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, as no one has ever in earnest been in any doubt that what Gøtzsche says or writes is his own opinion and not an official statement on behalf of the whole Cochrane Collaboration.Wilson writes policies, interprets them and judges if they have been broken; three functions we have otherwise sharply separated in civilized societies to prevent injustice. In Cochrane, some people are more equal than others: Wilson exonerated his own member of staff when he did the same as Wilson has punished me for doing (see my statement from 17 September below, about the HPV vaccines). In a letter from 3 October, the co-chairs exonerated me from having broken the Spokesperson Policy: “you had broken the spirit of the Spokesperson Policy if not the letter.” Has Cochrane become a religion? Will we see an Orwellian Cochrane thought police soon with CEO Mark Wilson as supreme judge? I mention this in my statement from 10 October (see below).Gøtzsche has documented that the Board’s statements about the reasons for his expulsion were mendacious and seriously misleading. See, in particular, his statements from 17 September (Gøtzsche was seriously defamed by Burton at the Annual General Meeting on this date), 26 September and 3 October below.
- 30 August. Peter C. Gøtzsche: My submission to Counsel – Cochrane’s hired law firm – where 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.
- 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.
- 14 September. Peter C. Gøtzsche: A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane.
- 16 September. Researcher Maryanne Demasi: Cochrane – A sinking ship?
- 17 September. Peter C. Gøtzsche: Comments on: Statement from the Cochrane Governing Board about alleged bad behaviour of “one individual”.
- 17 September. Peter C. Gøtzsche: The controversy related to the Cochrane review of the HPV vaccines.
- 17 September. Psychiatrist David Healy: Cochrane Cock-up.
- 20 September. 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.
- 26 September. Peter C. Gøtzsche: Comments on Statement from Cochrane’s Governing Board about why my appeal was rejected.
- 28 September. Peter C. Gøtzsche: Changes made to the website of the Nordic Cochrane Centre without our knowledge.
- 1 October. Rthorat: Some thoughts on the Cochrane mess.
- 9 October. Peter C. Gøtzsche: My complaint to the Charity Commission for England and Wales about serious mismanagement in the charity.
- 10 October. Resigned Board member David Hammerstein: Regenerate Cochrane to strengthen the production of trusted evidence for the common good of public health.
- 10 October. Peter C. Gøtzsche: Cochrane leadership in moral meltdown: miscarriage of justice and lies about the evidence in journal article.
- 12 October. Peter C. Gøtzsche: The Board’s rejection of the proposal made by all 31 Centre Directors from Spain and Latin America for an independent investigation of the process that led to my expulsion.
- 18 September 2015. Extract from “Statement by Cochrane” on the Cochrane website: “In his article ‘Prescription pills are Britain’s third biggest killer’ (MailOnline, 15 September 2015) Professor Peter Gøtzsche writes that: ‘As an investigator for the independent Cochrane Collaboration – an international body that assesses medical research – my role is to look forensically at the evidence for treatments’ and goes on to make a series of statements about the effects of psychiatric drugs and their use by doctors in the UK. These comments could be misconstrued as indicating that Professor Gøtzsche is conducting this work on behalf of Cochrane. Cochrane wishes to state unequivocally that the views Professor Gøtzsche has expressed on the benefits and harms of psychiatric drugs are not those of the organization.”
All documents below are from 2018.
- 16 February. Gøtzsche’s letter to a US funder asking for missing numbers of deaths and causes of death in a study of patients with schizophrenia.
- February. Announcement of a seminar about withdrawal of psychiatric drugs for psychiatrists in the Journal of the Danish Medical Association.
- 8 March. Tweet related to a seminar Gøtzsche held about withdrawal of psychiatric drugs for psychiatrists.
- 15 March. Wilson opines that Gøtzsche broke the Cochrane Spokesperson Policy in relation to a letter he wrote to a US funder asking for missing numbers of deaths and causes of death in a study of patients with schizophrenia. Wilson also refers to a tweet related to a seminar Gøtzsche held about withdrawal of psychiatric drugs for psychiatrists
- 18 March. Gøtzsche’s suggested replies to the US psychiatrist and to the tweet.
- 19 March. The second complaint, 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 a second complaint related to a Dutch homicide trial where Gøtzsche was an expert witness. 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 in his email from 11 April about two complaints and a tweet.
- 18 April B. Gøtzsche’s comments on Wilson’s draft response to US psychiatrist from 11 April.
- 18 April C. Gøtzsche’s comments on Wilson’s draft response to tweet from 11 April.
- 26 April. Gøtzsche’s reply to Board co-chairs’ proposal from 20 April about engaging an appropriately qualified, independent individual, from outside the Charity, to undertake a review and to prepare a confidential report for the Board. Gøtzsche rejects this plan because the plan is not impartial and asks the Board to adhere to the established procedure for disagreement between the CEO and a centre director, instead of inventing a new one.
- 13 June. Minutes from Board teleconference about getting a legal review of the issues.
- 23 July. Letter from Cochrane’s Lawyer, with minutes from Board teleconference about getting a legal review of the issues, but this time without the names of those who voted yes or no to instituting the review.
- 12 September A. Co-chair of the Governing Board, Martin Burton, wrote to the Board:
“You will shortly be receiving (or will have received) a copy of Counsel’s report. Marguerite [Koster, the other co-chair] and I want to emphasise the fact (stated therein) that this is confidential to the Board and Mark [Wilson]. 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.”
My comment: Cochrane prides itself for being an open, transparent and accountable charity. Secret processes should not occur in Cochrane, and the fact that Burton raises this issue, shows how deep the Cochrane leadership has sunk in a moral sense.
- 12 September B. Counsel’s report, which exonerates Gøtzsche from all charges.
It is hardly a coincidence that Cochrane wants to keep Counsels report from 12 September out of public view. I have decided to make it accessible, as the public interest in this report must override any attempts at keeping it secret by people who have exposed me to a witch-hunt over four years and a show trial now.
- 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 regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board. No clear reasoned justification has been given for my expulsion.
Transparency, open debate, criticism and expanded participation are tools that guarantee the reduction of uncertainty of reviews and improve the public perception of the democratic scientific process. These are conditions and tools that cannot be eliminated, as has happened recently, without placing into serious doubt the rigorous scientific undertaking of Cochrane and eroding public confidence in Cochrane´s work. My expulsion should be seen in this context.
