Cochrane in moral downfall
Show trial against co-founder of the Cochrane Collaboration Peter C. Gøtzsche leading to his expulsion from Cochrane.
Four people appear repeatedly in the documents:
Mark Wilson, Cochrane’s CEO (2012), journalist by education, with the Soviet Union and the Balkans as special interests. He controls virtually everything in the Cochrane Collaboration, including its Governing Board, although the Board is supposed to control him.
Martin Burton, co-chair of the Cochrane Governing Board (September 2017) and Director of the UK Cochrane Centre. He has a huge conflict of interest because Wilson is his line manager. He is therefore not likely to go against Wilson’s wishes in his role as co-chair.
Marguerite Koster, co-chair of the Cochrane Governing Board (September 2018) and Senior Manager at Kaiser Permanente in California.
Peter C. Gøtzsche, Director of the Nordic Cochrane Centre (1993), co-founder of the Cochrane Collaboration (1993), and elected Cochrane Governing Board member (January 2017). Expelled from the Board and as a member of Cochrane on 13 September 2018 in a show trial, after Cochrane’s hired Counsel had found no evidence of wrong-doing.
Gøtzsche is the only Dane who has published over 70 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine, and New England Journal of Medicine). His works have been cited over 40,000 times. His books, “Deadly medicines and organised crime: How big pharma has corrupted health care” and “Deadly psychiatry and organised denial” have been translated into many languages and have been much appreciated by the patients, but not by the Cochrane leadership, which has denounced them publicly.
Before we begin, a bit of humour about the whole ordeal: Gøtzsche is not there so whom can I trust.
The most important documents
- 2015. The Spokesperson Policy.
This has been used by CEO Mark Wilson to introduce scientific censorship in Cochrane and to persecute Gøtzsche for over four years, for no good reason. And Wilson exonerated his own member of staff when he did the same as Wilson has punished me for doing.
- 30 August. Peter C. Gøtzsche: My submission to Counsel.
I demonstrated serious mismanagement on the part of the CEO and his staff and the co-chairs of the Board, which included tampering with meeting minutes and other important evidence, in my submission to Cochrane’s hired law firm.
- 12 September. Counsel’s report.
Counsel exonerated me from all allegations raised against me. The next day, I was nevertheless expelled from the Board and from Cochrane, based on charges invented on the spot, and four of the 13 Board members resigned in protest over this unjustified decision.
- 20 September C. Peter C. Gøtzsche: My appeal to the Board of its expulsion of me where I asked for a due and fair process, which was denied.
- 9 October. Peter C. Gøtzsche: My complaint to the Charity Commission for England and Wales about serious mismanagement in the charity.
- 10 October B. Resigned Board member David Hammerstein: Regenerate Cochrane to strengthen the production of trusted evidence for the common good of public health.
- 18 September 2015. “Statement by Cochrane”
On the Cochrane website, the Cochrane leadership denounces my evidence-based statements in an article in MailOnline about the dangers of psychiatric drugs.
- 16 February. Gøtzsche’s letter to a US funder
I asked for missing numbers of deaths and causes of death in a study of patients with schizophrenia treated with neuroleptics.
The seminar was for psychiatrists and it was announced in the Journal of the Danish Medical Association.
Same seminar as just above.
In relation to the letter he wrote to a US funder asking for missing numbers of deaths and causes of death in a study of patients with schizophrenia treated with neuroleptics. See the letter above under 16 February. Wilson also refers to a tweet related to the seminar Gøtzsche held, see under February above.
- 18 March. Gøtzsche’s suggested replies
To the US psychiatrist and to the tweet.
- 19 March. The second complaint
This was related to to a Dutch homicide trial where Gøtzsche was an expert witness.
- 11 April A. Wilson writes to Gøtzsche
About the complaint and the tweet, and the second complaint. Wilson opines that Gøtzsche broke the Cochrane Spokesperson Policy in relation to both complaints; gives a two-day deadline; and threatens to close the Nordic Cochrane Centre.
- 11 April B. Gøtzsche’s mail to Governing Board
About Wilson’s threat of closing the Nordic Cochrane Centre for no good reason.
- 18 April A. Gøtzsche’s comments on Wilson’s opinions
Comments on Wilson’s email from 11 April.
- 18 April B. Gøtzsche’s comments on Wilson’s draft response
To the US psychiatrist, see under 11 April above.
- 18 April C. Gøtzsche’s comments on Wilson’s draft response
To tweet from 11 April.
About engaging an independent person to undertake a review and to prepare a confidential report for the Board. Gøtzsche rejects this plan because it is not impartial and asks the Board to adhere to the established procedure for disagreements between the CEO and a centre director.
- 13 June. Minutes from Board teleconference
It was decided with a majority vote to get a legal review of the issues.
- 23 July. Letter from Cochrane’s Lawyer
With minutes from the 13 June Board teleconference, but the names of those who voted yes or no to instituting the review were removed, in contrast to the rules.
The dispute between Cochrane’s CEO, Mark Wilson, and me concerned the interpretation of the Cochrane Spokesperson Policy related to two recent cases. The mismanagement of Cochrane is also described in detail in this report, and the most important issues are repeated in my complaint to the Charity Commission on 9 October (see below).
- 12 September A. Co-chair of the Governing Board, Martin Burton, wrote to the Board:
“Counsel’s report … is confidential … We are seeking advice from our lawyers as to whether or not the confidentiality extends to (a) the fact that the review was undertaken, and (b) the existence of the Report, or not.”
Cochrane prides itself for being an open, transparent and accountable charity. Secret processes should not occur in Cochrane.
- 12 September B. Counsel’s report, which exonerates Gøtzsche from all charges.
It is hardly a coincidence that Cochrane wanted to keep Counsel’s report from 12 September out of public view. I have made it accessible, as the public interest in this report overrides any attempts at keeping it secret by people who have exposed me to a show trial.
- 13 September. Bente Bundgaard: Blegner stråleglansen om Cochrane? [Is the aura around Cochrane fading?]. Ugeskr Læger 2018; 13 Sept.
- 14 September A. Peter Gøtzsche: A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane.
I informed people that I had been expelled from Cochrane and that no clear justification was given for my expulsion. The growing top-down authoritarian culture and an increasingly commercial business model that have been manifested within the Cochrane leadership over the past few years threaten the scientific, moral and social objectives of the organization. Many Cochrane centres have sustained negative pressure and a lack of productive dialogue with the CEO of the central office. Upon alerting the Cochrane leadership of these worrisome tendencies that negatively affect the operability and social perception of our scientific work, the Nordic Cochrane Centre has received a number of threats to its existence and financing.
- 14 September B. Nigel Hawkes: Cochrane HPV vaccine review: BMJ journal defends “inconvenient criticisms”. BMJ 2018;362:k3927.
From rapid responses to Hawkes’ article:
JK Anand: The credibility of Cochrane Collaboration is in tatters. The whole team should be wound up. Thank you, Prof Gøtzsche and your five colleagues, for showing that intellectual honesty is still alive.
Michael Baum: I have always admired the work of the Cochrane collaboration and have very high regard for Peter Gøtzsche, whom I know very well. Yes, he can be very abrasive in his manner and, yes, he can be provocative, but these are the qualities required by someone with intact scientific integrity who has sufficient courage of speaking truth to power. I believe that Peter is a luminary of the Cochrane collaboration and adds to the credibility of the organisation. Without Professor Gøtzsche we might be minded to cease collaboration with Cochrane. I would therefore like to suggest that if Peter and the other board members who resigned in protest, are not re-instated we will withdraw our support and challenge their right to make use of our data sets that have been collected for decades as a result of financially unrewarded efforts by clinical scientists all over the world.
Jeanne Lenzer: This is deeply, deeply disturbing. The scientific process advances through vigorous examination of conflicting evidence and claims. To silence one side undermines this process. Cochrane’s action in expelling Peter Gøtzsche is an ugly stain on Cochrane that will remain for many years to come. It reduces my trust. Shame on Cochrane.
