Time to Evolve Health Care's Gold Standard? Thoughts From 2011 Mobile Health Health Conference

May 9, 2011, 5:25 AM, Posted by

What does "works" mean? Like many things that seem superficially simple, the reality is much deeper. When BJ Fogg chose that as his theme and condition for the recent Mobile Health 2011 conference, he set the bar very high. The good news is that at some level the sessions all had an aspect of things working.

But there was some not so good news as well. Many still see Randomized Controlled Trials (RCT) as the universal and exclusive gold standard for evidence.  For a number of reasons, I think that's unfortunate in the mobile health field. First, to be realistic, the time scale for testing an mHealth intervention needs to be short, often on the order of at most 90 days. That will not provide sufficient evidence for dealing with a long term chronic illness where the time scale is measured in years, not days. I believe that many mobile health treatments that work in the short term will not be sustained long term, unless they change – and change is something that is generally not part of an RCT model.

Second, RCTs generally take a long time and require a fixed methodology, something that doesn't make much sense when dealing in a space where the technology is rapidly changing. By the time you can reach a conclusion, the intervention is often obsolete.

Finally, and perhaps most importantly, by its nature, mobile technology generates a large amount of data that can't be well controlled and is generally discarded (or ignored) in an RCT. Medicine may be the only field that I know of where we discard real life data in favor of clean, laboratory controlled measures. Imagine if the manufactures and maintainers of jet engines relied only on controlled tests and ignored measuring the real world wear and tear on an engine. If that were the case, I would certainly fly a lot less.The United States dropped the monetary gold standard in 1933. Isn't it about time that we at least consider the same thing for medicine?

We recognize this, as do others, and an mHealth Evidence meeting that we are cosponsoring with National Institutes of Health, McKesson, Department of Health and Human Services and the National Science Foundation on August 16 is focused on dealing with this directly. I'm happy to say that the response to the call for white papers for the mHealth Evidence workshop was such that the flyers I brought to Mobile Health 2011 were insufficient to meet the demand, and copies had to be made, not once, but twice.

Luckily, there were enough people with whom this resonates.

You can submit a white paper here on our website. If yours is accepted, you will be invited to attend the mHealth Evidence workshop (travel support will be provided).

Hope to see you there!

This commentary originally appeared on the RWJF Pioneering Ideas blog.