Yes, there will be an app for that …
Cell phone test touches on debate over how much health care should be placed in our own hands
While the announcement that public health leaders in the United Kingdom will develop a smart phone application to test for sexually transmitted diseases (STDs) had some joking about the thought of peeing on a computer chip—or even sharing the results on Facebook—the project deserves some thoughtful discussion.
Seen as a “portable personal medical technology,” a smart phone app to test for STDs is not much different than a home pregnancy test, according to Dan O’Connor , a faculty research scholar at the Johns Hopkins Berman Institute of Bioethics. Both tests would give people timely—and ideally, accurate—information to base decisions about having sex.
Someone who tests positive for an STD would be told to see a doctor, while a result that comes back “clean” might just compel an individual to resume normal sexual habits. But the spread of the cell phone’s influence into the bedroom isn’t on its face (or screen) cause for great alarm, O’Connor says.
“Ultimately, the smart phone STD test is best seen as just one more piece of information technology providing people with data about their health,” O’Connor says. “What they do, or what they are capable of doing, with that information will depend upon their intelligence, level of education and personal history.”
So, what’s the big deal? New smart phone apps come online every day, and in the health-care setting, those embracing “wireless medicine” are signaling an overall optimism about how mobile technology promises to enhance patient-physician communication and medical monitoring, while possibly lowering out-of-pocket costs by eliminating such things as minor face-to-face visits.
Enthusiasts of this new era of medicine give the obligatory nod to robust protection of patient information and privacy. And in regards to the mobile STD test specifically, those leading the project assure that privacy will be a top priority.
In another sense, the app’s developers say that privacy will be one of the test’s biggest plusses: It will allow people to find out if they have an STD on any personal device with a USB port—saving them the embarrassment of coming into a clinic.
There is comfort, however, in knowing that the results will be sealed and sent directly to you.
But what if the results are right there on your phone, which, these days, is often picked up or passed around freely among friends and relatives? “More cynically,” O’Connor says, “there is also the possibility of using the app on someone else without their knowledge. Major consent violations abound, potentially.”
In the United Kingdom, proper, new cases of syphilis actually decreased from 3,481 in 2005 to 3,273 last year, according to the Health Protection Agency, the U.K.’s leading public health entity (and a partner in the project). The agency also reports a drop in cases of the most common form of gonorrhea over that same time span—from 18,874 to 17,001.
However, new cases of herpes rose significantly between 2005 and 2009: from 19,591 to 30,126. New cases of Chlamydia also increased since 2005, from 107,908 to 114,686 last year.
The agency’s full set of annual STD surveillance data is available here , with statistics broken out by different regions, age groups and types of infections. On a related note, the agency reported last week that more than a quarter of individuals with HIV in the U.K. are undiagnosed.
And while this first version of the test will be designed to diagnose Chlamydia, gonorrhea and syphilis—either by analyzing a sample of urine or saliva—scientists reportedly hope that the chip will ultimately be able to test for HIV .
The project is called eSTI2 , which stands for electronic self-testing instruments for STIs (sexually transmitted infections). It is being led by Dr. Tariq Sadiq, a senior lecturer and consultant physician in sexual health and HIV at St. George’s, University of London.
Sadiq is heading a consortium of researchers in academia and industry that will work to improve sexual health in the U.K. through the use of new technology. The consortium has been given a $6.5 million grant to develop the testing chip, which its developers promise will provide results within 5 to 15 minutes.
They plan to make the chip available to the public once it can be priced at about $3, and eventually, have it sold through vending machines, at pharmacies and in social venues such as nightclubs. An initial story by the Guardian  reported that most STIs are acquired in the U.K. between the ages of 19 and 23.
“It’s brining the diagnostics to the population rather than having the population come into clinics,” Sadiq told CNN . “We’ve really wanted to do this process because there’s been this huge burden of sexually transmitted infections.”
This innovation fits into the broader discussion about “participatory medicine ,” a concept that entails patients playing a more active role in their own health, enabled by today’s technology.
But while the current move toward mobile medical devices might sync well with our increasingly do-it-yourself culture and our preference for personal empowerment—“Diagnose yourself! Research your own condition!”—O’Connor warns that the trend could just as easily result in a gradual shift of responsibility for health outcomes to the individual.
That, however, would ignore the greater environmental and social factors that massively impact health and which, O’Connor asserts, are actually the responsibilities of governments and corporations.
“There are some great opportunities for health care in the Internet era, but we should be very careful to ensure that those opportunities are not merely excuses for those larger, influential entities to abdicate their responsibilities,” O’Connor says.