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Speaker 1: High Prognosis listeners. This month, we're looking back at some

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Speaker 1: of our favorite stories from the podcast. On this episode,

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Speaker 1: we see if exercise tracking apps and gadgets like Fitbit

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Speaker 1: really do make us healthier. Thanks and enjoy. It's almost

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Speaker 1: seven thirty and I just got in from my morning walk.

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Speaker 1: Thanks to my Fitbit and my phone, I know that

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Speaker 1: I'm already more than half way to hitting my ten

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Speaker 1: thousand step target for the day. I have my Fitbit

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Speaker 1: who says that I have walked seven thousand and thirty

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Speaker 1: one steps. And you know what I have on my

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Speaker 1: phone as well, another health app. Oh, and that one

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Speaker 1: says I've done seven thousand, four hundred and eleven steps.

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Speaker 1: Now that it's warmer out, I'm on tract to beat

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Speaker 1: last week's numbers two. But I'll admit sometimes I wonder

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Speaker 1: if my Fitbit really makes me any more fit. Welcome

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Speaker 1: to Prognosis, Bloomberg's podcast about the intersection of health and

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Speaker 1: technology and the unexpected places it's taking us. I'm your host,

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Speaker 1: Michelle fe Cortes. Even if you never use it, you

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Speaker 1: most likely have a health app installed on your phone.

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Speaker 1: Apple Health, which comes with every iPhone, can clock everything

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Speaker 1: from steps to sleep. Some three thousand digital health apps

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Speaker 1: are competing for a share of the market to help

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Speaker 1: you track your calories, watch your blood sugar, guide your workouts,

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Speaker 1: or help you meditate. In the last episode, we told

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Speaker 1: you what these apps are doing with your data. This time,

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Speaker 1: my colleague Naomi Kresky looks into what the health apps

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Speaker 1: can do for their users. For us, My appetictions started

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Speaker 1: last year when a friend of a friend told me

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Speaker 1: he was using an app as a smart alarm clock

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Speaker 1: set to ring when he was sleeping most lightly in

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Speaker 1: the morning. I was super intrigued. I downloaded the app

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Speaker 1: and pretty soon realized it would also grade my sleep

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Speaker 1: on a one point scale. I love being told whether

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Speaker 1: I'm doing things right, so soon it became the first

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Speaker 1: thing I looked at every morning. But that wasn't enough.

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Speaker 1: I wanted to know why I was sleeping well or poorly,

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Speaker 1: so I caved and bought the premium version. That was

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Speaker 1: my first real sign of app addiction. Another friend gave

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Speaker 1: me a bunch of recommendations for other apps to try.

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Speaker 1: I started using a period tracker and telling that app

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Speaker 1: about way more than just my menstrual cycle. I recorded

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Speaker 1: gastro intestinal side effects, my moods, my sex life. That

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Speaker 1: app knew more about me than most real humans did,

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Speaker 1: and at the same time, I was researching apps for

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Speaker 1: diabetes patients for a magazine article, and then eventually also

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Speaker 1: started using a life tracking app linked to my sleep app.

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Speaker 1: That one shows you where you are during the day,

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Speaker 1: work or shopping or home, et cetera. So I could

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Speaker 1: watch how long I spend bicycling to work, walking or

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Speaker 1: at the gym. It felt like being able to watch

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Speaker 1: all these elements of my life so closely was giving

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Speaker 1: me more control over them somehow. But the big question

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Speaker 1: was whether it was actually improving my health. For example,

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Speaker 1: the sleep app showed me almost immediately what helps me

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Speaker 1: sleep well, things like meditating before bed and working out,

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Speaker 1: and what kills my sleep basically booze parties and early

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Speaker 1: morning light. But my sleep only really improved after my

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Speaker 1: life slowed down. I had just come off a jam

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Speaker 1: packed spring and summer in which I had moved, finished

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Speaker 1: a big project at work, and gotten married, so I

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Speaker 1: figured my next step should be collecting more data, which

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Speaker 1: meant downloading more apps. I'm part of a team of

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Speaker 1: reporters who write about European health and consumer goods companies,

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Speaker 1: So I asked my colleagues for recommendations. Their top pick

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Speaker 1: was this hugely popular my fitness Pal app. Sportswear company

