In 1992, Chalmers, Dickersin, and Chalmers published a landmark editorial for the BMJ. The title was “Getting to Grips with Archie Cochrane’s Agenda”. The closing paragraph gives the bottom line:
The editorial gave impetus to what became the Cochrane Collaboration. Thanks to the Collaboration, many of the editorial wishes have come to pass. Like all successful organisations, Cochrane expanded and moved on from a pioneering phase to the production of thousands of reviews, most of which sum up the effects of biologics, pharmaceuticals, and diagnostics.
In 2015, Cochrane decided to drop the “Collaboration,” but for many, this signalled a shift from the “can do” mentality of the early collaborative phase to a more commercial, less spontaneous and bureaucratic phase.
Originally, Cochrane was structured in groups themed around diseases or syndromes, such as acute respiratory infections, that interested its researchers. Carl and Tom were clinical editors of this group. The groups were heavily subsidised by the UK’s NIHR. Eventually, this led to a byzantine system of production and publication and the withdrawal of NIHR funding.
Funding for Cochrane in the UK ended in March 2023 after 32 years of support. The loss was around £5.3 million. The NIHR ended the financing to develop its own evidence synthesis programme. Cochrane’s approach had moved too far away from publishing evidence that could inform UK practice and was too long-winded.
The 2019 list of funders is now very long, as our reader Alan Richards listed but NIHR is no longer there.
In 2014, Cochrane had a chance to focus on producing fewer, more reliable reviews and fulfilling all of Archie Cochrane’s agenda. It moved away from extensive coverage and focused on the use of pharmaceutical registration data, which, as we have shown in our antivirals and Comirnaty series, is now more easily available than it was 20 years ago.
On the 17th of April 2014, Carl, Tom and Peter Doshi, on behalf of the authors of the Cochrane review on antivirals for influenza, posted the following on the Dryad repository website:
“Tamiflu, Relenza, and influenza: what the data do (or don’t) tell us
In the late 2000s, half the world was busy buying and stockpiling the neuraminidase inhibitors oseltamivir (Tamiflu, Roche) and zanamivir (Relenza, GSK) in fear of an influenza pandemic.
The advice to stockpile for a pandemic and use the drugs in non-pandemic, seasonal influenza seasons came from august bodies such as the World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and its European counterpart, the ECDC. However, they were stockpiling based on an unclear rationale, mixing the effect of the antiviral drugs on the complications of influenza (mainly pneumonia and hospitalizations) and their capacity to slow down viral spread, giving time for vaccines to be crash-produced and deployed.
It has since become clear that none of these parties had seen all the clinical trial evidence for these drugs. They had based their recommendations on reviews of “the literature” which sounds impressive, but in fact refers to short trial reports published in journal articles rather than the underlying detailed raw data. For example, critical assumptions of antiviral performance found in the US national pandemic plan trace back to a six-page journal article by Roche, which reported on a pooled analysis of 10 randomised trials, of which only two have ever been published.
In contrast, each of the corresponding internal clinical study reports for these ten trials runs thousands of pages (for background on what clinical study reports are, see here.) Despite the stockpiling, these reports have never been reviewed by CDC, ECDC, or WHO. The WHO and CDC both refused to answer our questions on the evidence base for their policies.
Our Cochrane systematic review of neuraminidase inhibitors, funded by the National Institute for Health Research in the UK, was based on analysis of the full clinical study reports for these drugs, not short journal publications. We obtained these reports from the European Medicines Agency, Roche, and GlaxoSmithKline. It took us nearly four years to obtain the complete set of reports. The story of how we got hold of the full clinical trials with no access restrictions is told in our essay Multisystem failure: the story of anti-influenza drugs.
With the publication of our review, we are making all 107 clinical study reports publicly available. If you disagree with our findings, want to conduct your own analysis, or are just curious to see what around 150,000 data pages look like, they are one click away. Now, the discussion about how well these drugs work can happen with all parties able to analyse all the trial evidence independently. This is called open science.”
At that stage, Cochrane had the opportunity to switch from producing large numbers of reviews based on questionable data from publications to doing more detailed work that would stand the test of time and help decision-making by identifying pharmaceuticals, biologics, and devices that could genuinely be worth investing in and benefit society.
Unfortunately, Cochrane chose to continue and enhance its structure-driven review production, trading on its fame and the very hard work of scores of pioneers and early volunteers.
At the 2015 Annual General Meeting of The Cochrane Collaboration, Carl stood up and asked:”
‘That when the Cochrane Review on Neuraminidase inhibitors for influenza was published, in media interviews he described himself as part of The Cochrane Collaboration. However, now he would not do so, and said he was confused as to whether Cochrane was still a collaboration. Later he asked if the word ‘collaboration’ could be brought back into the logo.’
Dr Lisa Bero replied, ‘that a Cochrane Review was always considered the work of Cochrane, and the issue was where you draw the line if you’re talking about research which you conducted as an independent researcher that may or may not be part of a Cochrane review.’
Mark Wilson, the new Cochrane CEO ‘confirmed that Cochrane’s logo has changed, and that the choices and the policies that the organization has made were being implemented. There is a governance process through which decisions are made and he encouraged those who have dissenting views to make them known, to stand for election and to continue to hold us to account.’
The Collaboration was over. Those who stood for election and tried to hold Cochrane to account - as Wilson proposed - were ridiculed and sidelined. In 2018, Peter Gøtzsche was sacked from his position as an elected Board member and lost his Cochrane membership. Why? He pointed out the “organisation’s shift towards a commercial business model approach, away from its true roots of independent, scientific analysis and open public debate.”
The final death knell of current management's credibility came in 2020 when the editors and board members advocated using circumstantial evidence to make measured gambles in the context of the recent pandemic.
The authors aimed to undermine the Cochrane review on interrupting the transmission of respiratory viruses, twice caving into the pressure of influencers and lobbyists.
History will judge whether they succeeded, but they trashed Archie Cochrane’s agenda.
In a linked post, we provide the complete documentation of this sad episode of wokery, censorship and political expediency. We take no joy in doing so.
This post was written by two old geezers who still think collaborating is worthwhile.
References
Chalmers I, Dickersin K, Chalmers TC. Getting to grips with Archie Cochrane's agenda. BMJ. 1992 Oct 3;305(6857):786-8. doi: 10.1136/bmj.305.6857.786.
Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Onakpoya I, Mahtani KR, Nunan D, Howick J, Heneghan CJ (2014) Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database of Systematic Reviews, online in advance of print. doi:10.1002/14651858.CD008965.pub4
Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Onakpoya I, Mahtani KR, Nunan D, Howick J, Heneghan CJ (2014) Data from: Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Dryad Digital Repository. doi:10.5061/dryad.77471
It seems to me that the vast amount of published research, including trials of medical interventions is excessive compared with the possible benefits. An anology with the arts is useful. When socialist governments decide to promote and support talented artists, the result is invariably the production of vast quantities of worthless paintings, music etc by people awarded funding by government bureaucrats. In the good old days, artists were rewarded by patrons in a free market, without government interference, and the result was that the Shakespeares, Rembrandts and the Beethovens rose to the position justified by their talents and achievements. The same principle applies in medical science and science in general. Government funding = bureaucratic government control = destruction of creative endeavour. Cochrane's job would be much simpler if there was less research, and research of higher quality. Not much is gained by having to review mountains of poor quality studies.
Maybe the solution could be to bring the two of you and join the dissidents from Cochrane Collaboration such as Peter Gotze and fund the "Trust the Evidence Collaboration".
The scientific world would be better!
Anyway, with TTE we are already much better than with nothing.