An app to diagnose melanoma, it sounds convenient and less expensive than going to the dermatologist. But what if you were told that the app had an error rate of 30 percent, would you still take the risk? The advent of digital media has broken physicians’ monopoly on health information, and this freedom comes at a price. Misinformation isn’t just a political issue, but a problem with serious health ramifications.
Digital health is nothing new. In short, it’s “the convergence of health care and the Internet.” Today, digital health is a billion dollar industry including a direct to consumer segment made up of wearables like Fitbit and countless mobile apps. Patients are increasingly turning to digital health to augment or even replace their usual medical care. A 2015 study from NYU Langone Medical Center showed that 58 percent of smartphone owners have downloaded at least one health-related app. As digital health and its acceptance in society progresses, the opportunity for unchecked individuals and companies to propagate inaccurate health advice and misleading information becomes increasingly problematic. For patients, the risks of health misinformation include misdiagnosis, false reassurance, delayed treatment, and even death.
Industry leaders have been debating regulation, credentialing services, and a professional code for years. However, there aren’t many easy answers regarding how to address the issue of health misinformation within direct to consumer software. The FDA only regulates mobile health tools that fit a narrow definition of so-called medical devices. The assumption behind this decision is that the majority of mobile health tools pose minimal risk to the average consumer. However, there are many counter-examples to this assumption. In 2011, the Federal Trade Commission fined AcneApp for claiming that it could treat acne with iPhone lights. Or, consider that when physicians tested the reliability of the $4.99 Instant Blood Pressure tool, once a top 50 best-selling iTunes app, they found that the app falsely assured almost 80 percent of hypertensive patients that they had normal blood pressure. Finally, a recently published evaluation of 137 direct-to-patient health apps found that the majority of these apps did not respond appropriately when users entered potentially dangerous health information, such as extremely low or high blood glucose levels. As these select examples show, while direct to consumer digital health products are more popular than ever, the potential risks of use belong exclusively to a uniquely vulnerable consumer group.
Innovators make progress by taking strategic risks, but when it comes to direct-to-consumer digital health, there’s a tendency to forget that consumers are also patients. On one hand, digital health represents an immense opportunity to change the way people experience health care, and more regulation may discourage innovation. On the other hand, the digital health sector is overwhelmingly profitable, and there is no reason to assume that innovators are motivated beyond their bottom lines.
At the opposite end of the spectrum, doctors have traditionally served as the sole collectors of privileged health information. Not that long ago, their advice was our only source of guidance. Today, it would be unwise for physicians to assume that patients are not weighing their options for more convenient truths. In the current climate of medical education, students are taught that practitioners should inquire about health maintenance behaviors such as diet and exercise, use of supplements, seat belts, helmets, etc. Notably missing from that standardized intake is a question about engagement with digital health tools and online resources. Doctors have yet to acknowledge and adopt strategies to battle health misinformation.
Patients deserve unbiased and reliable health information, but app store ratings are poor reflections of clinical utility and usability. Unfortunately, patients’ interests are not yet represented by the conventional approach of physicians or the aggressive pace of innovation. The best way for patients to protect themselves against health misinformation is to become a necessary bridge between physicians and health care innovators. Physicians should ask patients to show them the digital health tools they are using. The act of sharing encourages accountability. Whether it’s a Fitbit or a period tracking app, the doctor needs to know.
John Long is a business student. Jingyi Liu is a medical student.
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