Story snapshot: A review in the BMJ identified nine eligible studies that evaluated apps for risk stratification of skin lesions, and showed variable and unreliable test accuracy for six different apps.

Why is it notable? Evidence and regulation in question. 

• A number of people rely on diagnostic apps to do basic triage at home, especially with moles and skin lesions and this study raises concerns about this trend.
• Under the EU Medical Device Directive (MDD), smartphone apps are class 1 devices. Manufacturers can apply CE marking to class 1 devices as long as they have shown compliance with the “essential requirements” as outlined in the Directive, and without necessarily being subject to independent inspection by notified bodies. Under the new MDD Regulations which come into full force by May 2020, smartphone apps could be in higher device classes and will be subject to inspection by notified bodies. 
• P.S: No skin cancer risk stratification smartphone app has received FDA approval to date.
  

Industry Implications - Push for education and clarity. 

• In a rapidly advancing field, quality of evidence is poor to support the use of these algorithm based apps to assess skin cancer risk. And this is dangerous because it may lower the medical help seeking behaviors of the general population and result in delayed or non diagnosis.
• While the authors of the study are quite critical of the apps studied, and the laxity of EC's CE regulation for such apps, there is a need to educate the medical community, the general population on how to use such solutions, at what point to transfer to routine care. There is also a need to continue to validate and build the evidence base for all of digital health.

Story snapshot: On the note of diagnostic bots, and two sides to any story, Babylon Health gave in this week and reacted to provocation from their long-time Twitter critic, Dr David Watkins (i.e @DrMurphy11). In what has now become a media war, Babylon is defending it's algorithms and DrMurphy11 is challenging their validity and accuracy. 

‍Why is it notable? Set clear expectations. 

• Babylon Health is heavily funded, has bigwigs like Google Deepmind as partners, and has also made its way into the NHS as a triage tool.
• Brings into question the reliability of such solutions to accurately advise the common man on how to respond to a health condition.
• Dr Watkins may have taken this a step too far - very unlikely I will be typing on my Babylon app if my loved one is in a seizure, or an anaphylactic shock. So, being pragmatic in the expectations of what a bot is meant to do in our lives and in our health is much needed.

Story snapshot: As the world wide web is becoming increasingly awash with misinformation about the coronavirus (COVID-19), the modern gatekeepers of information - Facebook, Google, Amazon & Co. - met last week to discuss how to halt the spread of fake news about the disease.

Why is it notable? Nip it in the bud. 

• Misinformation modulates risk-taking behaviour and simulation studies suggest that reducing the proportion of false information and stopping people from sharing as well as believing bad advice can mitigate infectious disease outbreak outcomes. Individually, social media outlets and search engines are unable to screen and remove falsehoods. However a powerful coalition between key actors may be able to curb the spread of misinformation. 

Industry Implications - Social media is a boon and a bane. 

• Fake news spread fear. And fear tends to propagate social stigma. Fake news is also the kind of stuff that strengthens anti-vax rhetoric.
• While misinformation about COVID-19 has led some to shrug it off as hyped-up, or resort to questionable prevention or treatment measures, others (as a result of growing stigma) have become ashamed of being associated with the disease. Irrespective of how false virus related news is assimilated, it could risk delaying potentially infected individuals from seeking care.
• As the gatekeepers of information, tech companies must play a role in immunising against misinformation.

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