TY - JOUR T1 - Challenges for digital services in the NHS: drowning in a sea of innovation JF - British Journal of General Practice JO - Br J Gen Pract SP - 326 LP - 327 DO - 10.3399/bjgp19X704177 VL - 69 IS - 684 AU - Lara Shemtob AU - Rebecca Littlewood Y1 - 2019/07/01 UR - http://bjgp.org/content/69/684/326.abstract N2 - In August 2018, a paid Facebook advertisement for the Natural Cycles fertility awareness-based (FAB) contraceptive application (app) was withdrawn. This followed an investigation by the Advertising Standards Authority (ASA) which concluded that the advertisement was misleading, exaggerating the app’s accuracy and reliability as a form of contraception compared to other established methods.1 Natural Cycles is a landmark example reflecting wider issues of inadequate evidence for regulation and advertising of products being brought to market in this age of digital healthcare and social media. Through discussion of this case, which has parallels with Babylon and GP at hand, we highlight some of the challenges faced in digital healthcare innovation, and make some suggestions as to how to move forward.The Natural Cycles app uses an algorithm to calculate the fertile window of women who input data on daily basal body temperature, cycle length, and optional urine luteinising hormone (LH) testing. It is marketed as a stand-alone contraceptive method that couples can use to avoid unplanned pregnancies. Despite a Cochrane review concluding that the comparative efficacy of FAB methods remains unknown,2 they have a growing profile as they become available on mobile apps, and paid advertisements on social media have given them significant exposure. The UK code of British advertising that vets advertising of medical devices via a clearing process does not apply to social media. This inconsistency is of concern given that prescription only medication, including pharmaceutical contraceptives, is not allowed to be advertised in the UK.3When the ASA investigation1 triggered by five complaints found a Natural Cycles Facebook advertisement to be misleading, it was withdrawn following over 500 000 downloads. … ER -