DUBAI Health tracking apps have for years helped people collect and chart data on their heart rates, moods, sleep patterns and menstrual cycles. But now some of these apps are going further by using that data to predict an individual’s risk for problems like heart conditions. In other words, they are moving from simply quantifying consumers’ health data to medicalising it.
Of the several hundred thousand health apps available globally in major app stores, most lack high-level evidence on their outcomes, according to a recent study in Nature Digital Medicine. And as long as consumer health apps make vague health promises — like improved well-being — and do not claim to diagnose or treat a disease, they are not typically required to submit effectiveness evidence for vetting by the US Food and Drug Administration.
“It’s certainly become confusing for a consumer [as] these apps are making claims about helping you learn about mental health, PCOS, heart disease, diabetes,” said Dr John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston, one of the authors of the Nature study.
We ask five health experts in UAE to comment on the pros and cons of health apps.
“I think they can be extremely beneficial if utilised in a healthy manner,” says Mandeep Jassal, Therapist, the Priory Wellbeing Centre, Dubai.
“I’m aware of research which has reported reviewing 51 unique sleep apps and overall found that the procedures were not validated by scientific research. However, there are scientifically proven apps, some of which I would recommend,” says Jassal.
“For example, there are sleep apps that can monitor the amount of movement and fitness we have undergone throughout the day, help set goals for sleep patterns, or action-specific steps on how to achieve these goals. Some of the positive aspects reported with sleep-related apps are how they can help to regulate emotions and, importantly, help to support and restore our mental equilibrium.”
Can apps actually help an individual fall asleep?
“[They] can help individuals to learn to relax which, in turn, can help an individual to fall asleep,” says Jassal. “However, it’s important not to become dependent on sleep apps. If individuals are constantly checking the app, thinking about logging information, or becoming anxious about not sleeping, sleep apps are in danger of becoming more of a hinderance. Professional support is recommended to help uncover and treat any underlying issues causing the individual to struggle with sleep disturbance and insomnia,” says Jassal.
Are the meditative, calming, visualising features, including sound, images and story-telling that many apps say are sleep-inducing devices essentially a spin-off of traditional training methods of relaxation? “Yes,” says Jassal. “According to research, relaxation in the form of meditative breathing and visualisation can help an individual to better regulate their emotions. The brain is constantly trying to make sense of situations and process information and during deep sleep the brain ‘sifts’ through this information and places it into so-called compartments. A similar process of sifting through and compartmentalising information can be undertaken through meditative and calming features on apps, allowing our brain the ability to slow down thoughts and process information and events. This helps us to reach a desired state of equilibrium.”
1) Sleep apps can be effective for all – adolescents, adults or elderly individuals if used correctly. They can be particularly effective for those struggling specifically with stress or anxiety.
2) Do not use apps as a permanent resource for sleeping but rather as a support and guide to help learn how to manage anxious thoughts and self-soothe for healthy sleep.
3) If symptoms such as constant worrying, an inability to relax and being easily distracted by negative thoughts and feelings persist, reach out for professional support
Best sleep apps:
Headspace, Noisli, Calm, Slumber: Fall Asleep, Insomnia, Sleep Score.
“On a general scale, I would recommend the use of mental health apps - however, not as a complete substitute to individual face-to-face mental health services,” says Malak Kamel, psychologist and Clinical Director at Thrive Wellbeing Centre, Dubai and adjunct instructor of Psychology at the American University Of Sharjah. “I would recommend its use as a way to receive quick tips and tricks on how to manage anxiety and reduce stress.
Mental health apps, however, are not intended to replace individual psychological or psychiatric services. “Though still in their early stages of use and implementation, these apps may instead serve to assist individuals with meditation, mood tracking, thought management, and breathing exercises, “ she says. “I would recommend apps that assist with guided mediations, stress management, and relaxation techniques.”
On the positives in using these apps, Malak says, “Some of the positive aspects include: spreading mental health awareness, monitoring and tracking our moods, and receiving quick and efficient tools (such as thought management tips and guided meditations).
On the cautionary side, “Engaging in self-diagnosis is a big concern with regards to using mental health apps, “ she says. “Mental health apps can be a great platform to become more informed about mental health challenges - but they do not in any way substitute a diagnosis from a mental health professional.”
Who should not use these apps?
“Individuals whose difficulties and challenges are severely impeding their functioning and causing them significant distress wherein a psychological or psychiatric concern may be of concern. If unsure, please seek guidance from a licensed mental health professional,” she advises.
1) Always check the credentials of the mental health service provider. Just because it is an app, and some of the content (or even service) is free, this does not mean the service should be compromised or place your mental health at more risk.
