Stethoscope-clutching physicians are morphing into Star Trek’s Dr McCoy with his multipurpose tricorder and making this possible is the ubiquitous smartphone, which has arguably become almost as indispensable as air, water and caffeine.An increasing number of apps and peripheral devices are now helping people collect clinically-relevant data using their smartphones.
These apps go beyond being simple medical wikis, pill reminders and fitness sensors to record vital signs, instant heart rhythm checks using ECG, and hi-definition images using ultrasounds. And all this can be done by simply hooking handy little gadgets such as arm cuffs, probes and sensors to a smartphone to closely monitor health without having to carry multiple devices.Most of these affordable devices —available online for less than $200 — are approved by the U.S. Food and Drug Administration (FDA).
The AliveCor Heart Monitor, for example, gives you an ECG reading in 30 seconds by just placing your fingers on a sensor. The recording can then be mailed to a cardiologist for analysis. In a clinical setting, the procedure takes at least 30 minutes and typically requires you to change into hospital robes to get probes and wires stuck to your chest.
The US-based Smartphone Physical offers smartphone-based weight/body fat scales, blood pressure cuffs, pulse oximeters, spirometers, otoscopes, ophthalmoscopes, electrocardiograms, stethoscopes, and even PCR (point-of-care genetic testing) and ultrasound probes.
"The Smartphone Physical is incorporating these into an integrated solution that clinicians, health care workers, or even patients may use to monitor health. Most of the components of Smartphone Physical involve a peripheral hardware device along with an app, which is generally freely downloadable in the Apple or Google stores," says founder Dr Shiv Gaglani, who is medical student at Johns Hopkins and editor of the medical technology blog, Medgadget.
“I realised that the physical exam manoeuvres I was learning at Hopkins were being replicated by smartphone-based apps and devices, so I decided to ask whether we could perform a complete clinical exam simply using these new technologies,” says Dr Gaglani, who debuted the concept at TEDMED this year and again at the World Innovation Summit for Health (WISH) 2013 on December 11-12.
Advocates of DIY (do it yourself) care insist it improves access to tests, cuts down on referrals, and provide overall better care. It increases access to treatment and care, especially in remote or under-resourced settings or among people with restricted mobility, such as among ageing populations.
It is also expected to increase patient compliance with medicine and lifestyle prescriptions as it can help patients track symptoms and take corrective action or seek medical advice if the readings are skewed.
These apps have already caught on in India. “People are using blood-glucose meters attached to phones to closely track fluctuations, with some apps helping to navigate insulin pumps as well,” says Dr Anoop Misra, director, Fortis C-DOC Centre for Diabetes, Metabolic Diseases and Endocrinology.
“These apps demonstrate tremendous usability and functionality in storing and transmitting data related to diabetes, such as blood glucose readings, calorific content, exercise programme and treatment,” says Misra.
Agrees Dr Anupam Sibal, director, health services, Apollo Group of Hospitals: “If patients monitor their vital signs, they will not need doctors for basic checks. And if patients do the tracking, we have more data to draw on when we do need them. In some cases, it may help diagnose disorders before the symptoms appear.”
There’s a risk of misuse for self-diagnosis or worse, self medication. “It is similar to the concerns that the field of health care had when patients began using the Internet as a resource for health information.
By linking the apps/devices to electronic health records and relatively inexpensive consults with experienced clinicians, a vast majority can use these new technologies appropriately. That being said, eventually it may be good for lower-risk interventions to become more accessible and not require clinical gatekeepers, as we’ve done with fever and headache management with over-the-counter medications,” says Dr Gaglani.
Data confidentiality is a concern, though many apps and device manufacturers have added encryption to their apps to stop others accessing a patient’s data.
It’s early days yet but the FDA cites industry estimates that 500 million smartphone users worldwide will use some type of health app by 2015. This has prompted the US regulatory agency to release guidance on mobile medical apps and devices under which some will be regulated like traditional devices. “At this stage, consumers should do their research and consult sources they trust before diving right in,” says Dr Gaglani.HEALTH PLUS
Smoking cannabis makes you dumb
Using cannabis regularly risks damaging memory, scientists say, with the brain abnormalities lasting for ‘at least a few years’ after users have stopped taking the drug.
The study also found that chronic cannabis use could lead to changes in brain structure associated with having schizophrenia, and may cause mental health problems in people predisposed to schizophrenia.
So people with a family history of schizophrenia who frequently smoke marijuana put themselves at an increased risk for poor working memory, which predicts everyday functioning and the ability to remember and process information in the moment and then transfer it to long-term memory.
Workouts boost sexual function
Just 30 minutes of exercise immediately before having sex, ‘significantly’ improves sexual functioning in women taking the drugs and boosts their ability to orgasm, reports a study in the journal Depression and Anxiety.
These findings have important implications for public health, as exercise as a treatment for sexual side effects is accessible, cheap and does not add to burden of care.
Ear acupuncture helps shed weight
Ear acupuncture can help shed the pounds, indicates a study published online in Acupuncture in Medicine. Using continuous stimulation of five acupuncture points of outer ear may be better at reducing abdominal fat than single point stimulation.
Participants followed a restrictive diet — but not weight loss — during the eight week period of their treatment. Apart from a drop in body fat, waist circumference also registered a fall, with the largest drop seen in the group on the 5-point treatment.Auricular acupuncture was first used in France in 1956 by Dr Paul Nogier who noticed that a patient’s back-ache was cured after s/he sustained a burn on the ear. Since then the approach has been used to treat drug addiction and help people give up smoking and lose weight.
Moderate drinking Enhances immunity
Drinking moderate amounts of alcohol — a glass of wine or beer, or one small peg of liquor — bolsters the immune system, say scientists in the journal Vaccine.
For the study, scientists trained 12 rhesus macaques to consume alcohol — a 4% ethanol mixture - of their own accord. Like humans, the monkeys showed highly variable drinking behaviour — some drank a lot, while others drank in moderation.
The monkeys were then vaccinated against small pox and separated into two groups — those who had ethanol and those who didn’t. Heavy drinkers had greatly diminished vaccine responses compared to the teetotallers, but the moderate-drinking monkeys displayed enhanced responses to the vaccine compared to those who had no alcohol.
The conclusion, that moderate drinking bolstered their bodies’ immune systems, is expected to help find new ways to improve the body’s ability to respond to vaccines.