In the 1850s, America was full of self-proclaimed doctors peddling patent medicines that, if they didn’t kill you, rarely cured you. It took doctors and regulators decades to extinguish fraud and ban toxic products. Now, claims Dr. James Madara, head of the American Medical Association (AMA), we are entering a similar era, a “digital dystopia” of direct-to-consumer digital health products, apps, and ineffective electronic health records.
“This is the digital snake oil of the early 21st century,” Madara SAID at the annual meeting of the country’s largest physicians group on June 11. “Just as in the mid-19th century when we separated the useful anti-toxins and compounds like aspirin from Stanley’s snake oil remedy, today we’re tasked with separating the digital snake oil from the useful —and potentially magnificent—digital tools.” Despite the potential for progress, he said, “appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base, or that just don’t work that well—or that actually impede care, confuse patients, and waste our time.”
That’s a shot across the bow for entrepreneurs in digital health, which is being touted as a way for medicine to enhance patient care, rein in costs and improve peoples’ lives. There are some success stories to be sure. Robotic surgery, telemedicine, and better records have all made headway in hospitals. Apps show some promise as well. A 2015 study in the Journal of Medical Internet Research found that three out of nine app-only interventions led to a statistically significant improvement for people to manage symptoms of chronic diseases.
But the lightly-regulated industry of medical apps is still a mess. In 2015, so-called melanoma detection apps MelApp and Mole Detective were fined thousands of dollar by the Federal Trade Commission and barred from claiming they could detect skin cancer. Two recent studies also called the effectiveness of most apps into question. A Commonwealth Fund study examining 1,000 health-care apps for chronic diseases found only 43% of iOS apps and 27% of Android apps were likely to be useful. A second study by the Institute for Healthcare Informatics analyzed 40,000+ health-care apps in the US Apple iTunes app store (mostly in the diet and exercise category) and found a majority do little more than provide information from a mix of sources.
Madara said the future was not technology to bypass physicians. “A more promising digital future can be envisioned that enhances the physician-patient relationship, produces better and more efficient care, and allows more time for physician-patient interactions—the type of outcome that has been so falsely promised by much of the current digital snake oil,” he said. Madara lamented that technology was turning doctors into the world’s most expensive data-entry workforce: an AMA study found 50% of physicians’ time was at the keyboard, compared to a third spent interacting with patients.
Patients, it’s worthing noting, seem to love and trust the new apps. A 2015 survey of more than 1,400 providers and 1,100 users in the Journal of Medical Internet Research said patients prefer new technologies for a medical diagnosis (39.7%, compared with 13.8% among providers), reports Health Data Management. A second study in the journal found 65% of users believed apps improved their health, with a majority holding strong faith in their accuracy and effectiveness.
Madara said the AMA would now actively partner with vendors and regulators to inform entrepreneurs what physicians (and patients) really needed: “digital tools that would simplify and better organize our lives, and also adapt to the natural variations in our practices—those that would free more time for patient interactions—that’s what we want.”