2) Verify the actual content displayed on such apps. Just as there are systems and frameworks in place that ensure ethical mental health service provision in the ‘real world’, it is necessary for such checks to be present in the virtual world.
“With over 100,000 [health-related] apps available across iTunes and other platforms, caution and discretion must be exercised in identifying their utility,” says Dr. Yasir Parviz, Consultant Interventional Cardiologist, Canadian Specialist Hospital.
Apps are generally user-friendly and designed for the layman, he says, but, “the profile of the majority of users would fit a younger audience, well versed with technology and actively involved with their health and fitness. For those not very knowledgeable about the virtual world, it could present a challenge.”
He would not advise a patient to make a judgement about their health based on the results of an app. “The experience and knowledge gained and honed by healthcare professionals cannot be replaced by even the best of apps,” says Dr Parviz. “Each individual needs to be assessed properly, based on several other parameters. So, a broad generalisation regarding their efficacy is not advisable.”
He has a word of advice on the accuracy of the information on an app. “A large number of these apps lack reliability and credibility in terms of scientific evidence or validity of their claims,” he says. “It needs to be stressed that their clinical effectiveness and integration with healthcare delivery systems is extremely limited. As healthcare professionals, we need to conduct formal evaluations and reviews before recommending them to the public.”
What about apps that claim to measure arrhythmia? “The reliability for accurate readings [in such cases] is, again, debatable,” he says.
There are limitations to apps. “They involve a clear lack of cited clinical evidence and integration with mainstream medical pathways. There is also the concern around compromised privacy and patient confidentiality, and unclear regulations on information access and misuse in the virtual realm. Especially from the user’s point of view,” says Dr Parviz.
1) Use discretion and common sense while relying on apps. For further evaluation and clarification of any medical issues, consult a professional.
Dr Idrees Mubarik
Aster Hospital, Mankhool
“As a doctor, I cautiously welcome the use of technology/health apps in management/treatment of patients especially patients of diabetes mellitus,” says Dr Idrees Mubarik, Specialist Endocrinology, Aster Hospital, Mankhool, Dubai. “If used properly, patients can learn about calories/carbohydrate counting/portion control, keep track of blood glucose levels, provide alarms for high and low glucose levels, provide reminders for tablet intake thereby increasing compliance. Some apps help physicians also to monitor the status of patients, provided [patients] discuss app related details with their doctor.”
However, the information given by apps in not an end in itself. “Coordination with physicians remains the cornerstone for proper use of an app,” says Dr Mubarik.
How reliable are such apps? “Scientific studies are always tricky to interpret,” says Dr Mubarik. “Research has not shown any significant difference in end results, but studies have their own fallacies. I personally believe that apps related to diabetes or other chronic diseases can be helpful, especially for educating the patients.”
However, there are dangers too. “There are some apps which prompt the insulin doses depending upon what a person eats and the blood glucose levels of the person,” says Dr Mubarik. “From a physician’s point of view, that can be dangerous, as artificial intelligence should not be allowed to determine the dose of insulin. That should be decided by a physician,” he says. “Patients who are exclusively treated with insulin are also educated about the adjustments in insulin dosage.”
Who should use these apps? “In the UAE more than 50 per cent of people have smart phones and thereby have access to health apps. Needless to say, a person who uses the app should know how to use it. Also, whenever you see any confusing piece of information or some new information, get in touch with your physician.”
“I personally feel some [of the apps related to nutrition] are over- or under estimated,” says Lubna, registered dietician, Aster Clinic, Bur Dubai.
“Also, it’s difficult at times to quantify your meals to feed that information into the apps, for nutrient calculation. And this can turn the tables,” she says.
Many of the apps are also sponsored, so there is a bias “towards a particular perception of the diet”, she says.
Regarding the reliability of the apps, Lubna says it is important to check the source of information. “Most of them are developed by a programmer, collecting the information on the internet. So to verify the source is very important, since in today’s world, every second person is an unqualified nutritionist.”
The obsession aspect, as with all technology, is always on the front burner of concern. “Calculating your macros or nutrients can become an obsession for some, and then lead to negative association with the food,” she says. And given the rising cases of eating disorders in teenagers and adults, these apps can ruin the situation and can push a person to depression.”
1) Before using any app, always read the disclaimers on the app.
2) Nutrition related apps can be useful for people who are motivated enough and are being monitored. It’s a great tool for group motivation, where you are being supervised by a professional.
3) Individuals who are obsessed by their weight or counting every calorie, shouldn’t use these apps, it may affect their day to day living.
4) These apps aren’t a replacement for professional help at any point of time.
RECOMMENDED APPS (depending on the patient):
Many paid apps
— With inputs from New York Times