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Speaker 1: It's almost seven thirty and I just got in from

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Speaker 1: my morning walk. Thanks to my fitbit and my phone,

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Speaker 1: I know that I'm already more than halfway to hitting

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

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Speaker 1: my fitbit who says that I have walked seven thousand

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Speaker 1: and thirty one steps. And you know what I have

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Speaker 1: on my phone as well, another health app, and that

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Speaker 1: one 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 interception of health and

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Speaker 1: technology and the unexpected places 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 Krasky looks into what the health apps

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Speaker 1: can do for their users. For us, My app addiction

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

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

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

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

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Speaker 1: app and pretty soon realized it would also grade in

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Speaker 1: my sleep on a hundred point scale. I love being

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Speaker 1: told whether I'm doing things right, so soon it became

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Speaker 1: the first thing I looked at every morning. But that

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Speaker 1: wasn't enough. I wanted to know why I was sleeping

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Speaker 1: well or poorly, so I caved and bought the premium version.

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Speaker 1: That was my first real sign of app addiction. Another

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Speaker 1: friend gave me a bunch of recommendations for other apps

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Speaker 1: to try. I started using a period tracker and telling

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Speaker 1: that app about way more than just my menstrual cycle.

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

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Speaker 1: That 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. The top pick

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Speaker 1: was the 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 Lagardia, 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 in

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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 eatn 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'd cooked for myself, arguably the healthiest choice, required

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Speaker 1: a bit of guesswork to find out what the evidences

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Speaker 1: that this app, or any app can improve its users health.

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Speaker 1: I called Yucca b am Seran, a doctor and researcher

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Speaker 1: at Bond University in Australia. She published one of the

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

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Speaker 1: last year. We came to this research as you know,

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Speaker 1: just any other twenty one century UM citizen with smartphones,

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Speaker 1: and we started seeing a lot of UM news and

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

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

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Speaker 1: as the next big thing in health and tech. World.

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Speaker 1: Science is very specific about how we know medical treatments work,

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Speaker 1: but that's not the case when it comes to consumer products.

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Speaker 1: Like most health apps a Yucca started looking for rigorous studies.

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Speaker 1: She surveyed almost eight hundred trials of apps conducted between

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Speaker 1: two thousand eight and but once she looked more closely,

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Speaker 1: she found only a handful of the studies showed the

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Speaker 1: apps have some meaningful effect on health outcomes. Since then,

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Speaker 1: drugmakers have started looking more at apps that could be

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Speaker 1: used as therapies. Swiss Droukes Giant Novardes got US approval

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Speaker 1: for one to treat substance abuse last year, But across

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Speaker 1: the app world, YUCA says evidence still remains a rare commodity.

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Speaker 1: We would estimate that less than one percent of all

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Speaker 1: of these apps are actually been tested, and for apps

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Speaker 1: that aren't being reviewed by health regulators, just having done

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Speaker 1: any kind of test can be a marketing point, no

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Speaker 1: matter what the outcome was. The term for this is experrammercial,

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Speaker 1: a combination of experiment and commercial. And when the study

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

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Speaker 1: would mention in the app description that our app has

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Speaker 1: been scientifically tested, and that kind of gives this false

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Speaker 1: notion of legitimacy to the potential customers and consumers. My

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Speaker 1: Fitness Pal was among the few apps or Youka found

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Speaker 1: that had been tested in an independent clinical trial conducted

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Speaker 1: about five years ago in Los Angeles. The study randomly

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Speaker 1: assigned two hundred and twelve overweight adults to either use

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Speaker 1: the app or to pursue and I quote any activities

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Speaker 1: you would like to lose weight. After six months, neither

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Speaker 1: group lost much weight. The researchers did speculate, though, that

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Speaker 1: the app might be useful for patients who are already

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Speaker 1: trying to watch their calorie intake. I asked Michael, the

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Speaker 1: under Armour executive, for his thoughts on the results. That's

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Speaker 1: absolutely directly in line with our experience with this app.

