Whole System Demonstrator trial: policy, politics, and publication ethics

Limitations listed for the Whole System Demonstrator trial of telehealth 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 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.”2

The authors have not commented formally on the substantial mismatch between their findings and conclusions (which were measured and cautious1) and those used by the Department of Health to inform policy (which were one sided and sensationalist2 3), although individual Whole System Demonstrator researchers have expressed misgivings in scientific meetings.

Randomised trials, which control for context, have limited purchase for evaluating politically driven eHealth programmes.4 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.5

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