Dear Cochrane Colleagues,
This week, the Cochrane Governing Board decided with a vote of 6 in favour, 5 opposed, and one abstention, to expel Peter Gøtzsche from his membership in Cochrane because he has been “causing disrepute” to Cochrane.
Four of us who opposed this decision have resigned from the Board as a result. We consider the Boards use of its authority to expel Peter from Cochrane to be disproportionate. The general public, consumers, students, and researchers involved in Cochrane value the plurality of opinions, views, and perspectives Cochrane has worked hard to give voice to since its foundation. We believe that the expulsion of inconvenient members from the Collaboration goes against Cochrane ethos and neither reflects its founding spirit nor promotes the Collaborations best interests. We are concerned that these actions might cause great damage to the reputation of the Collaboration.
Governing Board members are expected to publicly uphold and defend all decisions taken. We could not adhere to this obligation in this case in good conscience. We also believe that those of you, who placed your trust in us to represent you on the Board, would not wish us to do so. For this reason, we have unfortunately felt the need to resign from the Cochrane Governing Board and have done so the day after the decision was taken.
It is our hope and deepest desire that this event will encourage all Cochrane members and the wider community to reflect upon where we currently find ourselves and give serious consideration to what we want for the future of Cochrane and its principles, objectives, and ethos.
Gerald Gartlehner, David Hammerstein, Joerg Meerpohl, Nancy Santesso
- 16 September A. Martin Enserink: Evidence-based medicine group in turmoil after expulsion of co-founder. Science 2018; 16 Sept.
- 16 September B. Maryanne Demasi: Cochrane – A sinking ship?
There are concerns that Cochrane has become preoccupied with “brand promotion” and “commercial interests”, placing less importance on transparency. At the Board meeting where Gøtzsche was expelled, co-chair, Marguerite Koster, allowed Gøtzsche ‘five minutes’ to state his case. Witnesses in the room say Gøtzsche was constantly interrupted before being asked to leave the room while the other Board members discussed the situation.
“The contention that Cochrane has been publishing reviews that are mainly beneficial to the sponsors of these interventions is probably a fact,” says Jefferson. “If your review is made up of studies which are biased and in some cases are ghost written or the studies are cherry picked and you don’t take that into account in your review, then its garbage in and garbage out – its just that the ‘garbage out’ is systematically synthesised with a nice little Cochrane logo on it”.
“Cochrane has become too sensitive to criticism of the pharmaceutical industry”, says one board member. ”They don’t believe in democratic plural science”, said one outgoing board member. “Good governance of science always requires open debates. The prestige of a scientific institution has to do with its ability to manage critical debates, not censor them”.
- 17 September A. Peter Gøtzsche. Peter C. Gøtzsche’s comments on: Statement from the Cochrane Governing Board about alleged bad behaviour of “one individual”.
The authorship of this statement is false and therefore constitutes scientific misconduct committed by the Board. The Cochrane statement is strongly defamatory for me and also strongly misleading, which serves to underline that Cochrane is in free moral fall under its current leadership.
- 17 September B. Statement from the Cochrane Governing Board.
The Cochrane statement is also misleading in its description of the letter from 15 September by the four Board members who resigned in protest over Gøtzsche’s expulsion (see above). It stated falsely that the four Board members have actively disseminated an incomplete and misleading account of events.
- 17 September C. Inga Vesper: Mass resignation guts board of prestigious Cochrane Collaboration. Nature 2018; 17 Sept.
- 17 September D. Nigel Hawkes: Cochrane director’s expulsion results in four board members resigning. BMJ 2018;362:k3945.
From rapid responses to Hawkes’ article:
Shyan Goh: I do not think that Archibald Leman Cochrane would have expected the massive catastrophic breakdown of trust and transparency … Unresolved serious issues involving potential conflict of interests, personality clashes and backroom maneuvering to expel dissenting or inconvenient members of the governing board should not be allowed.
Dick Bijl: We believe this crisis is a good opportunity to fix a big problem raised by Peter Gøtzsche and others about Cochrane’s conflict of interest policy. Currently, Cochrane allows some authors of its reviews to have conflicts of interest with drug companies, a policy that is widely criticized by insiders, and largely unknown to the public. Cochrane’s credibility and trust are largely at stake if they do not adequately deal with this issue immediately.
Hazel Thornton: When a new executive moves to establish a business takeover, dropping the word `Collaboration` from its communications, and steadily changing the Collaboration`s founding ethos which is based on collaboration and engages voluntary, enthusiastic contributions, they are likely to find that the support and membership will drop away rapidly. Productive, democratic teamwork cannot thrive under autocratic executive direction. Altruism does not sit well with a business model; trust once lost is difficult to regain.
- 17 September E. David Healy: Cochrane Cock-up.
As it grew, Cochrane recruited managers to run the organization who began to focus on the brand and policies and protocols with a tin ear for the nature of the enterprise being managed. The former Cochrane Collaboration – now Cochrane Dictatorship – are almost certainly wrong on the occasion of the breach, a Cochrane review that gave HPV vaccines a clean bill of health. The review was wrong technically in that it breached Cochrane procedures.
Although the Board denies this, our criticism of the Cochrane HPV vaccines review played a key role for my expulsion. We have a unique knowledge about these trials because we have worked with the clinical study reports obtained from the European Medicines Agency. In early September, letters of complaint were sent to co-chair Martin Burton, which he might have orchestrated himself. These letters, two of which were from previous co-chairs, argued for scientific censorship and for my expulsion from the Board because I had criticised a Cochrane review publicly. However, our Spokesperson Policy encourages this, and we also have an annual prize for it. We should not have double standards in Cochrane.
- 18 September. Bente Bundgaard: Magtkampen i Cochrane afgjort – for nu [Power struggle in Cochrane is over – for now]. Ugeskr Læger 2018; 18 Sept.
- 19 September. Bente Bundgaard: Liselott Blixt: ”Vigtigt med uafhængige stemmer” [Important with independent voices]. Ugeskr Læger 2018; 19 Sept.
- 19 September. Tom Jefferson: The Crucifixion of Brother Peter.
- 20 September A. Nigel Hawkes: Cochrane director says his sacking was flawed and came after “show trial”. BMJ 2018;362:k4008.
- 20 September B. Fiona Godlee, BMJ’s Editor in Chief: Reinvigorating Cochrane.
Gøtzsche calls for a ban on financial conflicts of interest among Cochrane reviewers. The BMJ supports this call. It would mean fewer but better systematic reviews.
From rapid responses to Godlee’s article:
Jeffrey K Aronson: The Board of Cochrane must act quickly, to show that they are not out of touch. They have two choices: either to publicly acknowledge the validity of scientific debate, swallow their pride, apologise to Peter Gøtzsche and his colleagues, and reinstate him; or to resign en masse and allow a new board to take things forward..
Alastair Matheson: Everybody wishes Cochrane well. The organization needs to reaffirm itself as a scientific, not a corporate endeavour. I can’t comment on the nitty-gritty of the dispute with Peter Gøtzsche, but would like to see a solution in which he is reinstated.
Donald Nicolson: I examined the dynamics and processes around the conflicts of interest debate at the 2003 Cochrane Colloquium in Barcelona. I am not surprised that conflicts of interest remain unresolved. Cochrane were slow in addressing the conflicts.
- 20 September C. My appeal to the Cochrane Governing Board.
Please read it. It is fundamental for understanding the current moral crisis in the Cochrane leadership, which includes gross injustice.
- 25 September. Tweet from the Nordic Cochrane Centre
Our criticism of the @Cochranecollab HPV vaccines review is appropriate and has been strengthened. Many patients and harms were missing and Cochrane needs to address the primary author’s COIs, which its policy does not allow @DavidTovey @KarlaWeiser
- 26 September A at noon.