There has also been a serious democratic deficit. The role of the Governing Board has been radically diminished under the intense guidance of the current central executive team and the Board has increasingly become a testimonial body that rubber-stamps highly finalized proposals with practically no ongoing in-put and exchange of views to formulate new policies. On dozens of issues the Board can only vote yes or no with very little opportunity to amend or modify the executive team´s proposals.
This 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. Many of the directors or other key staff of the oldest Cochrane centres in the world have conveyed their dissatisfaction with the senior central staff’s interactions with them. While the declared aims of interactions with the central office is to improve the quality of our work, the heavy-handed approach of some of the central staff has sometimes created a negative environment for new scientific initiatives, open collaboration and academic freedom. There has also been criticism in Cochrane concerning the over-promotion of favourable reviews and conflicts of interest and the biased nature of some scientific expert commentary used by the knowledge translation department of Cochrane.
There has also been great resistance and stalling on the part of the central executive team to improving Cochrane´s conflict of interest policy. A year ago, I proposed that there should be no authors of Cochrane reviews to have financial conflicts of interests with companies related to the products considered in the reviews. This proposal was supported by other members of the Board, but the proposal has not progressed at all.
Often it is forgotten that we are a scientific, grass-roots organisation whose survival depends entirely on unpaid contributions from tens of thousands of volunteers and substantial governmental support throughout the world.
Our work informs government legislation globally, it influences medical guidelines and drug approval agencies. Therefore, the integrity of the Cochrane Collaboration is paramount. We pride ourselves on being global providers of “trusted evidence” on a foundation of values such as openness, transparency and collaboration.
However, in recent years Cochrane has significantly shifted more to a business – a profit-driven approach. Even though it is a not-for-profit charity, our “brand” and “product” strategies are taking priority over getting out independent, ethical and socially responsible scientific results. Despite our clear policies to the contrary, my centre, and others, have been confronted with attempts at scientific censorship, rather than the promotion of pluralistic, open scientific debate about the merits of concrete Cochrane reviews of the benefits and harms of health care interventions.
Because of this moral governance crisis of the Cochrane Collaboration, I decided to run for a seat on the Governing Board and was elected in early 2017, with the most votes of all 11 candidates. It was considered an achievement, especially since I was the only one who had questioned aspects of our leadership. Regrettably today, I have been expelled because of my “behaviour”, while the hidden agenda of my expulsion is a clear strategy for a Cochrane that moves it further and further away from its original objectives and principles. This is not a personal question. It is a highly political, scientific and moral issue about the future of Cochrane. As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry. Because of this Cochrane has faced pressure, criticism and complaints. My expulsion is one of the results of these campaigns.
What is at stake is the ability of producing credible and trustworthy medical evidence that our society values and needs.
- 14 September B. Nigel Hawkes: Cochrane HPV vaccine review: BMJ journal defends “inconvenient criticisms”. BMJ 2018;362:k3927.
Extract from rapid responses to Hawkes’ article:
JK Anand: the credibility of Cochrane Collaboration is in tatters AND Prof Goetzsche will not be treated with the respect he has earned already, IF he rejoins the “team”. The whole team should be wound up. A new one should be created, without those who were party to Prof Goetzsche’s departure.
Thank you, BMJ Group, for not taking criticism lying down. And, thank you, Prof Goetzsche and your five colleagues, for showing that intellectual honesty is still alive.
Michael Baum: Cochrane – A sinking ship … I have always admired the work of the Cochrane collaboration and have very high regard for Peter Gotzsche, 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 against the received wisdom of an ideocracy. The behaviour of the Cochrane bureaucracy suggests a hidden agenda for firing Professor Gotzsche on the pretext that he was bringing the organisation into “disrepute”.
The opposite is the truth; I believe that Peter is a luminary of the Cochrane collaboration and adds to the credibility of the organisation. I have spent most of my mature years in promoting and leading multi-centre and multi-National randomised trials (RCTs) concerning breast cancer. We are proud that our publications and data bases are included into Cochrane reports that provide the overviews necessary for the practice of EBM. There are many like me with interests that include other cancers, cardiovascular disease, HIV/AIDS, etc. who feel the same. Without RCTs of clinical interventions there would be no Cochrane and without Professor Gotzsche 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. Whether you believe silenced or expelled voices to be right or wrong, it is not science.
Cochrane’s action in expelling Peter Gotzsche is an ugly stain on Cochrane that will remain for many years to come. It reduces my trust, and I suspect that of many others, in the analyses it issues.
Worse yet, this attack on Gotzsche is but one of a number of attacks that are percolating right now against a range of doctors and journalists who have dared to raise “inconvenient criticisms” of widespread overtesting and overtreatment. More will come on this.
Shame on Cochrane.
- 15 September. Letter from the four Board members who resigned in protest over Gøtzsche’s expulsion.
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 Gotzsche 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?
Click here to read an extract
A scandal has erupted within the Cochrane Collaboration, the world’s most prestigious scientific organisation devoted to independent reviews of health care interventions. One of its highest profile board members has been sacked, resulting in four other board members staging a mass exodus. They are protesting, what they describe as, the organisation’s shift towards a commercial business model approach, away from its true roots of independent, scientific analysis and open public debate. There are concerns that Cochrane has become preoccupied with “brand promotion” and “commercial interests”, placing less importance on transparency and delivering “trusted evidence”.
The Board of Trustees agreed to engage the services of an external law firm to independently assess the dispute between Gøtzsche and Wilson. In July 2018, Gøtzsche was presented with 400 pages of documents, containing allegations that he had breached Cochrane policies and damaged its reputation. Gøtzsche retaliated by submitting a 66-page dossier outlining, in painstaking detail, allegations that Wilson’s leadership team was ‘destroying’ Cochrane by treating it like it was a “brand or product”, accusing Wilson of “serious abuse and mismanagement of Cochrane”, “tampering with meeting minutes” and “management by fear”. The lawyers poured over the mountain of documents and were expected to deliver a verdict in time for the 13 Sept Governing Board meeting. Twelve hours before the meeting started, the Counsel’s report was delivered to the Board with a caveat that inadequate time was granted for a thorough review of all the issues. Nonetheless, the report found that none of the serious allegations against the Cochrane executive could be substantiated, nor did it find that Gøtzsche had breached the Spokesperson Policy or had acted inappropriately in his role as Trustee.
The Board Meeting.
