The apps that will save your life – or not

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Health and fitness is the new growth area for reward-driven apps, but do they actually work?

One of the favourite words of the smartphone era is “gamification”. Computer games entice players with a series of small rewards, little pats on the head, whenever some arbitrary goal is reached; and this creates a compulsion on the part of the player, a need to get the next gold star. People will put hours in, dedicate themselves to jumping through bizarre, frustrating hoops, for no gain other than a bingly-bongly noise and a voice saying “Level 32 completed”. If we can harness this need for socially or economically useful purposes, goes the idea, then we can change the world – or at least make money.

So a slew of apps have been released, pushing us to do small, positive things, and rewarding us with a “well done!” when we do them. DuoLingo, a free language-learning app, metaphorically rubs your tummy whenever you successfully form conditional tense verbs in French; HabitRPG tries to redefine your working life as a Dungeons & Dragons-style quest, losing hit points when you fail to complete an item on your to-do list, gaining experience when you get things done (“I’m a level 17 High Elf actuary”). There are even apps that turn money management and debt repayment into “games”.

The real growth area for gamification apps, though, is health and fitness. There is a profusion of them. Runkeeper, Nike Run, and Fitocracy, among others, reward you for taking exercise, with extra points for numbers of steps taken; DietBet and Skinnyo push weight-loss and calorie counting; Sleep Cycle encourages you to get more and better sleep; apps to make a game of physiotherapy, apps for people with autism, for people with dyslexia, even for pain management for burns. Our own NHS has a BMI calculator app out, allowing people to track their weight. Whether all this stuff actually works, of course, is a question for scientific research, and not much has yet been done, although a literature review by researchers at the University of Tampere in Finland found some patchy evidence of benefits.

Whether it works or not, health gamification is a hot topic. So in their grandiose annual conference WWDC (portentously tagged “Write the code. Change the world”), Apple have announced a new, cover-all app that brings together lots of lesser health apps under one roof. If you’re pretending to be running away from zombies, or just having the recorded voice of a former Olympic middle-distance bronze medallist congratulate you for setting a new personal best, you can keep all your data and achievements in one easily accessible place. You’ll be doing marathons in no time, presumably; you’ll be slim and beautiful and you’ll live forever. The obesity crisis is about to end, thanks to video-game addiction.

Or not. We love the idea of simple technological or medical fixes for complex social problems. A pill to make children behave in class, hypnosis to stop us smoking, a funny little lamp to cure depression. In recent years the miracle cure for society’s ills has been “big data”. The flood of numbers flowing in from all angles – phones, the web, store purchases – was going to transform health care, transform business, transform politics.

But – so far – it hasn’t happened, at least in the case of health care. As The Financial Times’s Tim Harford wrote recently, Google used its colossal database of internet searches to predict flu outbreaks, without anything so boring as talking to doctors: it simply looked at places where people were searching for flu-related terms, and said: there is going to be a flu outbreak there. And it worked – for a while. But then something – no one knows quite what – changed, and the Google Flu Trends predictions stopped being accurate. Advocates of big-data-led health care thought that the sheer volume of data would mean that the usual problems of data, like sample bias, would be overwhelmed. But it of course isn’t true. The problems of big data are the problems of small data, only bigger.

None of which is to say that it won’t, in future, be helpful. Marketing types talk of the “Gartner hype cycle”: new technologies arrive in a burst of publicity and excitement, then slump into disappointment as they fail to live up to their ludicrous early promises, and then slowly become useful as companies develop ways of applying them that actually work. Eventually they become mainstream and profitable and unremarkable. To me, at least, it looks like big data is in the “disappointment” phase of that cycle; health gamification, perhaps, is in the first stage, the overhyped excitement.

That technology is changing health care is obvious. That apps are changing it significantly is, so far, less obvious; all these things will no doubt play a role in the future, but for the time being, your iPhone is unlikely to replace your GP.

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