I received information that I had been unsubscribed from all Cochrane mailing lists, even the ones for authors, although I am an author of 17 Cochrane reviews, and that my appeal had been rejected. The two co-chairs of the Board wrote that the Board had carefully considered my appeal, which is difficult to understand, as it is very convincing. In reality, they just continued the Board’s gross injustice. As before, the Board gave no reasons. Cochrane’s own law firm had exonerated me on all counts. The show trial was over.
- 26 September B. Gøtzsche’s comments on Statement from Cochrane’s Governing Board about why his appeal was rejected.
The Cochrane Governing Board distorts the evidence, suppresses it, or lies blatantly about it and issues defamatory statements. At no point has Cochrane demonstrated to me, or Counsel, that I have damaged the “the charity’s work, reputation and members”. In fact, I have done the opposite. The world has revered Cochrane, partly because of the scientific contributions from my Centre. To claim that I have undermined Cochrane is both offensive and mendacious.
The Board instituted a legal review because of disputes between Cochrane’s CEO and me about the interpretation of the Cochrane Spokesperson Policy. It had absolutely nothing to do with “disruptive and inappropriate behaviour.” This excuse was only invented after Counsel had exonerated me.
It is not true that I repeatedly represented my personal views as those of Cochrane, and it was clearly stated by Cochrane’s Counsel that these allegations could not be substantiated. Quizzically, Cochrane’s CEO and Editor in Chief recently exonerated a member of their own staff for doing precisely what Wilson accused me of doing (see my appeal from 20 September above).
The Board misleads everyone into believing that Cochrane’s legal investigation was about an assessment of my ‘repeatedly, seriously bad behaviour’. This is a complete fabrication. The only complaints about me have been in response to my scientific critiques, often by those whose science I have disagreed with. Simply disagreeing with someone’s science is hardly a basis for complaint about my ‘behaviour’.
The Board conveniently ignored Counsel’s report (paid by Cochrane), which exonerated me, and other crucial evidence. The Board members were only allowed 1.5 days to read and thoroughly assess over 700 pages of documents before I was expelled at the Board meeting of 13 September, a period of time which was grossly inadequate. I was given 5 minutes for an oral defense. Co-chair Marguerite Koster interrupted me several times before she asked me to leave the room. Lastly, the co-chairs refused to take highly relevant evidence into consideration when presenting documents to the Board. It was clear that a decision to oust me from the Board was predetermined by a minority and that no finding from its Counsel would divert them from their objective. A lot was said during the 5 hours of the Board meeting where I was not allowed to participate that was wrong or misleading, but I was denied the possibility to defend myself.
The Board writes that 11 members of the Board voted that I had breached the Trustees’ Code of Conduct as a result of my ’behaviours.’ According to information I have, this is totally false. The Board knew that I had not breached the code of conduct and the Board could therefore not expel me from my democratically elected position as Trustee. Co-chair Martin Burton therefore tried to convince the Board that they should ask me to resign voluntarily. This was what the Board voted about. The Board also realised at some point that the only way they could kick me out of the Board was to expel me as a member of Cochrane.
In my appeal, I provided very strong evidence and arguments that the Board needed to reverse its decision about my expulsion. I also asked for a fair process. Burton and several other Board members were severely conflicted and should not have been allowed to vote.
In summary, my appeal was:
– to set up an independent committee of people who have had nothing to do with Cochrane, but who have experience in mediation, law, medical science and medical editing, who should judge my case, with no time constraints;
– alternatively, to simply reinstitute my membership of the Cochrane Collaboration, acknowledging the gross injustice and defamation I have been exposed to.
in any case, I must be given the opportunity to participate in any oral deliberations, like in a court case, and to contest any explicit reasons for my expulsion on 13 September.
The Board opines that I breached my obligations of confidentiality as a trustee and continued the pattern of behaviours which led to the Board’s initial decision. However, it was only after my expulsion that I made public statements about this process because it was the only way to shine a light on the gross injustice I suffered after being expelled on 13 September, and after Martin Burton had read aloud a seriously defamatory and misleading ‘hate speech’ at the Annual General Meeting on 17 September. Therefore, I made it clear that I waived my right to confidentiality. I must be allowed to defend myself against defamation, mendacious allegations and insinuations, and I have documented how misleading the Cochrane Board Statement from 17 September is.
- 27 September A. Moralsk ledelseskrise i Cochrane-samarbejdet.
Kronik bragt i Politiken.
- 27 September B. Moral leadership crisis in the Cochrane Collaboration.
Newspaper article in Politiken 27 September 2018.
On 26 September, Cochrane headquarters in London took forcible control over our website without our permission, consultation or knowledge. Cochrane blocked our communications consultant from being able to carry out administration duties on our own website. A journalist informed me that I no longer appear listed as a staff member of the Nordic Cochrane Centre on our website, which led her to believe that I had been fired from the centre. This is not true. I am head of department and that department is the Nordic Cochrane Centre.
Headquarters uploaded secretly on the front page the statement from 26 September by the Cochrane Governing Board, which is strongly misleading and defamatory for me. See here the front page from 25 September, and how it looked after Cochrane headquarters had tampered with it.
Headquarters removed from the front page our tweet column, which mentioned our published criticisms of two Cochrane reviews. We perceive this action to be akin to scientific censorship, which goes directly against the officially declared values of the Cochrane Collaboration.
Headquarters removed from the front page my much appreciated article that focuses on the essential problems in the current Cochrane leadership, which are harmful for the charity and therefore also for public health.
The fact that Cochrane headquarters has censored our website without our knowledge reinforces my concerns about the Cochrane leadership and its lack of democracy. It is a poor reflection on Cochrane and it is immensely damaging to its reputation, as reported in The Lancet.
Totalitarian actions like this only serve to humiliate and demoralise our staff members at the Nordic Cochrane Centre.
The current leadership of the Cochrane Collaboration does not honour the basic values upon which the Collaboration was built 25 years ago: collaboration, free scientific debates, transparency, openness and accountability. We also find it unacceptable that financial conflicts of interest related to commercial products that are being assessed in Cochrane systematic reviews are allowed.
There is widespread dissatisfaction among Cochrane centres with the current Cochrane leadership. Nine of the 12 oldest Cochrane centres have expressed such sentiments and the US Cochrane Center closed in the spring because its directors felt they could no longer co-operate with Cochrane’s CEO.
- 28 September C. Erroneous and mendacious statements by the Cochrane Governing Board.
Gøtzsche comments on Hawkes’ BMJ article “Cochrane board confirms dismissal of director at appeal“.
- 1 October A. Rthorat: Some thoughts on the Cochrane mess (about 5,000 words).
This is a brilliant analysis of the Cochrane moral downfall by an American. The modification of our website without our permission was a blatant violation of the collaboration agreement between the centre and Cochrane and sent a clear message: We have total authority and will do as we please.
The CEO brought a dictatorial mindset to Cochrane. Not being a scientist, he has no recognition that the work I do IS the brand. The ideal is someone who thoroughly vets the science being produced and is willing to challenge corruption at great personal risk.
That process failed, but leadership went ahead with the expulsion anyway, trampling all sorts of rules and agreements to get its way. And misleading Cochrane’s members about what it had done.
This new management had no moral authority, yet told the centres how best to build the brand they already built. While at the same time providing almost nothing back to the centres. I think the centres see the relationship as parasitic and one-sided.
A corporate power structure does not work for a scientific organization like Cochrane. For one thing, corporations operate more like dictatorships than democracies. Dissenting voices are squeezed out, not respected. A corporate structure is exactly what powerful interests like pharmaceutical companies want at Cochrane. Eventually you are left with subservient people who fill out the forms and publish the work without asking the difficult questions about the studies.
- 1 October B. Excerpts from Rthorat: Some thoughts on the Cochrane mess (about 2,100 words).
- 1 October C. Uddrag fra Rthorat: Nogle tanker om roderiet i Cochrane (ca. 2100 ord).
Dette er en brilliant analyse af Cochranes moralske forfald, skrevet af en amerikaner. Ændringen af vores hjemmeside uden vores tilladelse var en åbenlys krænkelse af samarbejdsaftalen mellem centret og Cochrane, som sendte en klar besked: Vi har total autoritet og gør, som det passer os.