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. Gøtzsche was given no further opportunity that day to defend himself. After more than 6 hours of deliberation, the remaining 12 Board members voted on whether Gøtzsche could remain as their 13th Governing Board member and continue to practice under the Cochrane license. Five voted to remain, six voted to remove and one abstained. In the end, a ‘minority’ vote [6 out of 13] saw Gøtzsche vacated from his position and lose his Cochrane membership.
After 25 years of service to Cochrane and author of 17 Cochrane reviews, Gøtzsche would officially learn of his fate by an email. “No clear reasoned justification has been given for my expulsion aside from accusing me of causing ‘disrepute’ for the organization”, claims Gøtzsche. “This is the first time in 25 years that a member has been excluded from membership of Cochrane”. Several board members were shocked over the treatment of Gøtzsche. “The legal assessment essentially exonerated Peter of breaching the Spokesperson Policy so his enemies spent the day inventing new excuses to get rid of him”, said one member.
“To expel Peter is totally disproportionate,” said another of Gøtzsche’s supporters. “It was like looking for any behavioural pretext to fire him.” The following day, 14 Sept 2018, four members resigned from the Governing Board in solidarity for Gøtzsche and because they felt something drastic had to happen in order to save the organisation.”
“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”.
Furthermore, Gøtzsche says that Cochrane’s policy regarding the conflicts of interest of the authors of reviews is inadequate. “I proposed a year ago that there should be no authors of Cochrane reviews that have financial conflicts of interests with companies related to the products considered in the reviews,” says Gøtzsche “But Cochrane did nothing about it”.
Currently, Cochrane allows up to half of the authors on a review to have conflicts of interest, a policy that is widely criticized by insiders, and largely unknown to the public.
So why hasn’t Cochrane done anything about it? “Cochrane has become too sensitive to criticism of the pharmaceutical industry”, says one board member. Insiders say a ‘possible concern’ might be that Cochrane fears that Gøtzsche’s criticism of the HPV vaccines review would negatively impact its sponsorship from the Bill & Melinda Gates Foundation.
Cochrane has been accused of ‘scientific censorship’ and is now in ‘damage control’ to contain the PR nightmare. Publicly, Cochrane has always maintained it encourages debate about scientific issues, including controversial ones. “Cochrane values constructive criticism of its work and publicly recognises this through the Bill Silverman Prize … with a view to helping to improve its work, and thus achieve its aim of helping people make well-informed decisions about health care”, states Cochrane.
However, the reality is very different. “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”.
“Science needs to be challenged, it should not be politically correct, it is not consensus seeking,” says Gøtzsche. “You cannot call a public challenge to science ‘controversial’, it’s a pejorative term. It’s simply what our job as scientists requires of us”.
The statement is apparently authored by the Cochrane Governing Board, but as I am one of the 7 Board members and had never heard about the statement before Burton read it aloud, the authorship is false.
The statement is about “the behaviour of one individual.” It is clear, from a flurry of articles in the last few days about the moral downfall of Cochrane caused by its current leadership, e.g. in BMJ Evidence-Based Medicine, Science, Nature, and BMJ, that this individual is me.
At a meeting on 13 September, the Board expelled me from the Board for no legitimate reason, as far as I can see, in a process that can best be described as a show trial where the verdict was prefabricated and the process was flawed. I am still a member of the Governing Board because I can appeal the Board’s decision till 20 September.
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. In Cochrane, we are proud that we base our decisions on the best available evidence, but this was neither the case at the Board meeting on 13 September, nor in the statement, which misrepresents the evidence. I shall explain this now, quoting from the “Statement from the Cochrane Governing Board.”
(I have informed the Board, the Editor in Chief and Cochrane’s CEO several times that so-called guest (or honorary) authorship is scientific misconduct. No one has replied. I also asked: Who wrote the first draft of this statement? Who subsequently read it and approved it? Are there other people than me who are false authors of the statement? Further, I requested that the Board should immediately append its statement with an apology, explaining what happened, who wrote the draft, and which persons are authors of the statement, and I encouraged the Board to consider apologizing for the many untrue statements it made about “an individual”, me, and about the four members who resigned. None of this happened.)
- 17 September B. Statement from the Cochrane Governing Board.
See my comments on this statement just above. The Cochrane statement is strongly defamatory for me and also strongly misleading. It was 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:
“Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign and have actively disseminated an incomplete and misleading account of events.”
After several people had protested that there is nothing misleading in the letter from the four resigned Board members, the statement was changed on 19 September into:
“Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign. At the same time, others contributed to a public and media campaign of misinformation.”
It is now no longer possible for anyone to see the original, misleading statement, and the Board only writes: “Edited (without prejudice),” which is not informative, and there was no apology. The arrogance in the Cochrane leadership is unbelievable.
- 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.
Extract from rapid responses to Hawkes’ article:
Shyan Goh: Archibald Leman Cochrane … I doubt he would have expected that the organisation bearing his name (founded in 1993 after his death) would reach all corners of the medical world with prestige, respect and reverence. Similarly I do not think that he would also have expected, within a single generation, the massive catastrophic breakdown of trust and transparency within the same organisation in circumstances likened by some to be a “civil war” … 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 to persist in its state. Have egos and vested personal/commercial interests corrupted the ethos of the organisation?
Dick Bijl: We believe Cochrane is a key source of scientific evidence on diagnostic and therapeutic medical issues. The very recent expulsion of Peter Gøtzsche from the Cochrane Board and subsequent retirement of four Board members have great impact on the existence of this organisation … 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. It is well known that researchers with conflicts of interest judge more positively about drug therapies than researchers without such ties.
Gøtzsche said that Cochrane’s policy regarding conflicts of interest of authors of reviews was inadequate. But Cochrane did not solve this problem. The International Society of Drug Bulletins (ISDB) has criticized this policy already in 2013. The International Society of Drug Bulletins (ISDB) is a worldwide network of bulletins and journals on drugs and therapeutics that are financially and intellectually independent of the pharmaceutical industry … In 2016 ISDB adopted a policy that will be totally implemented in 2019, in which members are not allowed to have conflicts of interest with the healthcare industry. Those who have not fulfilled the criteria will be removed from the full membership list.
Cochrane is damaging the trust and credibility doctors, pharmacists, scientists and patients have put in them. Cochrane’s credibility and trust are largely at stake if they do not adequately deal with this issue immediately.
