Thursday, April 16, 2015
But if those consumers are already healthy, the apps won't necessarily do them any good, according to a new report in The BMJ, a British medical journal.
On Tuesday afternoon, for instance, the top 10 free health and fitness apps for iPhones included MyFitnessPal, a calorie counterand diet tracker; the FitBit activity tracker; Pacer, a pedometer and blood pressure tracker; and Period Tracker Lite, a menstrual-cycle tracker, according to data compiled by App Annie, an analytics firm.
For consumers with concerns of a more medical nature, apps in the Google Play store, among others, offer all kinds of advice, self-diagnosis and treatment. One is marketed as an HIV risk calculator, another is a self-described self-test for erectile dysfunction, and a third purports to offer home remedies for cold sores, colitis, conjunctivitis and constipation.
An article published in The BMJ on Tuesday evening, however, questions whether such consumer health apps provide any real health value to already-healthy consumers – and whether the apps could even cause harm by stoking unneeded anxiety among the worried well.
Doctors don't yet have definitive answers to these questions, partly because smartphone apps are so new and partly because government health authorities regulate consumer health apps at their own discretion, depending on the possible risks to users. As a result, many health and fitness apps lack rigorous clinical evidence to demonstrate they can actually improve health outcomes.
The medical journal article, titled "Can Healthy People Benefit From Health Apps?," lays out arguments for and against the apps by juxtaposing the opposing views of two doctors.
Arguing in favor, Dr. Iltifat Husain, the editor in chief of iMedicalApps.com, a review site for medical professionals, contended that some apps, by encouraging healthy behavior, could hold great potential to reduce the rate of illness and death.
"They can help people to correlate personal decisions with health outcomes," Dr. Husain wrote, "and they can help doctors to hold patients accountable for their behavior."
He recommended that doctors become more involved in educating the public on which health details to track and which apps to use. If doctors waited for scientific studies to prove the benefits of health apps, he added, they could lose their power to influence patients to "the industry dictating which tools people should use."
To provide a dissenting perspective, The BMJ enlisted Dr. Des Spence, a general practitioner in Glasgow. He argued that many health tracking apps encouraged healthy people to unnecessarily record their normal activities and vital signs — turning users into continuously self-monitoring "neurotics." He recommended people view these new technologies with skepticism.
"The truth is that these apps and devices are untested and unscientific, and they will open the door of uncertainty," Dr. Spence wrote. "Make no mistake: Diagnostic uncertainty ignites extreme anxiety in people."
Although both doctors agreed there was no evidence that health apps had caused harm, federal regulators in the United States have been cracking down on health apps that make deceptive claims — an issue with the potential to cause mistreatment or misdiagnosis of medical problems.
Tuesday, April 14, 2015
One night in 1982, John Mumford was working on an avalanche patrol on an icy Colorado mountain pass when the van carrying him and two other men slid off the road and plunged over a cliff. The other guys were able to walk away, but Mumford had broken his neck. The lower half of his body was paralyzed, and though he could bend his arms at the elbows, he could no longer grasp things in his hands.
Fifteen years later, however, he received a technological wonder that reactivated his left hand. It was known as the Freehand System. A surgeon placed a sensor on Mumford's right shoulder, implanted a pacemaker-size device known as a stimulator just below the skin on his upper chest, and threaded wires into the muscles of his left arm. On the outside of Mumford's body, a wire ran from the shoulder sensor to an external control unit; another wire ran from that control unit to a transmitting coil over the stimulator in his chest. Out of this kludge came something incredible: by maneuvering his right shoulder in certain ways, Mumford could send signals through the stimulator and down his left arm into the muscles of his hand. The device fell short of perfection—he wished he could throw darts with his buddies. But he could hold a key or a fork or a spoon or a glass. He could open the refrigerator, take out a sandwich, and eat it on his own. Mumford was so enthusiastic that he went to work for the manufacturer, a Cleveland-area company called NeuroControl, traveling the country to demonstrate the Freehand at assistive-technology trade shows.
Mumford was in Cleveland for a marketing meeting in 2001 when he got news that still baffles him: NeuroControl was getting out of the Freehand business. It would focus instead on a bigger potential market with a device that helped stroke victims. Before long, NeuroControl went out of business entirely, wiping out at least $26 million in investment. At first, Mumford remained an enthusiastic user of the Freehand, though one thing worried him: the wires running outside his body would sometimes fray or break after catching on clothing. Each time, he found someone who could reach into his supply of replacements and reconnect the system. But by 2010, the last wire was gone, and without the prospect of tech support from NeuroControl, the electrical equipment implanted in Mumford's body went dormant. He lost the independence that had come from having regained extensive use of one hand. "To all of a sudden have that taken away—it's incredibly frustrating," he says. "There's not a day where I don't miss it."
Monday, April 13, 2015
Sunday, April 12, 2015
People living without disabilities can take for granted how much the built environment is suited for them. It's easy to walk into a space without noticing the couple of steps you took to reach the door or to forget that the tight spaces in your favorite cozy cafe might make it difficult for a blind person to navigate.
