Cochrane: Collaboration or Cult?

Editorial Note: This is the fourth in a sequence of posts on the possible disintegration of the Cochrane enterprise.  The most recent being the Valley of Death. 

Archie Cochrane was one of a group of British doctors who came back from World War II committed to social medicine, some of whom like Richard Doll, who with Tony Hill put the link between smoking and lung cancer on the map, turned to epidemiology.  Cochrane’s research centred on the epidemiology of the mining communities of the South Wales Valleys. Where mine owners, the government and the establishment were still blaming the respiratory problems of coal miners on tuberculosis and other lung disorders, his work inconveniently made it clear coal dust was the critical factor.

One of the towns in the Welsh Valleys his research covered was Mountain Ash. Today one person in every three in Mountain Ash is taking an antidepressant – from The Valley of Death to The Valley of the Dolls.

It is a racing certainty Archie would be horrified by this and likely even more horrified by the role that an association named after him has played and continues to play in supporting this state of affairs.

From Mountain top …

Archie might well have supported Cochrane when it began as a Collaboration in the early 1990s, three years after his death. But, while like Tony Hill he was an advocate of controlled trials, its impossible to believe either he or Hill would have tolerated the Collaboration’s willingness to accept a denial of access to clinical trial data and its preparedness to work from ghost-written industry publications, passing these off as the “real thing”.

He would likely have pointed to the role of factors like the concealment of trial data and ghostwriting of results in the creation of a situation in which one third of the residents of Mountain Ash have ended up on antidepressants.

But until Peter Goetzsche came along and soon afterwards Tom Jefferson, no-one in Cochrane has voiced such thoughts.

No more than Cochrane, Peter Goetzsche is not an easy-going customer. He can unquestionably be a pain in the neck.  This is widely recognized but also treasured by many.

It’s easy to have a stand-up row with Peter and fall out with him. But even those exasperated with him and unwilling to go along with his rejection of the medical model within mental health or his characterization of the operations of the pharmaceutical industry as organized crime, cannot but have some regard for the magnificence of his outrage at what we have been tolerating and some acknowledgement that there is considerable moral truth to the positions he takes even if they are not right in every detail.

To Ashes..

Cochrane dropped the term Collaboration from its name some years ago.

Recent events make the former collaboration look like a Cult, whose leadership dictate what can and cannot be said. A Cult, who in cutting off one of their only colourful figures, will be viewed as a bunch of grey men, 2-D cut-out apparatchiks rather than 3-D flesh and blood scientists.

A Cult whose value to science has plummeted to rock bottom and whose value to industry has likely nosedived also. It is not the industry way to make a martyr of someone.  Stick their head on a gibbet perhaps, if it can be done rapidly and with certainty, turn them into a spectre, but never make a martyr. Much better to ignore a Goetzsche than risk having people think there might be some fire beneath the HPV vaccine smoke.

What the Hell, we didn’t even have to ignore him. The best agencies can use a Goetzsche to sell HPV vaccines.  He was doing a good job helping keep SSRIs alive.  Unless that is someone fucks up and makes a martyr of him.

The Cult have even put SMC (the Science Media Centre), who co-ordinated the launch of the Cult Review of the HPV vaccine, in an awkward spot.  Which side do SMC take now, when the BMJ are coming out in favour of Goetzsche and Jefferson?  This will be worth watching.

Forget the fact that the HPV vaccine trials were designed not to find the predictable auto-immune problems that current vaccines bring in their wake. Forget the fact that the authors of the Cult Review clearly breached Cochrane Conflict of Interest policies. Forget the fact that, unlike cults, science is not about consensus building.

Just watch the line-up and remember in this very English game, cricket embodies the English idea of fair-play – 11 against 1.

A Good Collaboration Spoilt

Peter Goetzsche plays golf rather than cricket.  His greatest problem with the shenanigans of the last few weeks is likely to have been its interference with his ability to watch the Ryder Cup unfold – a competition in which Europe, led by a Dane, triumphed.

At the moment Goetzsche seems to be the only one standing on the tee – more than happy to let everyone have a look at and test out all the clubs in his bag.

Editorial Note:  This post hinges heavily on input from Johanna Ryan

Update – 26 of 31 Cochrane IberoAmerican directors call for an investigation