Kate Hemond, a nanny who cares for six children, was considering salmon for their supper recently. Standing at the fish counter of a Whole Foods market, she pulled out her cell phone to text message a service that could tell her whether the farmed Atlantic or the wild Alaskan contained toxic polychlorinated biphenyls, or PCBs.
"If one fish had higher levels, we wouldn't want to serve that to the children," said Hemond, 24, of Boston.
The new text-messaging service that Hemond uses -- which culls government advisories and scientific studies to provide environmental information on 90 species of fish -- is part of an emerging wave of technology that allows consumers to get instant health information through their cell phones.
Text messaging is fast, cheap and private. Unlike voice mail, it is easier to recall and easier to respond to. And unlike e-mail, it doesn't require a BlackBerry or other device when people are on the go.
In England, women have received text reminders to take their birth-control pills. In Australia, texting helped AIDS patients adhere to complicated drug regimens. And German researchers are examining how text messages can offer psychological support to bulimics. A recent study in New Zealand found that smoking-cessation programs were more effective in conjunction with supportive text messages.
The San Francisco Health Department started a texting service for sexual-health information last year, in response to rising gonorrhea rates among African-American adolescents and young adults. Via a text-message number advertised in public transportation and on billboards, callers can request answers to common questions provided by the city's health department, as well as details about health services available in town.
According to a preliminary evaluation of the system, called SexInfo and based on a similar program in Britain, there were more than 4,500 inquiries in the first 25 weeks, and more than half of those led to follow-up questions and referrals to health clinics. The service doesn't track what the referrals were for. The top three messages that were accessed by users were: "what 2 do if ur condom broke," "2 find out about STDs," and "if u think ur pregnant." In California, parental consent isn't required for people over 12 years old seeking reproductive health services.
In the U.S., health texting "is just starting up," says Jonathan Linkous, executive director of the American Telemedicine Association, a trade and professional group in Washington. Linkous says the organization is developing guidelines on the appropriate use of text messaging -- as well as other technologies such as videoconferencing and e-mail -- for delivering health information. "There are obviously times when telemedicine is inappropriate," he says. "Texting someone to tell them they have cancer is one of them."
In some cases, texting involves a language all its own in order to squeeze enough information onto tiny cell phone screens. Such abbreviated "text speak" or "txtspk," is familiar to the instant-message generation, but might be confusing to anyone over, say, 14. A few of the new services targeting adolescents use text speak intentionally, as a way to appear hip, but others are wary and try to communicate in plain, albeit shortened, language.
When it comes to content, Linkous says, any type of health-care information delivered to the patient should adhere to generally accepted standards and guidelines from the medical community. "If it's appropriate in the office, it's appropriate remotely," he says.
The majority of the programs don't cost users anything more than they are already paying for text messages through their various phone plans, and for the most part, all types of cell phones work. In general, the only information needed is the number to text and the unique message needed to access the service. For example, texting "SEXINFO" to (917) 957-4280 will connect users of the Metro PCS phone service to the San Francisco health information. People with other cell phone providers can text another number.
Some outfits are beginning to capitalize on the concept.
Intelecare Compliance Solutions Inc., based in New Haven, Conn., sells a service -- which companies can then provide to their employees or customers -- that sends text, e-mail or voice-mail messages reminding users to take their pills, refill prescriptions, get to appointments or check vital signs. Drug companies, insurers and large employers hoping to improve efficiency and decrease absenteeism are Intelecare's main customers, says 35-year-old Kevin Aniskovich, chief executive.
Next year, Aniskovich says, the company will start a direct-to-consumer service that for $60 a year will offer e-mail, text or voice-mail reminders about prescriptions and appointments. He says that since "txtspk" can be confusing, the service asks users to type in their own message reminders so they will be familiar with the message when it arrives.
A company called Smile Reminder in Lehi, Utah, lets businesses such as dentists and spas automatically send text and e-mail messages to remind customers of appointments. For dieters, a company called Sensei Inc. in Boca Raton, Fla., part-owned by insurer Humana Inc., will send weight-loss advice and information to Sprint and AT&T mobile-phone users for a weekly fee starting at $5.75. The information shows up in a multimedia format, rather than as a text message.
For FishPhone, the text service used by Hemond, the Massachusetts nanny, the process is pretty simple: Users send a text to the number 30644 with the message "FISH" and the species, and then get back a message. Hemond opted for wild Alaskan salmon over farmed because of its healthier profile, according to FishPhone, which was launched last month through Blue Ocean Institute, a nonprofit marine conservation organization that also offers information via e-mail and on the Web.
There is some debate over how beneficial text messaging can be in certain areas. It might not be of much use to the elderly, who are generally averse to using new technology in health care, according to a 2006 report from Vodafone Group PLC, the British mobile-phone provider.
In mental health, Linkous, of the telemedicine association, says his group is working with psychiatrists and others to develop clinical guidelines on "telemental health," which would cover the types of technology that might be appropriate for counseling patients with certain conditions. If, for instance, a person suffers from agoraphobia -- a fear of unfamiliar settings -- technology such as videoconferencing could provide an effective medium for counseling, he said.
Rifat Atun, professor of international health management at Imperial College in London, says several hospitals in England text-message appointment reminders and test results.
Texting has also caught on among some physicians in personalized tracking of acute and chronic medical conditions such as asthma and diabetes. In one study in Scotland, young diabetics could send a text message to their doctor to check how to modify their insulin treatment after eating certain foods, or drinking alcohol at a party.
The effectiveness of texting in addressing health problems hasn't been rigorously tested on a large scale. Atun says randomized clinical trials are still needed. He is designing a study in Africa to determine whether text messaging can help improve tuberculosis treatment in poor villages.
A division of the U.S. Army is trying to get funding for a program that could support soldiers with brain injuries. Ron Poropatich, deputy director of the Telemedicine & Advanced Technology Research Center at Fort Detrick in Frederick, Md., says the service would send daily questions to patients' cell phones to determine whether they are adhering to their therapy programs at home. Health workers would assess patient responses and figure out whether additional neurological or psychological help is needed. The service could be particularly useful to patients in remote areas, Poropatich says.