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Speaker 1: under Armour bought this app in for four hundred and

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Speaker 1: seventy five million dollars. Here's Michael LaGuardia, under Armour's senior

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Speaker 1: vice president of Digital Products, explaining why we look at

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Speaker 1: fitness as a holistic activity. That it's about the fuel

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Speaker 1: that you put into It's about the activity that you do,

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Speaker 1: and my Fitness Pal is there to help you keep

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Speaker 1: track of that. The central function of my fitness Pal,

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Speaker 1: like so many other fitness apps, is counting calories in

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Speaker 1: calories out now. I am almost forty years old and had,

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Speaker 1: if you believe it, actually never tried to do this

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Speaker 1: in a systematic way before. It's not that I didn't

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Speaker 1: read food labels or think about calories. It's just that

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Speaker 1: I had always been too lazy to write them down

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Speaker 1: and had relied on a combination of exercise and metabolism

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Speaker 1: to burn them off. But my colleagues assured me that

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Speaker 1: I would be able to find the calorie and nutrition

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Speaker 1: facts for almost anything in my Fitness Pal. So on

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Speaker 1: February one, I logged my first day's worth of meals.

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Speaker 1: The app told me I had eaten about calories, about

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Speaker 1: a third of which came from snacks, cookies and peanuts

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Speaker 1: I had eaten in the office, and then after work

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Speaker 1: bread and patte with a colleague. Oh dear, at least

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Speaker 1: I'd skipped having any wine. The app lets you set

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Speaker 1: a calorie target based on whether you want to lose,

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Speaker 1: maintain or gain weight. I set my target on maintain

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Speaker 1: and kept on logging. The easiest things to record were

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Speaker 1: straightforward items like pieces of fruit or eggs, but logging

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Speaker 1: anything I cooked for myself, arguably the healthiest choice, required

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Speaker 1: a bit of guesswork. To find out what the evidence

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Speaker 1: is that this app, or any app can improve its

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Speaker 1: users health. I called Yuka B. M Seran, a doctor

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Speaker 1: and researcher at Bond University in Australia. She published one

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Speaker 1: of the few overview studies of the effectiveness of digital

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Speaker 1: health apps last year. We came to this research as

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Speaker 1: you know, just any other twenty one century UM citizen

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Speaker 1: with smartphones, and we started seeing a lot of UM

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Speaker 1: news and articles on how smartphone apps are treating this

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Speaker 1: thing and that thing, and it's you know, being um

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Speaker 1: taught it as the next big thing in health and

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Speaker 1: tech world. Science is very specific about how we know

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Speaker 1: medical treatments work, but that's not the case when it

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Speaker 1: comes to consumer products. Like most health apps. Or Yucca

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Speaker 1: started looking for rigorous studies. She surveyed almost eight hundred

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Speaker 1: trials of apps conducted between two thousand eight and but

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Speaker 1: once she looked more closely, she found only a handful

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Speaker 1: of the studies showed the apps had some meaningful effect

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Speaker 1: on health outcomes. Since then, drugmakers have started looking more

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Speaker 1: at apps that could be used as therapies. Swiss Dukes

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Speaker 1: Giant Novartis got US approval for one to treat substance

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Speaker 1: abuse last year, But across the app world, or Yucca

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Speaker 1: says evidence still remains a rare commodity. We would estimate

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Speaker 1: that less than one percent of all of these apps

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Speaker 1: are actually being tasted, and for apps that aren't being

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Speaker 1: reviewed by health regulators, just having done any kind of

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Speaker 1: test can be a marketing point no matter what the

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Speaker 1: outcome was. The term for the is experrammercial, a combination

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Speaker 1: of experiment and commercial, and when the study doesn't show

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Speaker 1: any benefit, they don't mention it, but they would mention

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Speaker 1: in the app description that our app has been scientifically tested,

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Speaker 1: and that kind of gives this false notion of legitimacy

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Speaker 1: to the potential customers and consumers. My Fitness Pal was

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Speaker 1: among the few apps or Yuka found that had been

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Speaker 1: tested in an independent clinical trial conducted about five years

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Speaker 1: ago in Los Angeles. The study randomly assigned two hundred

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Speaker 1: and twelve overweight adults to either use the app or

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Speaker 1: to pursue and I quote any activities you would like

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Speaker 1: to lose weight. After six months, neither group lost much weight.

