Health apps don't save people, people do

  @FortuneMagazine September 24, 2013: 5:15 PM ET
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(Fortune)

Silicon Valley thinks it has found a way to address lifestyle diseases (hypertension, Type 2 diabetes, and the like) that are increasingly straining global health care systems: smartphone apps. This year venture funds have poured about $150 million into companies whose mobile software programs track and analyze exercise, diet, sleep, and other factors that contribute to good health. Much of the software tries to motivate people by turning healthy living into a game or contest, pitting users against their co-workers and friends, or doling out virtual rewards for staying virtuous.

Consumers appear to be gobbling up such apps: Last year mobile health apps for iPhones (AAPL, Fortune 500) and devices that use Google's (GOOG, Fortune 500) Android operating system generated some $718 million in revenue, up from an estimated $100 million in 2010, according to the National Venture Capital Association. MyFitnessPal, which just raised $18 million in funding, says it has 40 million users logging their workouts. Runkeeper, which bills itself as a "personal trainer in your pocket," claims at least 22 million users.

Yet so far there's little evidence that the smartphone apps can effectively reduce lifestyle diseases or the huge costs associated with them. (In the U.S. the total cost of diagnosed diabetes last year reached $245 billion; a person with diabetes has medical expenditures 2.3 times that of a healthy individual. The number diagnosed in the U.S. has nearly tripled in the past two decades.) The Journal of Health Communication recently published a paper raising serious concerns about the attention and hope piled onto such technology, largely because so much of it was "unsupervised" and relied on patients' faithfully recording their activities.

This year researchers at Johns Hopkins published one of the first papers to put health apps through a sort of rigorous equivalent to medical trials. The findings showed the apps were mediocre at best. Most of the apps' ability to manage disease was of "low quality, and nearly all were undertaken in high-income countries," they wrote. That last caveat may be the most important, for the kind of person who would download a health care app to his smartphone and obsessively feed it data -- imagine, well, a technology venture capitalist or entrepreneur -- generally isn't at high risk for diabetes, which disproportionately affects poor and older populations.

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If information technology and deep-pocketed startups can't make people healthier, what can? One of the most effective proven solutions is shockingly low-tech. In the late 1990s, as diabetes was noticeably on the rise, the National Institutes of Health wanted to see whether there was a better way to intervene, so it set up a test. It took three groups -- hundreds of middle-aged people in each -- from all over the country: One group received metformin, a prediabetes drug; another group, the control, received a placebo; and the third underwent a "lifestyle-modification program," with the goal of at least 7% weight loss.

The study was meant to last five years, but the results were so striking that they were published a year early, in 2002. The lifestyle intervention not only beat out the placebo, but was twice as effective as the drug too: Nearly 60% of the third prediabetes group never got the disease.

In 2010 the NIH, working with the Centers for Disease Control and Prevention, the YMCA, and insurance giant United Healthcare (UNH, Fortune 500), launched the Diabetes Prevention Program nationally, based on the 2002 study results. The way the DPP works is simple and cheap: The YMCA runs a 12-month group program to get people to eat better and be more active, with the goal of losing that 7%. The program costs about $400 per person and is often paid for by participants' insurers; it subsidizes payments for the uninsured.

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Judy Ouziel, who oversees the New York City YMCA's DPP, says she never turns anyone away, and that the program reaches far more than just those enrolled. "What we see is, it doesn't just affect one person -- they're taking their skills home: It's partners, families ... If she's in it, her husband is onboard," Ouziel says.

The savings are substantial: more than $10,000 in the first year for someone who staves off diabetes -- and early intervention can save insurers and patients additional tens of thousands of dollars. "These costs escalate substantially," notes Jonathan Lever, who is in charge of health strategy for the YMCA of the USA. "You don't just flame out with diabetes," he adds. "You rust away." Lever is working to make the program available at sites other than the Y: churches, community centers, libraries. Right now it's in 614 locations -- New York's program, which extends throughout the city, is counted as one -- and about half are not at the Y.

One can see why well-meaning and ambitious entrepreneurs have sought to use technology to address lifestyle diseases. Unlike for many other ailments, the optimal cure doesn't require surgery or a medication approved by the Federal Drug Administration. At-risk populations need to eat better, walk more often, take the stairs. They could benefit from better tools for monitoring their progress (e.g., "big data"), and, as the YMCA program shows, family and community support (a.k.a. social networks) helps too. It should be the perfect opportunity for infotech to transform health care. But people lie to their phones or ignore them. It's harder to do so in person, with a real live support group.

Fast food's healthy arms race

Granted, the mobile health app industry is still in its infancy. The potential for using technology and data collection in preventive medicine remains great, particularly as other parts of the health care infrastructure -- insurers, hospitals, nursing homes -- work with app developers to ensure use and drive results.

A study highlighted in the journal Diabetes Care called attention to one group of early adopters who already seem to benefit from health apps: kids. In it, children with Type 1 diabetes used their smartphones to better monitor and manage blood-glucose levels. Bernard Tyson, CEO of Kaiser Permanente, sees integrating technology into health care as a balancing act. "The trick is to figure out what it is about certain technologies that works so both doctors and their patients can partner to improve health outcomes," he says.

And yet the YMCA's experience suggests that the real motivating factor for prediabetics cannot be digitized. For people who have struggled with health and eating issues their whole lives, something clicks at those weekly meetings, "when you hear that Betty Sue from the Bronx has the same problem as you in Queens," Ouziel from the New York Y says. There is no app for that.

This story is from the October 07, 2013 issue of Fortune. To top of page



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