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Speaker 1: You know, like I said, it's not We don't think

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Speaker 1: of it as a health to it. We don't think

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Speaker 1: of it as something that someone would say, put this

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Speaker 1: on your phone, you will get better. But we think

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Speaker 1: of it as an integral part in someone's journey when

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Speaker 1: they've made the decision I'm going to change my life,

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Speaker 1: I'm going to hit some fitness goals. Will be there

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Speaker 1: to help. Maybe that was the problem with my diet

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Speaker 1: app experiment. I didn't start out with a particular fitness goal.

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Speaker 1: I wasn't actually trying to change my body or my life,

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Speaker 1: and in fact another force was at work, won a

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Speaker 1: lot stronger than willpower or workouts. I was pregnant, and

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Speaker 1: so for the first time practically since puberty, my body

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Speaker 1: felt like it was careening out of my control. Low

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Speaker 1: carb diet hard to handle when you need to eat

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Speaker 1: toast practically as soon as you open your eyes in

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Speaker 1: the morning in order to settle your stomach, and I

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Speaker 1: knew I would have to gain weight, not maintain it,

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Speaker 1: let alone lose it. Still, I kept logging my meals

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Speaker 1: and my exercise. I started to read more about the

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Speaker 1: nutrients I would need for a healthy pregnancy, and I

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Speaker 1: started to get a little obsessed of about making sure

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

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

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

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

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

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

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Speaker 1: many a rugulas salads. I started to wonder whether I

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

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

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

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

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Speaker 1: Business School. He co wrote a book called The Wellness Syndrome,

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Speaker 1: in which he argued that the pressure to become ever

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

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

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

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

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Speaker 1: of these wearables of rest band that logged my sleeping

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Speaker 1: 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 up

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

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Speaker 1: wellness as being part of an individualistic culture where you

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Speaker 1: need to demonstrate that you're performing at your peak, 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 prodes 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 have

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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 as 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 is 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 headspaces origins and really changing the

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Speaker 1: cultural perception of meditation and mindfulness, and you know, we've

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Speaker 1: certainly lifted all ships in the process of doing that

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

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

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

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Speaker 1: A few studies are also being done on headspaces big

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Speaker 1: competitor the app Calm, So when these trials read out,

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Speaker 1: assuming the results are published, we should get a better

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Speaker 1: idea if at least this particular corner of the app

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

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Speaker 1: an evidence space will become more necessary across the market

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Speaker 1: as a whole, not just for apps that could be

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

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

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Speaker 1: 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 entertained and dropping the rest. I'm still using

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

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

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

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

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

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Speaker 1: But my fitness pal was more complicated. The turning point

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Speaker 1: was around the time when I was moving from the

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Speaker 1: she ate too many burritos to the is that a

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

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Speaker 1: when I would skip the app, I felt so much

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Speaker 1: better about my food intake. And during the week when

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Speaker 1: I was worrying about protein and calcium and vitamins and calories,

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Speaker 1: I felt like I was going crazy. I would look

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Speaker 1: up online calculators to reassure myself that my weight gain

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Speaker 1: was within normal parameters, and then beat myself up for

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Speaker 1: not hitting a nutrient target even though I had exceeded

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Speaker 1: my calorie goal for the day. My husband Philip actually

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Speaker 1: started to worry about me. I mean, I wouldn't say

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Speaker 1: it was crazy. You used the worst crazy before. I

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Speaker 1: wouldn't say it was crazy, But definitely you were a

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Speaker 1: bit obsessed. I remember you always telling me like not

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Speaker 1: to worry so much about weight during pregnancy, and I

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Speaker 1: wonder whether some of the experience with this was just

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Speaker 1: tied together with that as well. That could definitely be

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Speaker 1: the case. I mean, I do remember that you asked

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

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Speaker 1: 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 difficult 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 health here in the US

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Speaker 1: or around the world we want to hear from you.

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

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Speaker 1: Cortes a Bloomberg dot net. If you are a fan

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Speaker 1: of this episode, please take a minute to rate and

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Speaker 1: review us. It really helps new listeners in the show,

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Speaker 1: and don't forget to subscribe. This episode was produced by

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Speaker 1: Liz Smith and topor Foreheads. Our story editor was Rick

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Speaker 1: Shine Francesco Leavie as head of Bloomberg Podcasts. We'll be

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