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Speaker 1: The researchers did speculate, though, that the app might be

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Speaker 1: useful for patients who were already trying to watch their

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Speaker 1: calorie intake. I asked Michael, the under Armour executive, for

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Speaker 1: his thoughts on the results. It's absolutely directly in line

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Speaker 1: with our experience with this app. You know, like I said,

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Speaker 1: it's not We don't think of it as a health

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Speaker 1: to it. We don't think of it as something that

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Speaker 1: someone would say, put this on your phone, you will

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Speaker 1: get better. We think of it as an integral part

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Speaker 1: in someone's journey when they've made the decision I'm going

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Speaker 1: to change my life. I'm going to hit some fitness goals,

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Speaker 1: will be there to help. Maybe that was the problem

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Speaker 1: with my diet app experiment. I didn't start out with

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Speaker 1: a particular fitness goal. I wasn't actually trying to change

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Speaker 1: my body or my life, and in fact another force

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Speaker 1: was at work want a lot stronger than willpower or workouts.

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Speaker 1: I was pregnant, and so for the first time practically

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Speaker 1: since puberty, my body felt like it was careening out

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Speaker 1: of my control. Low carb diet hard to handle when

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Speaker 1: you need to eat toast practically as soon as you

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Speaker 1: open your eyes in the morning in order to settle

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Speaker 1: your stomach, and I knew I would to gain weight,

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Speaker 1: not maintain it, let alone lose it. Still, I kept

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Speaker 1: logging my meals and my exercise. I started to read

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Speaker 1: more about the nutrients I would need for a healthy pregnancy,

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Speaker 1: and I started to get a little obsessive about making

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Speaker 1: sure I logged them. When my fitness pal inexplicably didn't

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Speaker 1: record the calcium in my brand of yogurt, it felt

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Speaker 1: like a personal insult. I started keeping a very very

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Speaker 1: close eye on my protein intake, and I started worrying

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Speaker 1: about whether I was getting too much vitamin A, something

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Speaker 1: that would never have occurred to me before from eating

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Speaker 1: too many are rubulous salads. I started to wonder whether

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Speaker 1: I was monitoring myself a little too much. Today we're

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Speaker 1: being reminded every single minute of how sub optimized we

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Speaker 1: are and what we should be doing in order to

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Speaker 1: be more optimized. That's Carl Staderstrom, an associate professor at

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Speaker 1: Stockholm Business School. He co wrote a book called The

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Speaker 1: Wellness Syndrome, in which he argued that the pressure to

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Speaker 1: become ever healthier is actually anything but healthy. For another project,

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Speaker 1: he also used himself as a guinea pig. So what

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Speaker 1: I did was that I was using an app to

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Speaker 1: log everything that I was eating. I was also using

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Speaker 1: one of these wearables of wrist band that logged my

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Speaker 1: sleeping and logged the activity I was doing during the day.

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Speaker 1: And then I was spending all my days in the gym,

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Speaker 1: and I was, over the course of that month gaining

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Speaker 1: something like eight kilos, And the month ended with me

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Speaker 1: participating in a weightlifting competition which I incidentally ended upcoming

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Speaker 1: last in. Carl writes about our society's obsession with wellness

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Speaker 1: as being part of an individualistic culture. Where you need

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Speaker 1: to demonstrate that you're performing at your peak okay, where

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Speaker 1: there's a moral value linked with how your body looks,

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Speaker 1: and also where workers who spend their days emailing and

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Speaker 1: organizing seek satisfaction or at least a sense of having

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Speaker 1: something to show for their efforts from improving their bodies.

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Speaker 1: He says health apps are a lot like an idea

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Speaker 1: from Freud, where your conscience prods you to do what

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Speaker 1: you know you should do but don't want to. So

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Speaker 1: it is using an app as this little angry man

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Speaker 1: sitting on your shoulder, constantly telling you that what you

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Speaker 1: do is wrong and what you should be doing is

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Speaker 1: this or that. And I think it's says something about

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Speaker 1: how difficult it is for for all your humans and

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Speaker 1: probably always been, to live the way that we are

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Speaker 1: supposed to be living. And I think to some extent,

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Speaker 1: the whole idea of being human is that we are imperfect.