Den administrerende direktør for Cochrane medbragte en diktatorisk tankegang til Cochrane. Idet han ikke er forsker, har han ingen erkendelse af, at det arbejde, jeg gør, ER ”brandet”. Idealet er en person, der grundigt dyrker den videnskab, der laves, og som er villig til at udfordre korruptionen under stor personlig risiko.
Proces faldt til jorden, men ledelsen fortsatte med bortvisningen alligevel, og trampede alle mulige regler og aftaler for fode for at få sin vilje. Og vildledte Cochranes medlemmer om, hvad de havde gjort.
Den nye ledelse havde ingen moralsk autoritet, men fortalte alligevel centrene, hvordan de bedst kunne opbygge det ”brand”, de allerede havde skabt. Samtidig giver ledelsen næsten ingenting tilbage til centrene. Jeg tror, at centrene ser forholdet som parasitært og ensidigt.
En ”corporate” magtstruktur dur ikke for en videnskabelig organisation som Cochrane. For det første opererer virksomheder mere som diktaturer end demokratier. Afvigende stemmer bliver presset ud, ikke respekteret. En virksomhedsstruktur er præcis det, stærke interesser som farmaceutiske virksomheder ønsker for Cochrane. Til sidst sidder man tilbage med ja-sigerne, der udfylder formularer og publicerer forskningen uden at stille besværlige spørgsmål om studierne.
On 4 October in the morning, 27 out of 31 Centre Directors in Spain and Latin America sent an important letter to Cochrane’s CEO and the Governing Board. As of 8 October, all 31 Directors have signed, which is the version shown in the above link. This letter called for an independent investigation of the process around my expulsion:
We have doubts that the process has been sufficiently appropriate and coherent with the principles of Cochrane … Any entity (e.g. a political party, a trade union, a religious organisation, the university) have well-established internal mechanisms that guarantee an objective analysis of the accusations and defences, as well as the right to appeal with the necessary guarantees to a neutral group or commission different from the one involved in the conflict. These mechanisms and the associated processes should be transparent and auditable … Expelling a member from an organisation can never become … a summary process that lacks the necessary transparency, and this is … how we and many other people in our organisation and outside of it have perceived the resolution of this conflict … We do not want Cochrane to become an organisation that passively accepts the decisions made by its leaders … without enough collective mechanisms for discussion, contrast and control … We propose the following 3 measures:
1 That the Governing Board calls immediate elections to renew the set of vacant positions in the Board, and thus give the opportunity to incorporate other perspectives and sensitivities to the government of the organisation, and particularly, to the management of this issue.
2 That the new Board appoints an ad-hoc commission, without the participation of any person who has been directly involved in the conflict, so that it independently reviews all the actions related to this conflict and establishes the possible responsibilities that will then be assumed consequently.
3 That the report of the mentioned commission is known and discussed by the different Cochrane members and entities, so that the conclusions derived from this discussion can be incorporated into the regulations and processes of the organisation: guarantees and rules to objectively assess possible faults and respect the presumption of innocence, the right to defence, the equality of opportunities, and the impartiality of those who qualify the alleged faults and apply proportional sanctions to the infractions, if any.
We would appreciate that you consider it and share with as many people as you feel appropriate.
It is noteworthy that this letter comes from Cochrane directors in Latin America. During the Annual General Meeting on 17 September, Jos Verbeek asked twice what my alleged bad behaviour was about but did not get a reply. Burton said that “We know bad behaviour when we see it.” In Latin America, they know a dictatorship when they see it.
Later, the same day, on 4 October, Cochrane’s CEO and Governing Board held three webinars for Cochrane members where they tried to explain why I had been expelled. The centre directors’ statement was not mentioned at all during the webinars. The leadership of Cochrane has stopped listening to other people.
- 9 October. Gøtzsche’s complaint to the Charity Commission about serious mismanagement of the Cochrane Collaboration.
I explain that the Cochrane Collaboration is experiencing a moral meltdown caused by poor leadership and ask the UK Charity Commission to intervene urgently, as the serious abuse and mismanagement over several years has harmed the charity’s services, beneficiaries and reputation. I also explain that, in a letter from 3 October, marked Addressee Only. Strictly Private & Confidential and NOT FOR PUBLICATION OR DISSEMINATION, the co-chairs admit, for the first and only time, that I have not broken the Spokesperson Policy, and that there is therefore no basis for the Board’s expulsion of me from the Board and from Cochrane.
The real reasons why Cochranes CEO, Mark Wilson, and his close ally, co-chair Martin Burton orchestrated my expulsion are that I challenged Cochrane’s business model, with its focus on “brand” and “our product,” with too little attention to getting the science right and keeping the drug industry at arm’s length. Clearly, my very visible advocacy in the fields of science, policy and medical ethics, exposing the unethical practices by the pharmaceutical industry, the harms and overuse of psychiatric drugs, the deadly effects of many drugs, the dangers of overdiagnosis caused by mammography screening, the concealment of clinical trial data, the gross inadequacy of drug regulation, and the harmful effects of patents on public health, among other issues, have many times caused great discomfort to Cochrane´s leadership.
I demonstrate in my complaint that virtually everything the CEO and the Board presented during a webinar on 4 October about the reasons for my expulsion was mendacious or seriously misleading.
The most important issues I summarise in my complaint are:
1) Serious acts of tampering with evidence to the detriment of the public we aim to serve.
2) Serious mismanagement in Cochrane, committed by its CEO and the co-chairs of the Governing Board.
3) Numerous violations of rules for charities and for Cochrane by the CEO and the co-chairs.
4) Lack of collaborative, democratic, transparent and accountable leadership in Cochrane.
5) Management by fear and bullying by the CEO.
6) An almost total lack of due processes in Cochrane, in stark contrast to other organisations.
7) Fierce resistance from Cochrane’s CEO towards introducing due processes.
8) Favouritism: other rules apply to CEO staff than to Cochrane collaborators.
9) Serious selection bias in the 400-page material sent by co-chair Martin Burton to Cochrane’s law firm, which favours his line manager, CEO Mark Wilson.
10) Serious conflicts of interest.
11) Repeated and serious violations of Cochrane’s core principles of openness, transparency, honesty and fairness by the CEO and the co-chairs.
12) Scientific censorship in Cochrane, although it is a scientific organisation whose whole justification is that the public can trust it, which is even part of Cochrane’s motto: “Trusted evidence.”
13) Repeated, very harmful actions by Cochrane’s CEO, which have favoured industry and guild interests.
14) A show trial against me, where none of the evidence in my favour that I, or Cochrane’s own hired Counsel provided, was taken into account; where I was denied the possibility to present crucial evidence that would have exonerated me; where the charges raised against me were changed on the spot when a report from Cochrane’s law firm had exonerated me; and where I was given five minutes to defend myself, after which the Board deliberated for five hours. The CEO’s and the Board’s total disregard for the evidence is particularly grave for Cochrane because this is an organisation that prides itself for basing its conclusions on “the best available evidence.”
15) Scientific misconduct.
It is not surprising that a growing number of people and organisations, both in- and outside the Collaboration, have come to the conclusion that the CEO and the Board should resign, and that if they are unwilling to do this, it is proof that they are not fit for office.
Appendices: Appendix 1, Appendix 2, Appendix 3, Appendix 4, Appendix 5, Appendix 6, Appendix 7, Appendix 8, Appendix 9, Appendix 10, Appendix 11, Appendix 12, Appendix 13, Appendix 14, Appendix 15, Appendix 16, Appendix 17, Appendix 18.
Gøtzsche’s 66-page report to Cochrane’s law firm from 30 August.
- 10 October A. Cochrane leadership in moral meltdown: miscarriage of justice and lies about the evidence in journal article.
Co-chair of the Cochrane Governing Board, Marguerite Koster, propagates mendacious or seriously misleading statements in an article in STAT and Retraction Watch.