ISDB therefore supports Gøtzsche’s claim that a recovery from this dire situation would call for the dissolution of the present board, new elections and a broad-based participatory debate about the future strategy and governance of the organization.
Hazel Thornton: Business takeover. 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. They are then likely to find that their new business model becomes inoperable and unpopular. The art of improving `Medicine` does not take kindly to top-down management; 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.
Change of name and change of ethos are a recipe for failure. (I speak from experience.)
It would seem to me that a full-on wider challenge to change the executive needs to be undertaken, otherwise the Cochrane Collaboration as originally defined (as a Charity) will quickly lose its identity, credibility and be unable to undertake its unique, vital role.
- 17 September E. David Healy: Cochrane Cock-up.
As it grew Cochrane also recruited managers to run the organization and these managers as with almost all managers in the health services or universities began to focus on the brand and policies and protocols with the same tin ear for the nature of the enterprise being managed whether health care or research.
That the Former Cochrane Collaboration – ? now Cochrane Dictatorship – are almost certainly wrong on the occasion of the breach – an apparent 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. This underlines the moral crisis in Cochrane.
For over two years, my research group has worked with clinical study reports obtained from the European Medicines Agency about the HPV vaccine trials, and we therefore have a unique knowledge about these trials. The clinical study reports can take up thousands of pages for just one trial, and they are far more reliable than the short reports the drug companies publish in medical journals, particularly in relation to harms.
We published a criticism of the Cochrane HPV vaccines review on 27 July. Cochrane’s Editor in Chief and his Deputy opined that we had “substantially overstated” our criticisms and they concluded that we made allegations that are not warranted and provided an inaccurate and sensationalized report. We dug deeper and strengthened our criticism (published 17 September), which was that many trials and patients had been missed in the Cochrane review and that harms had been overlooked.
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.
Extract: ”But he [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.”
Extract from rapid responses to Godlee’s article:
Jeffrey K Aronson: There is a crisis in Cochrane, and it is to be hoped that it will not bring that institution down too. 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. Speedy action is vital for the survival of the reputation of what used to be called, and should still be called, the Collaboration.
Alastair Matheson: Company trial reports, regulatory submissions and patient-level data are a better basis for review than journal articles, and a klaxon should be sounded if these are withheld by manufacturers. If Cochrane were to fail in its rigor, then its large, cash-generating paywall library of reviews would be in danger of becoming exploited as a de facto drug marketing channel.
It is surely inadvisable, for instance, for Cochrane to allow academics with conflicts of interest to author its reviews.
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 Gotzsche, but would like to see a solution in which he is reinstated.
Donald Nicolson: I watched from afar as the events unfolded online and off last weekend at the Cochrane Colloquium. I had a keen interest as having worked on several Cochrane Reviews, but more so as a Conference Scholar who examined the dynamics and processes around the conflicts of interest debate at the 2003 Cochrane Colloquium in Barcelona.
I was not surprised that conflicts of interest remain unresolved. Cochrane were slow in addressing the conflicts issue – it took them until 2003 when many other areas of research had addressed this sometime before. And their actions since the debate did not unequivocally resolve the issue, although it did remove funding from the pharmaceutical industry.
- 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. I also received a letter from the two co-chairs of the Board, Martin Burton and Marguerite Koster, called STRICTLY PRIVATE & CONFIDENTIAL:
We write further to the notice given to you on 13 September 2018 in accordance with Article 5.2 of
Cochrane’s Articles of Association regarding the termination of your membership of The Cochrane
Collaboration and your representations made in respect of that notice dated 20 September 2018.
As you are aware the Board met last night to consider the representations you made. The Board gave
careful consideration to all of your representations and the issues involved.
During the course of that discussion the Board acknowledged that you have made a significant and
longstanding contribution to Cochrane. However, multiple attempts to encourage you to be more
collegial and collaborative, and to follow the procedures and policies of the organization, over many
years, have failed.
On this basis the Board considered unanimously that you have breached the following provisions of
1. Code of Conduct for Trustees:
· Article 3.1 (Selflessness)
· Article 3.2 (Integrity)
· Article 3.4 (Accountability)
· Article 3.5 (Openness)
· Article 3.7 (Leadership)
2. Articles of Association:
· Article 5.2.1
· Article 5.2.2
The Board subsequently voted unanimously to terminate with immediate effect your membership of
The Cochrane Collaboration and by extension your position as a Trustee and member of the Governing
In accordance with Article 5.3 there is no right of appeal in respect of this decision.
A summary of the issues that the Board considered and the reasons for the Board’s decision will be
provided to you within 7 days.
My comment: It is still my view that I have not broken any of the provisions above and no such breaches have been pointed out to me. Furthermore, Cochrane’s own law firm exonerated me on all counts. The show trial is now over.
- 26 September B. Gøtzsche’s comments on Statement from Cochrane’s Governing Board about why his appeal was rejected.
The Cochrane Governing Board – instead of providing a good example for others to follow – distorts the evidence, suppresses it, or lies about it. I have devoted 25 years of my life to Cochrane, including many evenings and weekends, and got elected to the Board with the most votes of the 11 candidates because I wanted to change Cochrane’s current direction of travel, which contradicts its fundamental values. I feel sadness for the thousands of unpaid volunteers who have worked tirelessly to create the wealth of Cochrane, only to be under the cloud of the current leadership. This must change. If not, the moral downfall will continue and Cochrane will wither.
Statement from Cochrane’s Governing Board – 26th September 2018
With Gøtzsche’s comments in italics
The Cochrane Collaboration’s Governing Board of Trustees voted unanimously on 25th September to terminate Professor Peter Gøtzsche’s membership of the organization, and his present position as a Member of the Governing Board and Director of the Nordic Cochrane Centre.
My comment: First, a ‘unanimous’ vote from a heavily conflicted Board is both unsurprising and mischievous. Expecting that the remaining Board members would fairly assess my appeal and impartially vote on a situation, in which they have been embroiled, is nonsensical.
Second, I am head of department at Rigshospitalet that hosts the Nordic Cochrane Centre. This is not something the Cochrane Governing Board has power to “terminate.” The Centre is not funded by Cochrane but by the Danish Government.