Jason Da Silva cannot take such things for granted. A filmmaker whose work has aired on HBO and PBS, Da Silva was diagnosed with multiple sclerosis when he was 25. He now uses a power scooter to get around.
The loss of his mobility made Da Silva acutely aware of the difference between accessible and inaccessible spaces. Routines like taking the subway became impossible and favorite spots to meet with friends became unreachable. Da Silva made a documentary, When I Walk (available on Netflix), about his battle with MS and his gradual loss of mobility.
Wanting to do more than document the challenges he faced, Da Silva set out to take concrete action that would make it easier to get around with a disability. Together he and his wife, Alice Cook, created AXSmap, a crowdsourced map to rate businesses based on how accessible they are.
Thursday, April 9, 2015
But when I approached my dad, who had developed end-stage Parkinson's disease, to ask what his end-of-life wishes were, he indicated a desire for aggressive measures.
Bioethicists have long debated the issue of "precommitment." Which wishes are more valid — ones that someone indicates in advance or those expressed during serious illness? My father's case provided a vivid case study of this issue.
A main reason that my father had entered the field of infectious diseases in the 1960s was medicine's new ability to treat severe infections. What was then the fairly recent discovery of antimicrobial agents like penicillin and streptomycin meant that endocarditis, tuberculosis and other previously untreatable infections could now be cured.
But as my dad's career progressed, his consults were as often as not on gravely ill patients who had experienced infection after infection and were getting worse, not better, even if a particular infection could be treated. Typically, these patients lived in nursing homes. Many had dementia. Some required permanent feeding and breathing tubes. Others had terminal cancer. One of his consults, I learned through reading his journals, had an "absolutely rampaging lymphoma" and was "obviously terminal and slipping rapidly," but her primary doctor wanted to treat yet another infection.
Sunday, April 5, 2015
Tuesday, March 31, 2015
A scan of his brain eight years ago revealed a slight abnormality — nothing to worry about, he was told, but worth monitoring. And monitor he did, reading and studying about brain structure, function and wayward cells, and obtaining a follow-up scan in 2010, which showed no trouble.
But he knew from his research that his abnormality was near the brain's olfactory center. So when he started smelling whiffs of vinegar last summer, he suspected they might be "smell seizures."
He pushed doctors to conduct an M.R.I., and three weeks later, surgeons in Boston removed a cancerous tumor the size of a tennis ball from his brain.
At every stage, Mr. Keating, a 26-year-old doctoral student at the Massachusetts Institute of Technology's Media Lab, has pushed and prodded to get his medical information, collecting an estimated 70 gigabytes of his own patient data by now. His case points to what medical experts say could be gained if patients had full and easier access to their medical information. Better-informed patients, they say, are more likely to take better care of themselves, comply with prescription drug regimens and even detect early-warning signals of illness, as Mr. Keating did.
A 3-D print of Mr. Keating's M.R.I. data showing his large brain tumor, the white mass in the right front section of the brain. CreditErik Jacobs for The New York Times
"Today he is a big exception, but he is also a glimpse of what people will want: more and more information," said Dr. David W. Bates, chief innovation officer at Brigham and Women's Hospital.
Some of the most advanced medical centers are starting to make medical information more available to patients. Brigham and Women's, where Mr. Keating had his surgery, is part of the Partners HealthCare Group, which now has 500,000 patients with web access to some of the information in their health records including conditions, medications and test results.
Other medical groups are beginning to allow patients online access to the notes taken by physicians about them, in an initiative called OpenNotes. In a yearlong evaluation project at medical groups in three states, more than two-thirds of the patients reported having a better understanding of their health and medical conditions, adopting healthier habits and taking their medications as prescribed more regularly.
Wednesday, March 25, 2015
Miraculously, for many the disease went into remission, only to recur months later. But Dr. Farber's last-ditch attempt to save these children began an era of ultimately remarkable progress — decades of clinical trials of progressively complex treatments that now cure nearly 90 percent of children with leukemia.
Olivia Blair of Baltimore, who will be 3 in May, is showing the benefits of this progress. After her T-cell acute lymphocytic leukemia was diagnosed when she was 17 months old, Olivia has weathered more than a year of treatment at Johns Hopkins Kimmel Comprehensive Cancer Center with about 15 different drugs plus radiation to her brain and spine.
With her disease undetectable months later, she is now in a study of an experimental drug to help maintain the remission and is back to a near-normal childhood, a thriving, happy toddler who plays with other children, goes to day care and accompanies her mother grocery shopping.
Kelly Blair, Olivia's mother, said, "It was very hard for us to decide to participate in the new study, but we finally thought that even if it didn't help Olivia, it's going to help other kids."
The tortuous road to the kind of treatments now saving more than half of all cancer patients is graphically depicted in a six-hour series, "Cancer: The Emperor of All Maladies," produced by Ken Burns, to be broadcast on public television (PBS) March 30, March 31 and April 1.