David Hammerstein is one of the four Cochrane Governing Board members who resigned in protest after the unwarranted expulsion of me. Hammerstein is a former Member of the European Parliament for Spain and has headed large consumer organisations. He is currently Director for the Commons Network.
Here is a summary of Hammerstein’s brilliant analysis of the current crisis in the Cochrane Collaboration and his suggestions for a better future.
The crisis is about credibility. The focus on one individual´s behaviour is being used to avoid a serious debate on the future strategy and policies of the organization. What has moved the Cochrane leadership to take the exceptional decision to expel Peter Gøtzsche are his very visible actions in the fields of science, policy and medical ethics. The deliberate confusion of affiliation with representation has been used by the Cochrane leadership to attack and try to erode Gøtzsche’s prestige related to his scientific and policy positions.
The paradigm held by the CEO and a small majority of the Governing Board deems that the preservation of a unified “brand” and a more centralized and authoritarian “corporate image” is of the utmost importance for the financial growth and stability of the Cochrane central office. In this context the scientific, financial and policy independence of Cochrane centres outside of the UK could pose a threat to the consolidation of this common “brand”. The present executive team and Governing Board presidency are openly reticent of contact with most public health NGOs and against any visible Cochrane leaders taking clear public positions on transparency, open data, open science or medical innovation policies.
The other paradigm stresses support for much stronger policies to avoid biases and conflicts of interest in Cochrane reviews, and much greater visibility of Cochrane in policy debates. What is essential for this group is where the “evidence” comes from, who pays for it, and if all the clinical evidence is publicly available or not.
The big winner in this conflict has been the pharmaceutical industry, having succeeded in weakening the voice of one of its greatest critics and having consolidated a Cochrane leadership closer to industrial interests with fewer audible critical voices.
The Cochrane leadership has often shown disdain and impatience with any criticism of their work or proposals. What is especially grievous is that the Governing Board does not govern. It seems to be considered by the central executive team to be a mere rubber-stamp for their decisions. Only the two co-chairs of the Governing Board seem to have some fluid input into the decision-making process. They have never had a public word of discrepancy with anything presented to the Board by the CEO.
Another example of this top-down control obsession of the Cochrane leadership is the “webinar” organized last week to “explain” the current crisis sparked by the expulsion of Peter Gøtzsche. No convincing evidence was provided. All the microphones of the participants were muted. They were not allowed to speak, only to listen passively, and even their written questions sent to the CEO and the co-Chairs were “re-interpreted” and formulated in different terms.
The whole process against Gøtzsche has been anti-democratic and none of the basic tenets of due process, fairness and transparency have been upheld. There has been no attempt at seeking outside neutral arbitration nor the use of techniques of conflict resolution with the aim of reaching a friendly agreement. No time has been given to establish an independent committee of conflict made up of people from outside of Cochrane´s main institutions. Every step of democratic guarantees that is common in most large organizations has been ignored in this case with the objective of the rapid exclusion and tarnishing of Peter Gøtzsche. Any future independent investigation of this question should be centered on the violation of democratic processes by the CEO and the co-chairs of the Governing Board.
Peter Gøtzsche has had no chance to defend himself in person before the Board. He was expelled without even knowing what he was accused of, aside from the generic accusation of causing “disrepute” to Cochrane. The only accusation that had been made clearly, that he had violated the spokesperson policy, was not at all confirmed by the so-called “independent counsel” that found the spokesperson policy “ambiguous” and “open to different interpretations”. In fact, the so-called “independent counsel” did not reach any clear conclusions nor did it make any recommendations for disciplinary action against Gøtzsche despite this being requested from the Cochrane leadership. The ambiguous phrase used publicly by the Cochrane leadership that the open-ended counsel report – “did not exonerate”- falsely insinuated that Gøtzsche was found guilty of wrongdoing on the part of the Counsel, but that did not happen. It is disgraceful that the Cochrane leadership has used such personal defamation tactics without any proof nor transparency.
What is totally unacceptable and probably illegal is that dark and ominous insinuations have been made about Peter Gøtzsche, backed up with absolutely no evidence. Concerning his personal “behaviour”, the Cochrane leadership has publicly and privately used the language of the “me-too” movement and “zero-tolerance” of sexual harassment and abuse.
The exclusion of Peter Gøtzsche and the “suggested” resignation of another four members of the Board was a well-planned, pre-determined operation for the elimination of all the critical voices from the Governing Board. Shortly before the Governing Board vote that expelled Gøtzsche, one of the six members of the Board that voted in favour of the expulsion, stated that all the members of the Board were obliged to publicly defend the decision and not reveal the details of the close vote that was about to take place. What was also sought by the Cochrane leadership was a concealment of what had happened in the process, debate and vote.
At the Governing Board meeting a year ago, in September 2017, Peter Gøtzsche proposed a text, with the support of a number of other members of the Board, to substantially strengthen Cochrane´s conflict of interest policy which today allows up to half of the authors of reviews to have conflicts of interests with the company that makes the product they are evaluating. This proposal was met with considerable resistance and outright discomfort from the Cochrane leadership, one of the Governing Board leaders even said that “without conflicted reviewers we´ll find no-one to do our reviews”. Over the next year no progress was made on this conflict of interest proposal and a long, torturous bureaucratically procedure was suggested by the co-chairs with the intention of burying the whole issue.
It is no coincidence that Peter Gøtzsche’s expulsion took place when he had been insisting for over a year on a new, much stricter conflict of interest policy for Cochrane.
Over the past year, the CEO has insisted that they “are not ready” for taking public positions, that it is not a present priority and he expressed in a written reply the need to plan advocacy carefully based on the “products” (systematic reviews) Cochrane develops. When one top member of the Cochrane team was asked about Cochrane´s relationship with the major public health NGOs that often present proposals for access to medicines and new open innovation models before the World Health Organization, he/she said that these organizations held viewpoints “too radical” for Cochrane.
What is evident to any observer is that over the past few years Cochrane has not considered it important to influence public policy in areas extremely relevant and necessary for the production of “better evidence”. Apparently, there is a divergent viewpoint over what kind of public advocacy, if any, is based on the needs of its “products”.
As John Ioannidis has said ““evidence-based medicine” is misused and abused by eminence-based experts and conflicted stakeholders who want to support their views and their products, without caring much about the integrity, transparency, and unbiasedness of science. Some observers feel that many Cochrane reviews are being “misused and abused” in this very manner by the pharmaceutical industry. Especially criticized is the production of many Cochrane reviews based on journal articles without attention given to much of the clinical data which is often either hidden, censored or manipulated by the industry sponsors of the trials.
Tom Jefferson considers much of the raw material used in Cochrane systematic reviews as “garbage”. He suggests alternatives to focussing on unreliable journal articles.
It has become evident that the present Cochrane leadership has sometimes chosen to ignore overt industry manipulation of clinical evidence and has occasionally even fallen in the trap of serving as “an industry advertisement tool” with a shiny Cochrane stamp on it that lends this publicity “independent” credibility.
Peter Gøtzsche and others in Cochrane have defended the idea that evidence generated by companies with a vested financial interest in the marketing of the “reliability” of that evidence is a great problem for medical researchers and the carrying out of systematic reviews. Most of the Cochrane leadership thinks and acts otherwise in the way it treats the evidence usually used as the “raw material” for systematic reviews. If that is added to the fact of a weak conflict of interest policy that allows up to half of reviewers to have conflicts of interest, Cochrane has a growing credibility problem.
The people who have actively participated in this conflict, principally the CEO and the co-chairs of the Governing Board, are not credible organizers of a fair and transparent electoral process of new members of the Board and much less the establishing of the terms of reference and objectives of an investigative commission.
It is neither sensible nor appropriate that elections be held to only fill the vacant positions of the Governing Board, when the coherent and logical approach in these exceptional circumstances would be the complete renewal of the Governing Board.