Last, the events of the last few weeks has prompted our group to seriously reconsider whether we would even want to operate under Cochrane as it currently stands, given the lack of transparency and poor leadership. We would not be the first centre to reassess our goals. Many centres are dissatisfied with their interactions with Cochrane’s CEO, and the US Cochrane Centre closed for this reason in the spring. Several centres are considering leaving Cochrane because of its shift towards a commercial business model approach, away from its true roots of independent, scientific analysis and open public debate, and the growing top-down authoritarian culture, with a serious democratic deficit. Our centre is on government funding, and we believe we would benefit Denmark more by focusing on evidence-based medicine rather than Cochrane under its current leadership.
Cochrane is a collaboration: an organization founded on shared values and an ability to work effectively, considerately and collaboratively. The Governing Board’s decision was based on an ongoing, consistent pattern of disruptive and inappropriate behaviours by Professor Gøtzsche, taking place over a number of years, which undermined this culture and were detrimental to the charity’s work, reputation and members.
This has resulted in multiple complaints to the charity and damaged its credibility within the research community.
My comment: Firstly, this is an invention. 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. I have contributed to robust debate on important scientific issues, which has only served to strengthen Cochrane’s reputation. It is to a considerable extent because of the work that emanated out of the Nordic Cochrane Centre, that scientists around the world debate issues on breast cancer screening programs, psychiatric drugs and most importantly have greater access to clinical trial data from the European Medicine’s Agency (EMA). It begs the question; is my “disruptive and inappropriate behaviour” a result of consistently and resolutely challenging an opaque system, plagued with conflicts of interest and corruption? 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.
This is why people all over the world are outraged about my expulsion from Cochrane. I am only the messenger. Cochrane is now in a moral free fall. The international conversation over the recent unjust and dubious decisions of the current Board members is what has irrevocably damaged Cochrane’s reputation.
Secondly, the Board has conflated its baseless allegations about my ‘ bad behaviour’ with the legal investigation. The minutes from the teleconference on 13 June where the Board decided to establish an independent review states: “In brief, after MW [Mark Wilson, Cochrane’s CEO] referred the matter of an alleged breach of the Spokesperson Policy by PG [Peter Gøtzsche] to the Co-Chairs, and in the light of PG’s complaint directly to the Board about actions taken by MW [he planned to write to two complainants that I had broken the Spokesperson Policy, although this was not the case; and although Cochrane’s Counsel later agreed with me that I had not broken the Policy], the Co-Chairs made a proposal to both MW and PG. The proposal was that an Independent Review be undertaken, with the Reviewer making recommendations to the Board in the form of a confidential Report.”
So, 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 was a show trial.
Professor Gøtzsche has also repeatedly represented his personal views as those of Cochrane, including in correspondence with members of the academic community; in the media; and when acting as an expert witness for a criminal trial.
My comment: Again, it has been clearly stated by Cochrane’s Counsel that these allegations could not be substantiated. I have never presented any personal views in a way that could be honestly interpreted as if they were those of Cochrane as an organisation. Cochrane’s own law firm exonerated me in relation to these false allegations, which I have explained elsewhere on www.deadlymedicines.dk. For example, in my appeal to the Board from 20 September in relation to my role as expert witness I quoted from Counsel’s report: “My conclusion is the same in relation to the expert report and the subsequent complaint against Professor Loonen in the Dutch proceedings. PG was there plainly not speaking about “Cochrane-related issues.” I do not think it can be said that he was speaking officially on behalf of Cochrane.”
The Counsel does not in any single case agree with the Board and Cochrane’s CEO that I have broken the Spokesperson Policy.
Cochrane’s strength and independence rests on our ability to engage in frank, open and transparent debate about health evidence and Professor Gøtzsche, like every other Cochrane member, has the right to express his views. However, as a leader of Cochrane – a Director of a Cochrane Centre and a trustee of the charity – he had a special duty of care to the organization about the way his views were expressed; particularly those made in a personal capacity.
My Comment: On the contrary, Cochrane has not demonstrated that it engages in “frank, open and transparent debate”. It still has not even explained what it means by my alleged ‘bad behaviour’, and it misled everyone, both within and external to Cochrane, into believing that Cochrane’s legal investigation was about an assessment of my ‘repeatedly, seriously bad behaviour’. This was a complete fabrication.
For full transparency, I have decided to waive my right to privacy, and make Counsel’s report accessible, as the public interest in this report must override any attempts at keeping it secret by people who have exposed me to a witch-hunt over four years and a show trial now.
Despite numerous attempts to engage with him on this topic and warnings about his behaviour, he consistently failed to exercise this care.
My comment: This is mendacious. I have never received any “warnings” about my “behaviour” or any explanation about what is objectionable about my behaviour. Again, the only complaints about me have been in response to my scientific critiques, often by those whose science I have disagreed with. Simply publicly disagreeing with someone’s science is hardly a basis for complaint about my ‘behaviour’.
Cochrane’s CEO Mark Wilson has alleged that I had repeatedly breached the Spokesperson Policy, yet Wilson has failed to acknowledge that Cochrane’s own Counsel has overruled him on this matter. Notwithstanding, Wilson used this baseless accusation on several occasions, to threaten the future my centre and its employees, if I did not acquiesce to his demands.
Quizzically, Wilson and Cochrane’s Editor in Chief David Tovey, recently exonerated a member of their own staff for doing precisely what Wilson accused me of doing (see my appeal from 20 September above). It seems that, in Cochrane, some are more equal than others, as George Orwell wrote in Animal Farm. When I sought the opportunity to explain this double standard to the Board, I was denied the opportunity (see my appeal).
The decision has not been taken lightly and the process has included full Governing Board consideration of an independent legal review of the relevant facts.
Professor Gøtzsche has been given a number of opportunities to make representations and to put forward his perspective on events, both as part of the independent review and subsequently.
My comment: This is demonstrably false. First, the Board conveniently ignored the conclusions of the “independent legal review” (paid by Cochrane), which exonerated me, and other crucial evidence. Second, the Board members were only allowed 1.5 days to read and thoroughly assess over 700 pages of documents before the Board meeting of 13 September, a period of time which was grossly inadequate. Third, 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 final decision follows an initial Governing Board meeting on 13th September 2018. At this meeting:
Eleven members of the Board voted that Professor Gøtzsche had breached the Trustees’ Code of Conduct as a result of these behaviours;
My comment: 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 that case, I could not remain on the Board.
a majority voted that Professor Gøtzsche should accordingly resign as a trustee;
My comment: As just stated, this information is false. It was not according to a breach of code of conduct.
