Smartphones
are getting smarter, and the rising popularity of health and wellness mobile
applications (“apps”) gives users unparalleled access to information, tips, and
control over their healthcare choices in the palm of their hand. An estimated
500 million smartphone users around the world will be using a healthcare
application by 2015, a number that could climb to more than a billion by 2018.1
The functionality of these apps offers various services, such as a quick-and-easy
reference guide to symptoms, a pedometer that also records heart rate and
pulse, and even a way to connect to an insulin pump to monitor doses (for
insulin-dependent diabetics).
There
are numerous apps from an array of developers for herbal medicine references,
putting the “people’s medicine” back in the hands of individual users. It is
important for users to do their own research with reputable medical professionals
and organizations rather than relying only on information from any electronic
source, as developers do not always have the necessary qualifications to
dispense advice. Users should consider the following questions when choosing a
healthcare app:
- Who is the
publisher/developer? Are they a recognized name or company? Do they have a
functioning, professional website that explains who they are and their
qualifications?
- Who is the target
audience for the app? Patients, physicians, or the general public?
- How current is the
information it contains? Has it been updated recently?
- Read the reviews of
the app, both positive and negative. Are there functionality issues? Does it
work as described?
Companies
increasingly are embracing smartphone app technology as a platform for
healthcare and selfcare. In September 2014, Apple released a HealthKit app in
its newest operating system, while Google responded by issuing Google Fit in
October 2014. These apps allow users to enter a variety of health indicators,
including resting heart rate, steps taken, calories consumed, and even
specifics such as vitamin intake. In addition, users can create “medical IDs”
for emergency personnel that list existing conditions, medications taken, and
known food and drug allergies. Third-party apps also can interact with
HealthKit and Google Fit, which combines all of the collected data in one
place.
This
increased reliance on technology to enhance and guide healthcare choices
prompted the US Food and Drug Administration (FDA) to label smartphone apps as
medical devices in 2013; they now fall within the purview of the agency’s
regulation.
Telephone,
music player, encyclopedia, game console, and medical device. What can your
smartphone do for you?
Technology, Healthcare,
and Regulation
As
technology grows more sophisticated, the stakes for developer and user errors
grow higher. The FDA issued a guidance document in September 2013 announcing its
plans to take a more proactive regulatory stance towards applications that, in
the agency’s words, “are medical devices and whose functionality could pose a
risk to a patient’s safety if the mobile app were to not function as intended.”2
An app that can control another medical device (e.g., an insulin pump) or that has
the ability to display, transfer, or store medical device data is considered a
medical device and is thus subject to FDA oversight.
Other
health apps that do not fall into the categories listed above but “may be
intended for use in the diagnosis of disease or other conditions, or in the
cure, mitigation, treatment, or prevention of disease” may also meet the definition
of a medical device, but are considered to pose a lower risk to the public than
apps that directly control existing devices such as insulin pumps. In the case
of the former, the FDA will exercise enforcement discretion.3
Herbal
medicine references are mentioned specifically in the language of the guidance:
“Mobile apps that prompt a user to enter which herb and drug they would like to
take concurrently and provide information about whether interactions have been
seen in the literature and a summary of what type of interaction was reported.”3
However, the examples given in the guidance are not an exhaustive list, and
most if not all herbal medicine apps fall under the FDA’s definition for a
medical device. (However, apps strictly focused on identifying or cataloguing
botanicals that make no mention of the medicinal uses of plants would not
qualify as medical devices.)
In
2012, HerbalEGram Managing Editor Tyler Smith wrote on the topic of mobile apps
designed by herbal and dietary supplement organizations; the article can be
found here.
Here are a few examples of the latest herbal medicine reference apps, which may
or may not be considered medical devices per FDA regulation.
New Herbal Medicine
Reference Apps*
Wild Medicine
(Free; Apple)4 Created by the New York
Botanical Garden
An
interactive companion to the New York Botanical Garden’s (NYBG) Wild Medicine
exhibit, this app was created to enhance the experience of touring the Enid A.
Haupt Conservatory. Even if the Bronx is too far to visit in person, the app contains
photos as well as information about the featured plants and descriptions of
their healing properties. Audio commentary from Vice President and Director of
the Institute for Economic Botany at NYBG and American Botanical Council Board
of Trustees member Michael J. Balick, PhD, as well as discussion on the latest
botanical research from leading scientific and ethnobotanical experts, provides
a unique dimension to the data. The app uses “augmented reality” technology —
which adds information to an image the visitor takes with their device’s camera
— to interact with the exhibit.