An independent commission must be created specifically in charge of guaranteeing the election process. The members must enjoy maximum independence and must be elected by a joint meeting of the Council, the Governing Board and the centre directors. The electoral commission for the electoral process must assure a public and transparent census of the members of Cochrane. The legitimacy and validity of the voting process and candidacies must be established from the census of Cochrane members existing prior to the current crisis that started in June 2018. The electoral commission created must establish sufficient time periods and open forums of debate to provide for a democratic campaign and debate.
Any proposal to create a commission of inquiry that is appointed and oriented in its tasks by the current leadership of Cochrane, including the remaining Governing Board (6 out of 13) or the executive team, does not offer guarantees of impartiality. Moreover, this inquiry commission should integrate broader objectives beyond the reasons for Gøtzsche’s expulsion and also consider the organizational, democratic and strategic issues that are substantially involved in the current conflict.
Robert Whitaker is an American journalist and author who has won numerous awards as a journalist and book author covering medicine and science, in particular psychiatry. He is the publisher of www.madinamerica.com, which has 2 million visitors annually.
The reason for my confidence that Gøtzsche would survive the turmoil was that the Cochrane Collaboration had a reputation for publishing systematic reviews that challenged conventional wisdom and practices. That would, I thought, ultimately make it protective of Gøtzsche.
If you read Counsel’s report. it’s clear that the complaints about Gøtzsche’s “behavior” were very much tied to his vocal criticisms of psychiatry.
Gøtzsche’s ouster is a betrayal of the scientific enterprise, which is a collective social good. By failing to resolve this dispute in some other way, Cochrane failed in its mission to serve as a collaboration of scientists that would dare to challenge conventional medical wisdom.
The expulsion had nothing to do with Gøtzsche’s work as a scientist. Counsel praises Gøtzsche for the “rigour and quality of his academic work,” and as an “academic of very considerable eminence.” This is to say that his scientific work is of the very kind that burnishes the image of the Cochrane Collaboration as a first-rate scientific organization.
The most “recent issue” related to psychiatry was a complaint from psychiatrist E. Fuller Torrey. Gøtzsche had written to Torrey requesting information about deaths in a study, and Torrey responded by filing a formal complaint against Gøtzsche.
The complaint is revealing, for it highlights this dynamic within psychiatry: You can be a leading figure who makes public statements that are belied by science but consistent with psychiatry’s disease model ideology, and you will suffer no harm or consequences; yet psychiatrists and other medical professionals who publicly prick holes in that story do so at great professional risk.
Gøtzsche wrote: “We believe funders have an ethical obligation to ensure that information, which is of great importance for public health, and which has been collected in the funded study, gets published. That would be a great service to psychiatry, the patients, and everyone else with an interest in this vitally important issue. When young people who are receiving antipsychotics die, we need to know why they died in order to reduce the risk of death in the future.”
Torrey responded not by providing such information, which would be the expected thing to do if you were following the dictates of good science, but by making a “complaint” about Gøtzsche to Cochrane CEO Mark Wilson. He said that Gøtzsche had identified himself as the Director of the Nordic Cochrane Center and as the “Protector of the Hearing Voices Network in Denmark.” The fact that Gøtzsche had a relationship with a group that promoted such ideas, Torrey wrote, showed a “clear lack of objectivity” by Gøtzsche, and for that reason he “personally would not find any Cochrane publication on mental illness to be credible.”
Torrey’s letter was clearly unhinged, and hardly one that the CEO of the Cochrane Collaboration could be expected to treat as serious, but Wilson, in a letter to Torrey dated March 2, 2018, basically threw Gøtzsche under the bus.
This is the moment in this dispute that perhaps is the most embarrassing of all for the Cochrane Collaboration. A director of the Cochrane Center wants to find out more about the deaths in a long-term study of psychotic patients, and the CEO of the Collaboration, rather than finding that pursuit worthwhile, finds reason to think it might provide cause to expel the director from the collaboration, and all because he receives a letter from an American psychiatrist that, even if one viewed it charitably, could best be described as disrespectful toward a users’ group, ignorant of the science, and silly in its threat to now see all Cochrane reviews related to psychiatry as lacking “credibility.”
You would think that all members of the Cochrane Collaboration would be red-faced upon knowing of this exchange.
I am sure Gøtzsche will continue to speak his mind about psychiatric drugs, and will find a way to continue to research this topic. He is not going to disappear.
The future of the Cochrane Collaboration is not clear. Its reputation as an organization that fosters critical thinking is now stained, and that is the public’s loss. The medical literature—and this is particularly true of the literature in psychiatry—is already seen as corrupted and biased due to the influence of pharmaceutical money and guild interests, and now the public will have reason to question whether the work of the Cochrane Collaboration is similarly untrustworthy.
The public needs a collaboration that will provide a home for the “scientific” heretic, and this decision to oust Gøtzsche betrays that value. The Cochrane Collaboration needs to remember that it serves the public, and this decision to oust Gøtzsche fails to fulfil that obligation.
- 13 October. Statement of Cochrane Work Review Group Editorial Base on recent developments in Cochrane.
No attempt has been taken to try to solve this workplace conflict in other ways than by voting on whether to expel Gøtzsche. We strongly believe that if engaged at an early stage, mediation, instead of legal action, could have given a different course to this conflict and could have limited the damage.
It would have been wise if the remaining members would have stepped down. New elections would then have enabled a new start.
It seems that Gøtzsche’s views on the Cochrane HPV vaccine review did play a role in the conflict.
Peter Gøtzsche is the director of the Nordic Cochrane Centre which to our knowledge contributes substantially to the daily activities of the collaboration. As the NCC is an independent unit funded by the Danish government and not by Cochrane, the Cochrane Governing Board does not actually have jurisdiction to fire Prof Gøtzsche from his post as director, which they claim to have done. So, there is also an element of the absurd here.
- 15 October A. Gøtzsche’s comments on Governing Board letter to 31 centre directors from Spain and Latin America.
In its reply to the 31 centre directors from Spain and Latin America, which called for an independent investigation of the process that led to my expulsion from Cochrane, the Cochrane Governing Board writes:
”We believe it is not in the charity’s best interests to undertake another independent review.”
There never was an independent investigation, let alone any due and fair process. The Cochrane directors asked for justice, and the Board denies them this. Cochrane Centres and Cochrane members will need to decide whether this is an organisation to which they want to belong. The Board broke the rules for charities and for Cochrane numerous times in its show trial against me.
”The Trustees wanted the process to be as transparent as possible while respecting the privacy and confidentiality of all those involved.”
This is false. Cochrane did everything it could to keep the entire investigation ”confidential” and control the public message by issuing false and misleading statements. There was no transparency before I released Counsel’s report and other essential documents on my website. Confidentiality needs to be broken when serious injustice has occurred: ”If you are neutral in situations of injustice, you have chosen the side of the oppressor” (Desmond Tutu).
”We believe that Cochrane’s willingness to tackle problems of this nature are reflective of an organization that really ’lives up to its values’, makes it more attractive to individuals to join and stay, and to funders to support, rather than less so.”
It is tragic that the Board is out of touch with its members and with reality. Even in the face of international criticism about how it handled this latest scandal, the Board continues to congratulate itself with blind enthusiasm.
”This is especially true of the next generation of younger people whom Cochrane seeks to attract, and who are put off by out-dated and inappropriate patterns of behaviour that may have been tolerated 20 years ago in academia but no longer.”
Cochrane’s CEO, Mark Wilson, has introduced scientific censorship. The Board believes that this will attract young people. The opposite is true. Cochrane has demonstrated that any young person who wants to challenge vested interests and call out bad science, will not be supported by the organisation and might be reprimanded or expelled for not ’towing the party line’.
The Board and Cochrane’s CEO have disqualified themselves and harmed the Cochrane Collaboration to such a degree that the only honourable thing for them to do is to admit their injustice and other failures and resign, so that we can get the Cochrane Collaboration back to its core values.