And a majority concluded that Professor Gøtzsche has acted counter to the best interests of the charity as a whole and therefore voted to serve notice to terminate Professor Gøtzsche’s membership of the charity, in accordance with Cochrane’s Articles of Association.
My comment: No information has been offered to me privately or publicly to support the view that I have acted ‘counter to the best interests of the charity’. I strongly deny any allegation. The Board has not been “open and transparent” about its decision, even though these are key Cochrane values. Furthermore, only six members voted yes, and five voted no. Thus, a minority of the Board (six of 13) voted for my expulsion.
Professor Gøtzsche was then given the opportunity to provide further representations to the Governing Board, in accordance with the established procedure, which were considered fully by the Board on 25th September before a final decision was made.
My comment: 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, but in Cochrane, some are more equal than others.
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.
In making its decision, the Governing Board has also taken into consideration events since the independent review began: in particular, a series of public statements by Professor Gøtzsche which have breached his obligations of confidentiality as a trustee and continued the pattern of behaviours which led to the Board’s initial decision.
My comment: 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 his 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.
We are committed to the highest standards of governance and to ensuring that Cochrane is a welcoming, open, dynamic organization, that lives up to its values, and has a working culture which attracts the best researchers, clinicians and others interested in healthcare evidence.
We continue to lead and support the organization to deliver our Strategy to 2020, which aims to put Cochrane evidence at the heart of health decision-making all over the world.
My comment: The Board’s self-praise, is in stark contradiction to its recent actions. The Cochrane Governing Board, instead of providing a good example for others to follow, has distorted evidence, and censored information that does not support its narrative. This has resulted in the dissemination of misleading and defamatory information about me. I have devoted 25 years of my life to Cochrane, including many evenings and weekends, and got elected to the Board with the most votes of the 11 candidates because I wanted to change Cochrane’s current direction of travel, which contradicts its fundamental values. I feel sadness for the thousands of unpaid volunteers who have worked tirelessly to create the wealth of Cochrane, only to be under the cloud of the current leadership. This must change. If not, the moral downfall will continue and Cochrane will wither.
Cochrane’s Governing Board
Wednesday 26th September 2018
For media enquiries, please contact email@example.com
September 26, 2018
- 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. Without any notice, 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, to which I informed her, was 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, and removed the announcement of our 25th Anniversary Symposium.
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 firmly 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 today in The Lancet.
Totalitarian actions like this only serve to humiliate and demoralise our staff members at the Nordic Cochrane Centre.
It has become clear, particularly during the last couple of years, that the current leadership of the Cochrane Collaboration does not honour the basic values upon which the Collaboration was built 25 years ago. These fundamental values are collaboration, which is the first of our ten key principles, 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.
Cochrane has significantly shifted more to a business – a profit-driven approach. Even though it is a not-for-profit charity, our “brand” and “product” strategies have taken priority over getting out independent, ethical and socially responsible scientific results. Furthermore, despite our clear policies to the contrary, my centre, and others, have been confronted with attempts at scientific censorship, rather than the promotion of pluralistic, open scientific debate about the merits of concrete Cochrane reviews of the benefits and harms of health care interventions.
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 the Cochrane Executive Officer. The director of the French Cochrane Centre declared his immediate resignation three years ago for the same reason. He has only continued as director because the funding of the French Cochrane Centre is attached to him personally.
It is also telling that four of the 13 members of the Cochrane Governing Board resigned in protest when I was expelled from the Board after a show trial, and after having been completely exonerated for the charges raised against me by the law firm Cochrane had hired to look at the issues. The Governing Board has caused great harm to Cochrane and thereby to public health by their inappropriate actions and the ensuing lack of credibility in Cochrane. This harm seems to continue.
There are other Cochrane centres than mine that are currently contemplating to become independent of the current Cochrane leadership. We will continue to contribute to the aims of the Cochrane Collaboration, and we feel we are in a better position to do so as independent centres.
- 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 (I know his identity but not the person). Here are some appetizers.
The modification of the Nordic Cochrane Centre’s website without their permission was a blatant violation of the collaboration agreement between the centre and Cochrane. The message sent was: we have total authority and will do as we please. In my opinion, the remaining Cochrane Centres have a decision to make regarding the board’s seizure of the Nordic Cochrane Centre’s website. Do they want to acquiesce to this naked power grab? If a centre gets into a dispute with the board, are you prepared to have the board seize your website and deface it with statements from the board about your ‘insubordination’?
The board has been misleading and/or dishonest throughout the entire process.
The CEO brought a dictatorial mindset to Cochrane, and he believes Gøtzsche is bad for the “brand”. Not being a scientist, he has no recognition that the work Gøtzsche does IS the brand. The ideal of science is not sitting by idly while science is perverted by moneyed interests. The ideal is someone who thoroughly vets the science being produced and is willing to challenge corruption at great personal risk.
That process failed [the lawyer’s report paid by Cochrane exonerated me of all charges], but leadership went ahead with the expulsion anyway, trampling all sorts of rules and agreements in the process to get its way. And misleading Cochrane’s members about what it had done. In my opinion, this all became inevitable with the centralization of power in Cochrane. The executive staff of Cochrane was given ultimate authority Once power was centralized, it was inevitable that Cochrane central would seek to claim more power. This always occurs.
This new management had no moral authority, yet was tasked with telling 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, and I cannot blame them.
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. Because corporations will move quickly to remove people they deem controversial. Eventually you are left with subservient people who fill out the forms and publish the work without asking the difficult questions. Many studies are already produced in a check box manner, where companies are sure to cross off every technical requirement while producing a biased design that results in the desired outcome. Their ideal world would include a Cochrane that produces meta-analysis the same way. Check off all the boxes. Do not ask any difficult questions, just publish the free marketing materials.
- 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 deroute, skrevet af en amerikaner (jeg kender hans identitet men ikke personen). Her er nogle appetitvækkere.
Ændringen af det Nordiske Cochrane Centers hjemmeside uden deres tilladelse var en åbenlys krænkelse af samarbejdsaftalen mellem centret og Cochrane. Den afsendte besked var: Vi har total autoritet og gør, som det passer os. Efter min mening må de andre Cochrane-centre tage stilling til bestyrelsens beslaglæggelse af det Nordiske Cochrane Centers hjemmeside. Ønsker de at acceptere dette utilslørede greb om magten? Hvis et center kommer i tvist med bestyrelsen, er de så villige til, at bestyrelsen beslaglægger hjemmesiden og lægger en udtalelse op om, at de ikke vil indordne sig?