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Speaker 1: There's no way of always being able to do everything

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Speaker 1: that we're supposed to be doing. But I think what's

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Speaker 1: different today than in the past, and the health apps

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Speaker 1: are a big part of this, is that we are

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Speaker 1: being reminded seven that we're not living up to that

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Speaker 1: idealized version of ourselves. Carl argues that this focus on

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Speaker 1: self optimization is part of a larger political development in

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Speaker 1: which health is viewed more as an individual concern and

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Speaker 1: less as a broader social good, and the more society

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Speaker 1: moves in that direction, the easier it becomes to demonize

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Speaker 1: and ridicule people who do not have the resources to

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Speaker 1: look after their own health. Talking to Carl made me

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Speaker 1: think about my own app experiments in a different way.

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Speaker 1: There I was obsessing about vitamin A and analyzing the

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Speaker 1: nutrition content of the free protein bars in the Bloomberg pantry.

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Speaker 1: The whole thing seemed so narcissistic. There was one time, though,

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Speaker 1: that an app did help me do something that's actually

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Speaker 1: objectively healthy. I quit smoking a couple of years ago.

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Speaker 1: As any former smoker would know, the way cigarettes fit

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Speaker 1: into your daily ritual is one of the things that

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Speaker 1: make it super hard to quit. I used to love

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Speaker 1: smoking in the late afternoon. It's a little moment to

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Speaker 1: rest my brain before the last few hours of my

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Speaker 1: work day. So once I quit, I started using a

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Speaker 1: meditation app called Headspace as a replacement. I didn't think

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Speaker 1: of Headspace at the time as a health app. Per se.

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Speaker 1: It has more than one million paying subscribers and offers

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Speaker 1: everything from a cat's and boats soundscape for falling asleep

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Speaker 1: to meditation prep for students who are taking exams. But

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Speaker 1: when I talked to the apps chief science officer, Megan

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Speaker 1: Jones Bell I found out that they actually do see

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Speaker 1: themselves that way. The company says there are sixty seven

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Speaker 1: randomized clinical trials being done on its app, including studies

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Speaker 1: on everything from quitting smoking to managing stress and pain.

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Speaker 1: There are a number of ways that people can use

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Speaker 1: meditation to improve their health and happiness, and that can

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Speaker 1: range from using it as we think about it as

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Speaker 1: kind of a vitamin, which means that you are um

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Speaker 1: using it more on a preventative health capacity, such as

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Speaker 1: trying to boost your resilience to stress, which is something

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Speaker 1: that we have researched in a number of our trials

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Speaker 1: and have a number of very rigorous studies underway looking

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Speaker 1: at how that actually has proven out in brain changes.

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Speaker 1: The company is also working on a separate version of

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Speaker 1: its app that doctors could prescribe to their patients like

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Speaker 1: a medicine. This is more complicated because Headspace needs to

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Speaker 1: figure out with the food and Drug administration how best

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Speaker 1: to test the new app and regulate it to make

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Speaker 1: sure it works. Headspace hasn't started these trials yet, and

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Speaker 1: it could be a couple of years before the new

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Speaker 1: product has approved. I asked Megan why Headspace would spend

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Speaker 1: money in the meantime testing its consumer app too, when

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Speaker 1: there's no regulator demanding data. I think, because we're really

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Speaker 1: playing the long game here. Our science strategy is not

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Speaker 1: unlike the way that we've approached redefining the brand of meditation.

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Speaker 1: You can think about Headspace as origins and really changing

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Speaker 1: the cultural perception of meditation and mindfulness, and you know,

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Speaker 1: we've certainly lifted all ships in the process of doing

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Speaker 1: that and really helping create this market and moving it

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Speaker 1: out of this kind of more woo woo experience into

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Speaker 1: something that is very approachable for a diverse range of

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Speaker 1: of consumers. A few studies are also being done on

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Speaker 1: headspaces big competitor, the app Calm, So when these trials

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Speaker 1: read out, assuming the results are published, we should get

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Speaker 1: a better idea if at least this particular corner of

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Speaker 1: the app market works. Some in the health apps industry

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Speaker 1: think that an evidence space will become more necessary across

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Speaker 1: the market as a whole, not just for apps that

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Speaker 1: could be prescribed as medicines. I talked to Carl Johann Hateroth,

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Speaker 1: CEO of sleep Cycle, the alarm clock app that got

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Speaker 1: me started on this project. It's really really interesting for us.