A genuinely independent commission needs to be established to investigate what happened in relation to my expulsion. The CEO and the Board know perfectly well that they would not survive such an investigation, which is why they refuse to approve it. I very much hope the Charity Commission will grant my request to open a statutory inquiry. If not, Cochrane might disintegrate further and ultimately disappear.
In their reply from 12 October, the co-chairs of the Cochrane Governing Board, Marguerite Koster and Martin Burton, repeat many falsehoods they have propagated previously.
“Your letter contains a number of inaccuracies. It also draws conclusions on the basis of limited, biased evidence. Given your network’s position in promoting the teaching and practice of evidence-based medicine we hope that, moving forward, you will consider the entire body of evidence pertaining to this matter.”
There are no inaccuracies in the network’s letter, which highlights the significant lack of transparency in the process. It also points out the ambiguity of my alleged “bad behaviour” and the difficulty in understanding the Board’s “reason to expel one of the most respected scientists and Cochrane founders”. This esteemed group of scientists is deeply concerned about the democratic basis for this decision, it strongly recommends a ‘rethink’ of the decision and asks the Board to transparently unveil all arguments which have guided the Board’s decision.
It is the Board that has deliberately disseminated incomplete and biased information. I have tried to correct the misinformation by publishing the documents on my website, and the German EBM network therefore had access to unbiased information.
“Many of his behaviours were beyond explanation by academic or cultural differences.”
It seems that Cochrane has introduced a kind of thought and behaviour police, as we know it from certain dictatorship states. George Orwell’s 1984 comes to mind here. Whatever one might think of my behaviour, the behaviour displayed by Cochrane’s CEO and the two co-chairs of the Board is much, much worse.
“It appears that you condone the behaviour of Professor Peter Gøtzsche. We respectfully suggest that the behaviours he demonstrated both before 13th September 2018, when our Board first considered them, and especially subsequently (he has continued to disseminate shockingly defamatory materials) are not behaviours that would be found acceptable to the Universitåtsklinikum Hamburg-Eppendorf, Universität Witten, Universitåt Hamburg, Martin Luther University, or other esteemed institutions. We should like to understand why then would they be acceptable to the EBM Netzwerk?”
My so-called behaviours have always been accepted at the University of Copenhagen and at Rigshospitalet where I work. In contrast to Cochrane, these institutions appreciate scientific criticism and do not accept scientific censorship.
“We are disappointed if your organization, and those who fund you, believe that high esteem is more important than respectful, collaborative behaviour that clearly serves the best interests of Cochrane.”
This comment is interesting, as there has been absolutely no “respectful, collaborative behaviour that clearly serves the best interests of Cochrane” on the part of Cochrane’s CEO, the two Board co-chairs and the remaining four members of the Board.
- 24 October. Rthorat: Authoritarianism at Cochrane
Brilliant analysis. Some extracts:
The Cochrane Governing Board has not said a lot about their expulsion of Peter Gøtzsche. Perhaps because when they do speak, they tend to make things worse. The Board appears to have no sense of irony. They must challenge decisions and make sure decisions are not being driven by one person. That is precisely what has happened.
The directive to “comply” with decisions does not mean you have to publicly defend decisions, as the Board has implied or stated. Much like a legislator who votes against a law must comply with the law when it passes, but is still free to criticize the law and the process that led to its passage.
It is not correct to say that board members do not represent the interests of those who voted for them. Members act in the interests of the charity as a whole by representing the interests and philosophy of their constituents.
A charity with Cochrane’s history and structure should probably not have any unelected board members. You can see the end result of appointed members right now. Concentration of power in the central executive staff.
Trustees must … Not much to say about these statements, other than the current Board does not follow them.
Authoritarian systems silence dissenting voices because they fear if dissenting voices are heard, people will lose confidence in the decisions of the authority. They seek to control information because information is power. By withholding information about the decision making process, they minimize questions about their decision. The only information people receive is that which the authority wants them to receive.
The Board has sought to control information on the Gøtzsche expulsion since the beginning. The Board has further used the concept of privacy to maintain control over information. That is an increasingly common trick when democratic leaders do not want to be transparent.
Even sillier, the Board has then used Gøtzsche’s transparency on his own website as some further vague evidence against him. The legal principle here is simple: When you are the subject of a public smear campaign, you are entitled to release information to defend yourself.
That this information has been made public is entirely the fault of the Cochrane Board. Their expulsion directly led to the exposure of this information. When Gøtzsche was expelled, he no longer owed a duty to maintain privacy in these matters, particularly when his rights are so adversely affected. Note that before he was expelled Gøtzsche did keep these matters private.
The Board went even further and urged the minority members to resign. When a Board member resigns in protest, it indicates a potentially serious issue with governance. When four resign in protest, it indicates the governance process is fundamentally broken.
This suggestion to resign resembles the way communist parties operate. When one faction gains control of the party, competing factions are asked to resign or forced out of the party. Do we want a scientific organization like Cochrane operating in the same manner as communist leaders?
The Board’s authoritarian disposition and their push for more power to be centralized at Cochrane should scare every member, particularly the collaborating centers, who the Board clearly no longer sees as collaborators, but as subordinates.
The Board have removed a dissenting voice in an absurd process and used that process to purge the Board of all other dissenting votes. They have told members and centers concerned over their actions to stuff a sock in it and get over it.
Clearly, there will be no backing down or admission of error by this Board. Members and centers must take drastic action to force the Board and executive staff to resign. The time for half measures is over. This Board will not approve any investigation into its actions. Authoritarians never do.
Open letter to Cochrane’s CEO Mark Wilson:
“We have received a response by Marguerite Koster and Martin Burton to our letter, but this response does not answer our questions at all. We are still or even more disappointed because the response does not contain any facts, but keeps repeating the nebulous intimations regarding Peter Gøtzsche’s “behaviour” without presenting any evidence.
This does not go along well with the quite impertinent incrimination of the German Network of Evidence-based Medicine and us as Board members in this response. Ms. Koster and Mr. Burton accuse us of being inaccurate and drawing conclusions on the basis of limited, biased evidence. From our point of view, it is quite evident that the governing board is not presenting any evidence for its accusations but keeps reiterating intransparent and incomprehensible statements which endanger the trustworthiness of Cochrane and damage the reputation of the organisation. Once more, the spirit of Cochrane and its excellent standing require open communication and disclosure of the reasons why Peter Gøtzsche has been expelled from the Cochrane Governing Board, and furthermore why the other board members have not yet resigned to open up the opportunity for new elections and strengthen the democratic basis of Cochrane.
We completely miss the spirit of Cochrane in the handling of this affair. We fear that Cochrane’s reputation is at risk of severe damage, not only among the German scientific community but on an international level.”
The world’s most cited medical researcher, Professor John Ioannidis from Stanford, has provided a brilliant analysis of what is wrong with the current leadership of the Cochrane Collaboration; why it was wrong that it expelled Peter C Gøtzsche; and why it is wrong that his hospital now plans to fire him. Emails Gøtzsche’s lawyer has obtained via the Freedom of Information Act show that Cochrane’s CEO Mark Wilson has required Gøtzsche’s dismissal, although he has no authority to intervene in this way in another country’s internal affairs.
Extracts from Ioannidis’ article (read the full article here):
Some 9,000 people signed a petition complaining fiercely against the decision and many (including myself) have written their own additional letters to the minister to support PG. The full details of what drove these events unfortunately remain opaque. Secrecy is perhaps the most damaging part of this sad story.
Despite the statement of the Cochrane Governing Board that what has happened is not about freedom of speech, scientific debate, tolerance, dissent, or criticism, it is precisely these issues that unavoidably surface in this clash.
Anyone can and will unavoidably wonder: under its recent CEO leadership, is Cochrane silencing scientists? Is it being subverted by commercialization? Is it paralyzed? Has it been hijacked?
Expelling an elected member of the Board who expresses a different viewpoint with some vague excuse that cannot even be disclosed does not befit a scientific organization.
The dismissal of PG from his main job seems even more traumatic to freedom of thought and human dignity. It enforces the message that if one is not aligned with some majority (or what some people claim is a majority), one can be fired.