Bestyrelsen har vildledt og har været uærlig i hele processen.
Den administrerende direktør for Cochrane medbragte en diktatorisk tankegang til Cochrane, og han mener, at Gøtzsche er dårlig for “brandet”. Idet han ikke er videnskabsmand, har han ingen erkendelse af, at det arbejde, Gøtzsche gør, ER ”brandet”. Videnskabens ideal er ikke at se passivt til, mens videnskaben perverteres af pengemæssige interesser. Idealet er en person, der grundigt dyrker den videnskab, der produceres, og som er villig til at udfordre korruptionen under stor personlig risiko.
Denne proces [den såkaldte uafhængige advokatrapport betalt af Cochrane] mislykkedes, 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. Efter min mening var alt dette en uundgåelig følge af centraliseringen af magten i Cochrane. Cochranes lederskab fik den ultimative myndighed. Når magten var centraliseret, var det uundgåeligt, at Cochranes lederskab ville søge at kræve endnu mere magt. Dette sker altid.
Den nye ledelse havde ingen moralsk autoritet, men fik til opgave at fortælle 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, og det kan jeg ikke bebrejde dem.
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. Fordi virksomheder vil handle hurtigt for at fjerne folk, de anser som kontroversielle. Til sidst sidder du tilbage med ja-sigerne, der udfylder formularer og publicerer forskningen uden at stille besværlige spørgsmål. Mange studier produceres allerede på en afkrydsningsfacon, hvor virksomhederne er sikre på at overholde alle tekniske krav, samtidig med at der laves et forudindtaget design, der medfører det ønskede resultat. Deres ideelle verden ville omfatte en Cochrane-organisation, der producerer meta-analyser på samme måde. Afkryds alle felterne. Stil ikke vanskelige spørgsmål. Publicer bare det gratis markedsføringsmateriale.
Please read this report and judge for yourself. The whole dispute between Cochrane’s CEO, Mark Wilson, and me concerned the interpretation of the Cochrane Spokesperson Policy related to two recent cases. My report to Cochrane’s law firm documents:
– Serious acts of tampering with evidence, in the form of manipulating the minutes of meetings and other evidence by the CEO, his staff, and the co-chairs of the Cochrane Governing Board.
– Serious mismanagement in Cochrane, committed by its CEO and co-chairs.
– Numerous violations of rules for charities by the CEO and Governing Board co-chairs.
– Lack of democratic and collaborative leadership at the Cochrane Collaboration.
– Management by fear and bullying by the CEO.
– Lack of due processes in Cochrane.
– Fierce resistance from Cochrane’s CEO towards introducing due processes.
– Favouritism: other rules apply to CEO staff than to Cochrane collaborators.
– Serious selection bias in the 400-page material (see tabs after this message) sent by co-chair Martin Burton to Cochrane’s law firm, which favours his line manager, CEO Mark Wilson.
– Repeated and serious violations of Cochrane’s core principles of openness, transparency, honesty and fairness by the CEO and the co-chairs.
– Scientific censorship in Cochrane.
– Repeated, very harmful actions by Cochrane’s CEO, which favours industry and guild interests.
– Empirical testing of the Cochrane Spokesperson Policy showed that by far most of the 21 respondents found it ambiguous and difficult to interpret, and that it should be rewritten. They also found that I had not breached the Policy in relation to the two most recent complaints, which caused the Board to ask for a legal investigation.
– Documentation that I have never breached the Cochrane Spokesperson Policy.
On 4 October in the morning, the Iberoamerican Cochrane Centre sent a very important letter to Cochrane’s CEO and the Governing Board signed by 27 out of 31 Centre Directors in Spain and Latin America. The letter says 26, but there were actually 27 signatories. As of 8 October, all 31 Directors have signed, and this is the version shown in the above link.
This letter called for an independent investigation of the process around my expulsion:
“… With the information provided, we have doubts that the process has been sufficiently appropriate and coherent with the principles of Cochrane to deal with a conflict of this nature … 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, by all means, 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 – whoever they may be – without enough collective mechanisms for discussion, contrast and control. For all the above, 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 should [sic] 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.”
The directors wrote in their email: “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, also 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 Latin directors’ statement was not mentioned at all during the webinars, and as of 8 October, Cochrane has still not informed its members about the letter. The leadership of Cochrane has stopped listening to other people than themselves.
- 9 October. Gøtzsche’s complaint to the Charity Commission about serious mismanagement of the Cochrane Collaboration.
In my complaint, I explain that it has become international news that Cochrane, arguably the most important global organisation in science and healthcare, is experiencing a moral meltdown caused by poor leadership.
The organisation has expelled one of its founding fathers from the Board (me), four other Board members have resigned in protest, and now many Centre Directors from around the world are calling for the entire Board to step down in order to save the organisation.
Cochrane is currently imploding and it requires the UK Charity Commission to intervene urgently. Several Cochrane centres are already making moves to sever themselves from the organisation; international protests from thousands of people are mounting; and people have lost trust in the charity.
All 31 centre directors in Spain and Latin America have signed a document, which describes the lack of transparency, accountability and due processes, and proposes the establishment of an ad-hoc commission, without the participation of any person who has been directly involved in the conflict between Cochrane’s CEO and me, that should independently review all the actions related to the conflict. As is characteristic of Cochrane’s leadership, it has ignored the letter.
My complaint is about serious abuse and mismanagement over several years, which has harmed the charity’s services, beneficiaries and reputation. The evidence I provide not only outlines the risk of additional harm to the organisation, but also has broader implications for medical research, policy-makers and most importantly, people’s health and well-being. I have tried to challenge the leadership on these important issues but, as a whistle-blower, I have endured intimidation, bullying and witnessed corruption, by a leadership that is bringing the organisation to its knees. There is a substantial risk that Cochrane will fall apart if nothing is done.
The conflict between Cochrane’s CEO and me was a trivial issue about the interpretation of Cochrane’s Spokesperson Policy in relation to two recent cases. Cochrane’s own Counsel exonerated me from all charges, and 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. 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.