Natural Medicines
Comprehensive Database
(Free; Apple/Android)5 Created by
Therapeutic Research Center
This
is the mobile version of the extensive database created by the Therapeutic
Research Center, an advisory service for drug therapy and medication management
and publishers of Pharmacist’s Letter,
Prescriber’s Letter, and Pharmacy Technician’s Letter, the
extensive Natural Medicines Comprehensive Database (which is in the process of incorporating
information from the Natural Standard database), as well as corresponding
Canadian publications. While the app itself is free, most of the information is
accessible only by subscribers ($49/year for the consumer version and $299/year
for the professional). However, the monograph on ginkgo (Ginkgo biloba) and list of United States Pharmacopeia (USP)-verified
ginkgo products are available for free (but not the references).
First
released in 1999, the database is updated daily with new research and includes evidence-based
monographs on natural ingredients, effectiveness ratings, safety ratings, and
interaction ratings. It also contains a list of brand name nutritional dietary
supplement products (mostly non-botanical) that are verified by the USP. The
monographs list information that many pharmacists would find useful, such as interactions
with herbs, supplements, drugs, and foods; lab tests; diseases or conditions;
as well as dosage guidance.
About Herbs
(Free; Apple/Web)6
Created by Memorial
Sloan Kettering Cancer Center’s Integrative Medicine Service
Memorial
Sloan Kettering Cancer Center, the world’s largest and oldest private cancer
center, has a strong integrative medicine program to assist with symptom
management and enhance patient care. The Center released its About Herbs app to
serve as a quick reference guide to information on herbs, botanicals, dietary
supplements, and complementary therapies that is available offline (i.e., a network
or Internet connection is not required to view the material).
Each
entry contains information at both professional and consumer levels, and
multiple citations of scientific studies as well as study abstracts and links
to the full text where available. Users also have the option to bookmark
specific pages for easy access without searching. The entries for specific
herbs include data on constituents, mechanisms of action, pharmacokinetics,
warnings, reported adverse reactions, herb-drug interactions, literature
summaries, and references.
Home Remedies
(Free; Android/Web)7 Created by ProThoughts
While
the previous apps provided information on herbs, this app focuses instead on
ailments. Users can scroll through a list of common, non-life-threatening
conditions such as acne, blisters, and menstrual cramps for remedies that rely
on botanicals and functional foods in the place of pharmaceuticals and
conventional medicines. The guide is interactive, and users can submit their
own home remedies and read through submissions from other users. Each remedy
includes several suggestions for home cures, do’s and don’ts for treatment, and
when a condition may warrant visiting a doctor. The app comes in two versions,
Lite and Plus; the Plus version of the app contains more information and can
connect to various social media accounts, allowing the users to share a remedy
with their social circle.
Conclusion
Both
the consumer and the professional with an interest in herbal medicine and
natural healing can find a plethora of apps to assist with their healthcare and
selfcare. These mobile references can be regulated by the FDA, but the growing
numbers make complete oversight difficult; therefore, users are advised to
research the origins of any health and wellness app, verifying that it comes
from a trusted source and can be relied upon to contain accurate information.
*
The listing and summary of the applications in this article are meant for
educational purposes only and are not to be considered as recommendations by
the American Botanical Council (ABC). ABC has not conducted a critical review
of the information in any of these applications.
—Hannah
Bauman
References
- Mobile Medical
Applications. US Food and Drug Administration website. Available here.
Accessed October 27, 2014.
- Mobile Medical
Applications: Guidance for Industry and Food and Drug Administration Staff. US
Department of Health and Human Services, Food and Drug Administration.
September 25, 2013. Available here.
Accessed October 27, 2014.
- Examples of Mobile
Apps For Which the FDA Will Exercise Enforcement Discretion. US Food and Drug
Administration website. Available here.
Accessed October 27, 2014.
- App Tours for
iPhone. The New York Botanical Garden website. Available here. Accessed October 27, 2014.
- Natural Medicines
Comprehensive Database App. Natural Medicines Comprehensive Database website.
Available here.
Accessed October 27, 2014.
- Our mobile apps.
Memorial Sloane Kettering Cancer Center website. Available here. Accessed October 27, 2014.
-
Apps. Home Remedies Natural Health and Healing
website. Available here.
Accessed October 30, 2014.
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