Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial

Whole System Demonstrator: Policy, politics and publication ethics

25 June 2012

Limitations listed for this trial did not include close involvement of the funder in its design and execution. Under ‘Finances’, the authors state: “The Department of Health reviewed the protocol … and provided project manager support”.[1]

The Department of Health makes greater claims for its own involvement in the trial. In January 2012 it signed a ‘concordat’ with the technology industry, which referred to “a randomised controlled trial funded and run by the Department of Health” (paragraph 1).2

The authors have not commented formally on the substantial mismatch between their findings and conclusions (which were measured and cautious[1]) and those used by the Department of Health to inform policy (which were one-sided and sensationalist[2,3]), though individual WSD researchers have expressed misgivings.[4]

Randomised trials, which ‘control for’ context, have limited purchase for evaluating politically driven e-Health programmes.[5] The Department of Health’s cherry-picking of unanalysed data to put on its website before the trial had finished recruiting was scientifically inappropriate but politically expedient.[6]

The BMJ has led the field in exposing how the pharmaceutical industry’s conflicts of interest distort research. In failing to require the WSD’s authors to consider conflicts of interest by the state (whose intention to implement telehealth was enshrined in policy before the WSD results were analysed[7]), and in privileging randomised trials over study designs that allow analysis of political influences,[8] the BMJ has let itself to be used as a pawn by an increasingly powerful industrial-political complex.

1. Steventon A, Bardsley M, Billings J, Dixon J, Doll H, Hirani S, et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 2012;344:e3874.
2. Department of Health. A concordat between the Department of Health and the telehealth/telecare industry. http://www.3millionlives.co.uk/pdf/Concordat - FINAL.pdf. London: Department of Health, 2012.
3. Department of Health. Whole Systems Demonstrator: Headline findings December 2011. London: Stationery Office, 2011.
4. Praities N. Telehealth 'unlikely to be cost effective', admit researchers leading DH pilot. Pulse 2012;http://www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/13585495/telemedicine-unlikely-to-be-cost-effective-admit-researchers-leading-dh-pilot.
5. Greenhalgh T, Russell J. Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles. PLoS Med 2010;7(11):e1000360.
6. Greenhalgh T. Whole System Demonstrator: Desperately seeking peer-reviewed papers (rapid response). BMJ 2011:http://www.bmj.com/rapid-response/2011/11/03/whole-system-demonstrator-desperately-seeking-peer-reviewed-papers
7. Department of Health. Operating Framework 2012-13. London: Stationery Office, 2011.
8. Greenhalgh T, Procter R, Wherton J, Sugarhood P, Shaw S. The organising vision for telehealth and telecare: discourse analysis. BMJ Open 2012;in press.

Competing interests: None declared

Trisha Greenhalgh, Professor of Primary Health Care

Queen Mary University of London, 58 Turner St London E1 2AB

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