arise with information apps is that some of them are forum-based, that is they are based on the opinions of other patients. This may potentially be misleading, Dr Tan highlights.
Other disadvantages are linked to smartphones in general, such as security and privacy of data, loss of data if the phone crashes, and “hanging apps”.
When it comes to diabetes, he says, there are two main categories apps for recording and tracking glucose levels and other parameters and those that are educational.
As most of the apps are from the US, this may be a problem as different units to measure glucose levels are used, he cautions.
But there are benefits, such as it helps to record and track glucose levels, food intake, blood pressure levels and medications.
“It will help someone with diabetes understand how his or her body responds to food, medication and exercise,” he says, adding that sharing of information and analysing it with their doctors is made easier.
Despite this, Dr Tan feels such apps only play a small part in managing diabetes.
“Diet and exercise, taking medications and self-monitoring are still the foundations for good diabetes control,” he stresses.
Helping the doctor
There are also apps in the market to help healthcare professionals in their daily jobs.
National Heart Institute (IJN) deputy head and consultant cardiothoracic surgeon Prof Dr Mohamed Ezani Md Taib finds certain apps useful, such as those that help him explain procedures such as a bypass or valve replacement to a patient.
“The animation and graphic form make it easier,” he says.
This is especially so since there are problems like language barriers and different levels of understanding.
“You think they understand, but they don't,” he says.
Dr Mohamed Ezani adds that having the apps at hand helps him to be more “wired” with his patients, especially post-surgery as he can keep track of their condition by using the various smart gadgets that he has.
“I can monitor patients anywhere in the world,” he says of the apps that are integrated with the hospital's information system.
“I have patient information in real time. It is revolutionary in terms of managing patients.”
However, he warns patients who use health apps to not take them as the “gospel truth”.
Health apps may help you to keep fit but experts warn against them