Editorial Note: This post follows last weeks In the Name of the BBC. There will probably be two more posts on Hostile Environments and The Anti-Facts Brigade. The titles and this photograph come from the movie In the Name of the Father – a compelling 1993 move about the Guildford Four which comes complete with an astonishing cast. The movie costs almost nothing to rent on Netflix.
The BBC and The BMJ (British Medical Journal) probably seem dependable to most people (90%) on both the Left and the Right of British politics. I’m not aware of any medical journals or broadcaster that would attract the same levels of support from all sides in either America or the rest of Europe. British newspapers are viewed as and are far more partizan. Its not clear there is one that would command support from both sides of the aisle.
This is what underpins my sense of dismay at the recent BBC programs on children and antidepressants, especially given prior Panorama programs that had made this a scandal the BBC had scooped the world on.
The Cochrane Collaboration until recently occupied a rather similar position. The sense was that regardless of who was offended they were going to get the truth out.
Some months back, the Nordic Cochrane Center, one of the centres in the Cochrane Collaboration, sent a review of studies done on the HPV vaccine to the BMJ. Much to their surprise, BMJ turned down this article which contained all studies done on HPV and a serious attempt to flag up the limitations of the trials and accordingly the limitations of what we could confidently say.
Subsequently the Cochrane Collaboration published an alternate or competing review claiming that the HPV vaccine was marvellously effective and close to side effect free. The launch of this review was co-ordinated by the Science Media Centre (SMC) – essentially an out-sourced industry public relations outfit.
A short time after that, we had news of a major push to promote the vaccine to boys as well as girls.
The Nordic HPV Review will likely be published somewhere soon. In the meantime, its authors Lars Joergensen, Tom Jefferson and Peter Goetzsche have published a unique paper taking the Cochrane Collaboration to task for breaching the Cochrane mission statement (motto) ‘Trusted Evidence’ by publishing the alternate HPV review. This is an extraordinary indictment.
Joergensen and colleagues’ paper is rather like Gareth Pierce (aka Emma Thompson) holding up a piece of paper at trial “Not to be Shown to the Defence”. Rather than keep to the Cochrane mission of hunting down all trials and working to expose all biases and limitations, the alternate review uses the Cochrane name to front an advertising campaign. The Joergensen paper critiquing Cochrane is Here.
The Cochrane Collaborations approach is rather like the English State in the case of the Guildford Four using the then good name of British Justice to front a counter-terror campaign – putting on a show trial to assure the public everything was just fine. The end result has been a collapse in a belief in the justice system. It begins with one case and ends with complete cynicism.
Cochrane and the pharmaceutical companies are playing with fire.
For readers outside the UK, who may not have heard the name, its worth googling Gareth Pierce who on Wikipedia is described even by critics has having single-handedly changed the British criminal justice system, destroying the public’s perception of it as inherently impartial.
The English system is all about honours. The French is also. In the case of the English, everyone’s goal is get letters after their name – OBE order of the British Empire, CBE (commander), MBE etc en route to becoming a Sir. Its a marvellous system that costs very little to get people to crawl over burning coals or sell their mother for the good of the system. The good of the system is not the good of patients or of the average person in the street. Its the maintenance of the status quo and the promotion of business.
Its important for perceptions though that some very average people doing public-spirited things get minor honors. The occasional major honor is given to decent individuals like John Sulston who led the Human Genome Project.
When offered an honor, Gareth Pierce sent it back with a note saying there must have been some mistake.
In the Name of the BMJ
Somehow BMJ has managed to retain trust where British Justice hasn’t.
There are some wonderfully honorable people in the BMJ – possibly better on average than was the case several decades ago. There have been some pretty shady customers in the past.
There are also people like Richard Smith, who like Richard Horton in the Lancet, make a big deal of wringing their hands and sanctimoniously saying in public our journals have become pharmaceutical company laundering conduits, while at the same time behind the scenes buckling in the face of company or government pressure to deny access to articles that might tackle problems like ghostwriting or lack of access to trial data.
A good case can be made that no-one could be implicated in more deaths than Richard Smith, as a consequence of his endorsement of and publication of the Beasley et al 1991 article in the BMJ – see Vampire Medicine and succeeding posts through to Call to H-ARMs. Smith’s probably accidental role in a cover-up allowed the Merck Vioxx cover-up to succeed by endorsing the idea that any meta-analysis even a meta-analysis of garbage has the same status as Tablets newly brought down from a mountain-top.
It doesn’t have to be crooks who wreak the most damage. Innocence is what keeps the wheel spinning.
In the case of Cochrane, the person in the frame is probably Iain Chalmers – only someone inside the organisation is in a position to tell.
If trust is going to be restored its going to need someone to do a Jose Mario Bergoglio and say we’ve fucked up. Here and here and here is what was done – all of which might have looked reasonable at the time but in retrospect was unfortunate.
Trust is a fragile commodity. In pushing HPV as aggressively as they have done, pharmaceutical companies risk blowing trust in all vaccines out of the water.