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Speaker 1: I think the whole industry is heading in that direction.

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Speaker 1: I think this industry is going to be regulated in

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Speaker 1: some way the coming years. I don't know exactly how,

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Speaker 1: but I think it will. And I mean, we like that.

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Speaker 1: And now I have a confession to make. Like a

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Speaker 1: lot of health app users, I wound up using what

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Speaker 1: kept me in attained and dropping the rest. I'm still

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Speaker 1: using sleep Cycle, partly because I like to compete with

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Speaker 1: my husband to see who gets a better night's sleep,

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Speaker 1: and because I take a morbid interest in seeing how

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Speaker 1: much worse my sleep might get as I get more

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Speaker 1: and more pregnant. Well you know what I mean, bigger

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Speaker 1: and bigger. But my fitness pal was more complicated. The

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Speaker 1: turning point was around the time when I was moving

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Speaker 1: from the she ate too many burritos to the is

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Speaker 1: that a bump stage of pregnancy. I noticed that on

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Speaker 1: the weekends when I would skip the app, I felt

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Speaker 1: so much better about my food intake. And during the

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Speaker 1: week when I was worrying about protein and calcium and

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Speaker 1: vitamins and calories, I felt like I was going crazy.

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Speaker 1: I would look up online calculators to reassure myself that

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Speaker 1: my weight gain was within normal parameters, and then beat

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Speaker 1: myself up for not hitting a nutrient target even though

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Speaker 1: I had exceeded my calorie goal for the day. My

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Speaker 1: husband Philip actually started to worry about me. I mean,

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Speaker 1: I wouldn't say it was crazy. You use the word

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Speaker 1: crazy before. I wouldn't say it was crazy, but definitely

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Speaker 1: you were a bit obsessed. I remember you always telling

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Speaker 1: me like not to worry so much about weight during pregnancy,

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Speaker 1: and I wonder whether some of the experience with this

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Speaker 1: was just tied together with that as well. That could

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Speaker 1: definitely be the case. I mean, I do remember that

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Speaker 1: you asked very often like, oh God, am I too big?

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Speaker 1: Am I gaining too much weight? And I then, I mean,

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Speaker 1: I even get angry about this question because it's not

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Speaker 1: a competition of like who gains more or who gains

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Speaker 1: less weight during pregnancy. Your body does. What your body

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Speaker 1: does in each pregnancy is different. Different. At some point

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Speaker 1: in time, I was afraid that you would, I don't know,

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Speaker 1: stop eating when you if you thought that you had

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Speaker 1: gained too much weight, which would maybe have been unhealthy

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Speaker 1: for you or the baby. And if an app makes

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Speaker 1: you even consider something like that, it's definitely not a

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Speaker 1: good app. After Philip told me that, I quit using

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Speaker 1: the app. But not everybody is as neurotic as I am,

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Speaker 1: and with so little evidence about health apps and health,

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Speaker 1: I think the bottom line here is that you can

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Speaker 1: take what's good for you and just leave the rest behind,

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Speaker 1: and that sometimes the more you try to control things

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Speaker 1: to optimize yourself, as Carl would say, the more you

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Speaker 1: eventually realize that you just need to let go. And

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Speaker 1: that's it for this week's prognosis. Thanks for listening. Do

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Speaker 1: you have a story about healthy in the u S.

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Speaker 1: We're around the world we want to hear from you.

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Speaker 1: Find me on Twitter at Fay Cortes or email m

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Speaker 1: Cortes at Bloomberg dot net. If you're a fan of

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Speaker 1: this episode, please take a minute to rate and review us.

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Speaker 1: It really helps new listeners find the show, and don't

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Speaker 1: forget to subscribe. This episode was produced by Liz Smith,

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Speaker 1: and tofor forehaz Our story editor was Rick Shine. Francesco

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Speaker 1: leave as head of Bloomberg Podcasts. We'll be back with

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Speaker 1: our next episode on July four. See you then,