It is inappropriate to silence opponents with administrative machinations. Conversely, it is essential in science to respect and to offer to opponents a maximal opportunity to defend their positions. Criticism from PG and other critics should be welcome even when their attack is targeting our own work. When PG wrote to me that he will attack one of my own meta-analyses, I wrote back to him to thank him and to urge him to do it with all his force, data and evidence. Science needs freedom of thought, freedom of criticism, and tolerance of contrarian evidence.
This brouhaha exposes a crisis at the core of the Cochrane leadership and its core values. It is worrisome that neither the remaining Board members nor the Cochrane CEO have a particularly strong track record in what Cochrane became famous for: evidence-based medicine and high-quality, independent systematic reviews. None of them have published as key authors any pivotal, highly influential paper on systematic reviews and evidence-based medicine methods. Several of
them seem to have major academic, directorship or policy power, e.g. being involved in shaping recommendations and guidelines in their countries or in huge organizations like Kaiser Permanente. However, this means very little. Despite valiant efforts to make them more evidence-based, guidelines, recommendations, and exercise of policy power unfortunately remain among the least evidence-based activities, impregnable strongholds of expert-based insolence and eminence-based innumeracy.
Focusing on the big picture, Cochrane needs to keep itself more than just an arm’s length both from uninspiring bureaucracy and from the industry.
Now this collaboration apparently seems to get hijacked primarily by marginal bureaucracy without vision, not necessarily by conflicts. Nevertheless, there is a threat that, so weakened, it will then also be easily hijacked at scale by financial or other conflicts, e.g. if conflict of interest policies become inappropriately relaxed for systematic review authors and reviewers. These policies need to be reinforced, not weakened.
Cochrane is a charity and it started as a collaboration. Even though the name Cochrane Collaboration remains the official name, it is perhaps ominous that, once a CEO was hired, its name in usage has become plain Cochrane.
Expulsion of dissenters, intolerance, secrecy, and emphasis on resolution of debates with administrative intrigue and vague, unsupported proclamations rather than by data creates serious damage. Repeated use of strong language and using words written in bold letters cannot replace disclosure of facts and evidence.
The Cochrane leadership, including its CEO and the remaining Board members need to assume responsibility for this fracas and be proactive in correcting the damage. This has become indeed a matter of integrity, accountability, and leadership: at this point, it is primarily their own integrity, accountability, and leadership that is at stake. The position that the alleged bad behavior needs to
remain undisclosed has become entirely untenable, given this evolution. Without sufficient documentation and open explanation of their unusual and suspect actions, the behaviour of the remnants of Cochrane leadership cannot be easily differentiated from a combination of slander, administrative incompetence, and character assassination. If they have solid evidence against PG, they should be transparent about declaring it. Moreover, even if it is proven that they have acted with the utmost of responsibility, at a minimum they should safeguard their integrity, accountability, and leadership by resigning, as soon as the 5 replacements of the Cochrane Board have been voted in.
I trust that everyone would then applaud their selflessness. This may allow Cochrane to have a fresh start in defending its ideals that have led to such great accomplishments.
Original in Danish: Min fyring er et videnskabeligt justitsmord. Kronik i Politiken 11. december 2018.
The Cochrane Collaboration’s CEO, Mark Wilson in London, is behind the planned dismissal of me.
Through the Freedom of Information Act, my lawyer recently found out that the Danish Ministry of Health and Rigshospitalet, which hosts the Nordic Cochrane Centre, have worked closely together with Wilson.
I have not been heard, although it is well documented that Wilson does not always provide a complete and correct picture, which I had warned Rigshospitalet about, and provided examples of in my hearing letter to the hospital.
Wilson has required that I shall no longer be allowed to work at the Nordic Cochrane Centre, and the Ministry and Rigshospitalet have pleased him, although, according to Cochrane rules, I can continue working as head of department or as chief physician. It is outrageous that a person in this way interferes with internal affairs in another country, on top of this contrary to the rules.
I believe my impending firing is about silencing an important voice in the debate, just like my expulsion from the Cochrane Collaboration on September 13th. Cochrane’s leadership was very annoyed that I had published a well-founded criticism of the Cochrane review of the HPV vaccines, and I was told that it is bad behaviour to criticize colleagues’ science when you are a Governing Board member or a Cochrane Director. Obviously, this is scientific censorship.
It led to massive resentment, with several articles in, for example, Science, Nature, BMJ and Lancet, that I was expelled from the Cochrane Collaboration after a process where new accusations were invented on the spot after Cochrane’s own lawyer’s investigation had exonerated me from all charges. I believe I have unequivocal evidence that the process is invalid. The next day, four members resigned from the board in protest.
The case is not about my person, but about important principles that the leadership of Cochrane trampled underfoot. Cochrane’s credibility plummeted because I am known for high quality research, integrity and incorruptibility.
More than 8000 signatures have been sent to the minister with a request to overturn my sacking, with such prominent names as Cochrane co-founder, Sir Iain Chalmers, BMJ’s editor-in-chief, Fiona Godlee, Member of the European Parliament Margrete Auken who has done a lot to make data available to researchers, psychiatrist David Healy, highly respected as one of the world’s leading experts on psychiatric drugs, and the world’s most cited health researcher, John Ioannidis from Stanford University.
Some of these people have also sent personal letters to the minister.
It seems that the Ministry and the hospital have used all means at their disposal needed to accommodate Wilson’s unusual requirement that I must be fired, even though 50 employees suffered as a result, fearing for their jobs for a period of more than two months.
This is a huge scandal, and Wilson’s actions will sully Cochrane’s reputation even more than the Governing Board has already accomplished. Everyone will lose on this.
To be updated.
The International Institute for Psychiatric Drug Withdrawal (www.iipdw.com)
The institute, located in Göteborg, was registered as a charity on 1 Sept 2017.
The International Institute for Psychiatric Drug Withdrawal (IIPDW) was created to respond to a glaring need in mental health: to develop ways for helping people withdraw from psychiatric drugs.
Mental health has failed to provide support to people who want to reduce or withdraw from their psychiatric drugs. Often, people are simply told it is a bad idea, and thus are left to try to reduce or withdraw without the support they need.
Indeed, although psychiatric drugs have been prescribed for over 100 years, there is little research that has been conducted on how to withdraw from these drugs. Most of the withdrawal studies that have been conducted have involved abrupt drug withdrawal, and even in studies where the drugs were more gradually withdrawn, there was no effort to identify the needed supports.
The mission of our institute is to bring together practice-based knowledge and research data to fill in this gap. Our goal is to gather such knowledge and disseminate it to patients, family members, professional helpers, professional organizations, and throughout society.
The documentary, “Diagnosing Psychiatry,” sheds light on the scientific career and efforts of Professor Peter C. Gøtzsche in changing the field of psychiatry. It portrays the uphill battle Peter experiences when he, supported by the patients, advocates for a more humane psychiatric practice, with very little use of psychiatric drugs, no forced treatment, and a main focus on psychotherapy.
The film is produced and directed by Anahi Testa Pedersen, an independent filmmaker, who has been working on the project for over four years. It focuses not only on Peter’s work but also on Pedersen’s own reflections and experiences as a mental health patient.
The Happy Pill
Silje Marie Strandberg was seriously mentally ill. She had a heavy schizoaffective and dissociative disorder diagnose. She heard voices, hallucinated, cut herself, had an eating disorder and repeatedly tried to kill herself. She was so sick that no one thought she could ever recover. But after 10 years in mental wards, 10 years of compulsion, isolation, electrolysis and heavy medication, she finally recovered and is now completely healthy.
The difference was her psychiatric nurse, Lone. Lone went further in terms of proximity and self-interest. It’s almost like a miracle. This story is unique. A story of hope. But it’s also the story of a young girl with little self-confidence that lost 10 years of her life. Where did it go wrong? Did she have to go through 10 years of torture in mental wards? These are the answers Silje Marie is looking for in this documentary.