By Marika Sboros
It was once revered as “the world’s most prestigious scientific organisation” devoted to independent, evidence-based medicine. Today, the Cochrane Collaboration is in “moral crisis”, say insiders. They are predicting the beginning of the organisation’s end.
Critics say that the Collaboration has “lost its way”. It has grown too close to the drug industry and too far from delivering “trusted evidence”.
That follows the expulsion of one of its most high-profile members, Dr Peter C Gøtzsche at its annual board meeting in Edinburgh, Scotland recently.
The Board has accused Gøtzsche of bringing the organisation into disrepute. That followed Gøtzsche’s harsh criticism of a Cochrane review of the evidence for the human papillomavirus (HPV) vaccine. He and his team called it “incomplete and biased”.
Gøtzsche is unrepentant and says that the Cochrane has “a moral governance crisis”. Four more board members have resigned in protest at Gøtzsche’s shock sacking.
(Editor’s update: Cochrane’s governing board has hit back with a statement containing a thinly veiled attack on Gøtzsche, promising to reveal all soon.)
Back home in his native Denmark, Gøtzsche is professor in clinical research design and analysis and an internal medicine specialist at the University of Copenhagen. He has published more than 70 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine and the New England Journal of Medicine). His scientific works have been cited 30,000 times.
Drug industry’s bête noire
Gøtzsche is also well-known as the drug industry’s bête noire and for his scathing indictment of industry influence on health care. He is the author of Deadly Psychiatry and Organised Denial and Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Health Care.
Among his most memorable quotes: “The main reason we take so many drugs is that drug companies don’t sell drugs. They sell lies about drugs.
“This is what makes drugs so different from anything else in life. Virtually everything we know about drugs is what the companies have chosen to tell us and our doctors.”
Doctors may know a lot about diseases and human physiology and psychology, Gøtzsche has said. But they know “very, very little about drugs” that the drug industry hasn’t “carefully concocted and dressed up”.
“The reason patients trust their medicine is that they extrapolate the trust they have in their doctors into the medicines they prescribe.”
Investigative science journalist Dr Maryanne Demasi has taken a forensic look at what went down in Edinburgh. In a report on the BMJ EBM blog, Demasi has declared her interest. She is a researcher working with Gøtzsche at the Nordic Cochrane Centre. She was also present in Edinburgh at the time of the meeting. However, she was not in the discussion room where the vote was taken to expel him.
Demasi notes that Gøtzsche is well-known for his “blunt criticisms over harms of breast cancer screening programs and overuse of psychiatric drugs”.
But it was Gøtzsche’s most recent article, with co-authors Lars Jørgensen and Tom Jefferson, that was his undoing. Its title: The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias. It would have been a red rag to bullish Cochrane colleagues.
It was, Demasi notes, “a stinging critique of the quality and methodology of Cochrane’s HPV vaccines review”. Immediate backlash ensued, she writes.
The Cochrane leadership accused Gøtzsche’s team of causing reputational damage and fuelling “anti-vaxxers”
The editor of the Cochrane group that published the review said that Gøtzsche was risking “the lives of millions of women worldwide by affecting vaccine uptake rates”.
Gøtzsche stood by his group’s paper, sparking an urgent, internal review at Cochrane, writes Demasi.
On September 3, 2018, Cochrane’s editor-in-chief, David Tovey, and deputy, Karla Soares-Weiser, issued a statement.
They claimed that Gøtzsche and his team had “substantially overstated” the criticisms of the HPV vaccine review. They also said that the criticisms were “inaccurate and sensationalized”.
Click here to read: Death by medicine: doctors who harm more than heal
Thereafter, the Cochrane board brought in an external firm of lawyers to review the dispute.
Gøtzsche fired after ‘unfair practice’
Demasi goes on to describe what appears to have been unfair treatment. Gøtzsche was interrupted and given little time to defend himself adequately. After the announcement of his expulsion, the resignation of four board members followed two days later.
That has led to critics predicting the beginning of the end of Cochrane.
Scottish GP Dr Malcolm Kendrick was once a big fan of Cochrane but believes that it has lost its way. In a recent blog, he likens the reason to the dire warning then-US president Dwight Eisenhower made as a threat to democratic government 50 years ago.
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Eisenhower, a retired five-star Army general who led the allies on D-Day, made the remarks in his farewell speech from the White House, Kendrick writes. Eisenhower used the speech to warn about “the immense military establishment” that had joined with “a large arms industry”.
Kendrick gives an excerpt from a (National Public Radio) talk by Tom Bowman to his Morning Edition co-host Renee Montagne.
Drug/medical device industry complex?
“In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists, and will persist.”
Had Eisenhower been alive today, Kendrick is certain he would have recognised that another player had joined the party. That player is the “pharmaceutical/medical device industry complex”.
Thus, Eisenhower’s warning about “the potential for the disastrous rise of misplaced power exists and will persist” is “equally valid today”, Kendrick writes.
In fact, it is not just a “potential”. “It has happened,” he says.
(Click here to read a full version of Kendrick on: Peter Gøtzsche – a scandal.)
Gøtzsche’s expulsion from Cochrane is ongoing. An article in The BMJ notes that the expulsion notice gives Gøtzsche until midnight tonight (Sept 20) to make written representations.
It adds, “Given your behaviour today, we must also ask … that you do not try and attend any other Governing Board meetings.”