• Andrew

    One thing I worry about is that these apps can further exaggerate the relevance of surrogate or intermediate outcomes to our health, so that we are pushed to produce the best lab test results, instead of living the most healthful lives that fit with our goals and values.

    Too many patients are already obsessed with the test. For example, a survey of people with diabetes found that one in four considered their hemoglobin A1c levels to be a more important outcome than even death, stroke or heart attack!
    (Murad MH, Shah ND, Houten HKV, et al. Individuals with diabetes preferred that future trials use patient-important outcomes and provide pragmatic inferences. J Clin Epidemiol. Jul 2011(7):743-748.)

    Such distortions occur when the first thing clinicians talk to their patients about is their test results. Patients know they’ll get gold stars for good lab tests and a harrumph for missing the mark.

    Sure, people with diabetes should be aware of hemoglobin A1c, heart attack survivors should track their LDL, and so on. But we should not let these numbers consume our attention far out of proportion with their actual usefulness to promoting health.

    Smartphone apps are great at tracking numbers, but can any track how many times we…