It also plays a role that I: demonstrated that Wilson’s use of the Spokesperson Policy against me has been totally inappropriate; challenged Wilson’s leadership in many aspects and expressed concerns about his ‘management by fear’; demonstrated serious mismanagement in my report to Cochrane’s law firm, on the part of Wilson and the co-chairs, which included tampering with minutes and other essential evidence; and published a scientific critique of Cochrane’s HPV vaccines review, which is encouraged by Cochrane, but people in the leadership felt offended by it. They now claim they did not receive ‘internal’ warnings about our publication, which is demonstrably false.
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 us, 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 on 28 September.
David Hammerstein is one of the four Cochrane Governing Board members who resigned in protest after the unwarranted expulsion of Peter Gøtzsche from the Board and the Cochrane Collaboration. 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.
You should read Hammerstein’s brilliant analysis of the current crisis in the Cochrane Collaboration and his suggestions for a better future. Below follows a summary.
The crisis in the Cochrane Collaboration is about its credibility. It is extremely superficial and probably an act of bad faith to focus the present crisis on one individual´s behaviour, which 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 over the past few years to attack and try to erode Gøtzsche’s prestige related to his scientific and policy positions.
A confrontation of paradigms: a collaboration or a “brand”? 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 upmost 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 on health technology evaluation, open access publishing, shared structured data and open models of biomedical innovation. 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 co-chairs of the Governing Board seem to have some fluid input into the decision-making process. The two co-chairs of the Governing Board 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 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 is 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-presidents 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.
- 13 October A. Statement of Cochrane Work Review Group Editorial Base on recent developments in Cochrane.
In the statements of the board and those made by Peter Gøtzsche, we notice that no attempt has been taken to try to solve this workplace conflict in other ways than by voting on whether to expel him. 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.
Even though the Board says that opinions are not at the basis of Peter Gøtzsche’s expulsion, the statements are contradictory in this respect. It seems that his views on the Cochrane HPV vaccine review did play a role in the conflict.
It is unclear how this will develop further. 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 too.
Robert Whitaker is an American journalist and author who has won numerous awards as a journalist covering medicine and science, including the George Polk Award for Medical Writing and a National Association for Science Writers’ Award for best magazine article. In 1998, he co-wrote a series on psychiatric research for the Boston Globe that was a finalist for the Pulitzer Prize for Public Service. His first book, Mad in America, was named by Discover magazine as one of the best science books of 2002. Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book award for best investigative journalism. He is the publisher of www.madinamerica.com, which has 2 million visitors annually.
Extract of Whitaker’s excellent article:
I knew that for the past few years Gøtzsche had increasingly run into difficulties with some members of the leadership of the Cochrane Collaboration, and during the past year, he had often complained that the leadership was seeking to boot him from the organization. But I never thought that would actually happen.
The reason for my confidence that he would survive this turmoil was that the Cochrane Collaboration had a reputation for publishing systematic reviews that challenged conventional wisdom and practices. That was an organizational point of pride that would, I thought, ultimately make it protective of Gøtzsche.
If you read the report of the “independent person” appointed by the Cochrane collaboration to investigate this conflict, 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 what might be called the scientific enterprise, which is a collective social good. The Cochrane Collaboration, by failing to resolve this dispute in some other way, failed in its mission to serve as a collaboration of scientists that would, in their reviews, dare to challenge conventional medical wisdom. In order to stay true to that mission, the Collaboration needed to be protective of “heretics” in its midst.
The expulsion had nothing to do with Gøtzsche’s work as a scientist. The reviewer, in his report, 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, Grant wrote, was a complaint from E. Fuller Torrey. Gøtzsche had written to Torrey requesting information about deaths in the Norwegian TIPS study, and Torrey responded by filing a formal complaint against Gøtzsche.
The complaint by E. Fuller Torrey 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.
However, the future of the Cochrane Collaboration is less 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.
One would hope that the Cochrane group, as it moves forward, will remember that the public needs a collaboration that will provide a home for the “scientific” heretic, and that this decision to oust Gøtzsche betrays that value. Perhaps the Cochrane members can dig into their medical history books and read about Ignaz Semmelweis and his efforts to get other doctors to wash their hands before operating, and let that story of the medical community’s treatment of Semmelweis serve as a reminder of why it is important to provide such protection to the heretics in medicine. The Cochrane Group needs to remember that it serves the public, and this decision to oust Gøtzsche fails to fulfil that obligation.
- 15 October A. Gøtzsche’s comments on Governing Board letter to 31 centre directors from Spain and Latin America.
In its reply to the letter from 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.”
My comment: As I have documented at length, there never was an independent investigation, let alone any due and fair process. The 31 Cochrane directors merely 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. As I explain in my complaint to the Charity Commission, 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.”
My comment: 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 at all before I released Counsel’s report and other essential documents on my website. There are situations where confidentiality needs to be broken, e.g. when serious injustice has occurred, as in my case. Desmond Tutu says about this: ”If you are neutral in situations of injustice, you have chosen the side of the oppressor.” I did not choose the side of the oppressor.
”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.”
My comment: It is tragic that the Board is out of touch, not only with its members, but with reality. Even in the face of international criticism about how it has 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.”
My comment: Cochrane’s CEO, Mark Wilson, has introduced scientific censorship in Cochrane. The Board mistakenly 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 their organisation and will probably be reprimanded or expelled for not ’towing the party line’.
My conclusion: 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 from the Board and Cochrane. 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, I’m afraid that Cochrane will 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.”
My comment: There are no inaccuracies in the network’s letter, which rightly 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, Peter C. Gøtzsche”. 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.”
My comment: It seems to me 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.
“lf we interpret your letter correctly, 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 comment: My so-called behaviours have always been accepted at the University of Copenhagen and at Rigshospitalet where my centre is located. In contrast to Cochrane, these institutions appreciate appropriate scientific criticism. We do not have scientific censorship in Denmark, in contrast to Cochrane.
“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, as well as other organizations that hold employees, volunteers and others to high standards of conduct.”
My comment: 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.
- 18 October. The moral meltdown of the Cochrane Collaboration: Interview with Peter C Gøtzsche. Interview in Danish, subtitles in English. Duration: 15:24.
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.
A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane
Help for psychiatric drug withdrawal/ Hjælp til udtrapning af psykofarmaka
Here you can find advice and guidance about how to withdraw from psychiatric drugs and a list of therapists who may help you.
Her kan du finde råd og vejledning om, hvordan man trapper ud af psykofarmaka og en liste over behandlere, der gerne vil hjælpe dig.
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.