Concerns about Cochrane

I'm confused about the proceedings, but Swedish Läkartidningen and Danish Dagens Medicin both write that he will continue.

Here is a google translation of the article in Dagens Medicin:
Peter Gøtzsche continues as head of the Nordic Cochrane Center

 

Ah, I've clearly misunderstood some of the comments - will edit my post, and thanks (foggy-headed and shouldn't be posting... )

But then the situation will be truly absurd...? He's (probably) exluded from International Cochrane, but will continue to lead/be the chief of the Nordic Cochrane Center - how will that even work...?

(google translation)

 

Yes, I think that's safe to say!

 

The article in Ugeskrifted is well worth a read - do continue past the letter from the board.

I'm baffled at this bit:

(google again )

That's only 2.67 % (but do take my math at this point with a grain of salt... ) of Cochrane members casting their vote...?? So a smallish group of people are actually deciding who will lead the organisation and in what direction.

 

Council For Evidence-Based Psychiatry (CEP) declares its support for Professor Peter Gøtzsche

Prof Peter C. Gøtzsche is known throughout the medical world as a tireless advocate for research excellence, a fearless critic of scientific misconduct, and a powerful opponent of the corruption of research by industry interests. His meticulous integrity in demanding the highest standards from his colleagues has won him the admiration of patients, researchers, doctors, campaigners and advocacy groups worldwide.

 

My arithmetic suggests that the Board had at most 8 elected members, including Gotzche.
Of these one was sacked and four out of a maximum of seven others resigned in sympathy.
It might have been four out of six.
That does not make Gotzsche sound like a heretic outsider. The majority of elected members thought it better to crash the whole board than to allow Gotzsche to be victimised.
Sadly it looks as if the rest of Cochrane membership wants a quiet life.

 

It could be that a lot of them already had a problem with Gotzsche? I am surprised members seem to have swung behind the board so readily after their statement. Shows that they know their target audience better than I do!

 

Since so few of the Cochrane members even bothers to vote, hardly anyone - 2.7 %, it looks to me the majority of members just don't want to engange in or be bothered by these sorts of politics policy-making decisions. They are there for the science bits - someone else go figure out the rest and don't disturb or discomfort the sciency people.

Well, that's my impression at least.

I'm still shocked that only just over 1200 people voted, and was part of the decision. That's a real problem, for an organisation that promotes itself as wanting to be the epi-center of knowledge and judge of science quality. When such a small percentage are part of decision-making and in effect don't bother with the quality control of the organisation itself.

 

It may well be that members do not want to engage in anything that threatens to upset any apple carts the way Gotzsche likes to. I also wonder if this was a secret ballot or a show of hands.

It is interesting to ponder why people do Cochrane reviews. I am pretty sure it used to be mostly a political move - to publish something and bolster the CV. And very often it was very likely to reflect a desire to prove a point of view about treatment in an area - probably mostly a positive point of view. So the idea that Cochrane reviewers were ever impartial is probably naive. More recently, I suspect a lot of reviews are done by people employed to do reviews full time in these Cochrane units. Again, it is hard to believe that choice of who does what review is impartial. We have the exercise review done by someone trained as a physic and someone who seems to have a deep belief in therapist-delivered treatments as in PACE. There may also be a smattering of people like Gotzsche whose chief interest is in paring back anything based on dubious evidence, but there are only so many zealots of that sort.

 

I hesitate to butt in as I'm always asking some really basic questions but well, where do reviewers come from? Do they get paid? What expertise do they need?

I think I might even have asked this previously but forgot the answers.

What suggestions do people here have for improving the review process?

 

When I did a review in about 1995 people just volunteered to do a review and submitted it for approval. They were not necessarily paid. However, junior academics would get credit for doing reviews. More recently I think the centres have regular incoming funds and put staff members on to reviews.

I am beginning to think there should not be reviews like this, done by unaccountable quangos pretending to be impartial. The evidence for each treatment should be assessed by official government funded bodies when guidelines are being drawn up. Otherwise health care professionals should read the evidence themselves.

 

A bit OT, but there's a new article on problems/controversies with meta-analyses here. Includes tiny bits from Coyne and Tovey on COIs: http://www.sciencemag.org/news/2018...scientific-debates-often-they-only-cause-more

 

I think that broader perspective is very useful.

Basically, meta-analyses were never very powerful. They are now probably completely misused and useless.

If you think about it, if individual studies are good enough there should be no need for any meta-analysis. And in the great majority of situations that is the case. In rheumatology I am not aware that a policy decision was ever affected by a meta-analysis, except possibly for preventive measures in osteoporosis, where the evidence is very marginal.

And that is the bottom line - meta-analyses are only relevant when the evidence is marginal. And the chances that the meta-analysis allows you to be sure what the answer really is is almost certainly close to zero.

For CBT and GET all you need to do is look at the published studies and see that none are good enough even to take notice of, in terms of positive evidence of efficacy. They may provide some quite useful negative evidence but there isn't enough there to think the treatments work so they should be dropped.

All these complicated procedures for trawling literature and comparing data are a complete waste of time and money. In the old days nobody even thought this was worth doing. The only reason these meta-analysis organisations exist is that decision makers want to get someone else to make the decisions for them.

So while it may be true that if there is a very difficult decision to make about whether a breast screening is cost effective Cochrane might have the wherewithal to gather all the evidence for one to analyse oneself (rather as Rothstein suggests) for most things there was never any need to bother - we all know the evidence is not good enough, or the trials are cut and dried. For drugs to be licensed the trials have to be pretty cut and dried so in most cases a portfolio of adequate evidence is already readily available.

What one should not do is, like Fiona Watt, use a Cochrane decision as surrogate evidence for quality.

 

Yes. I have suspected this for a long time. Also the difference between evidence based practice and evidence based medicine is the first focuses on giving doctors the necessary training and resources to evaluate for themselves. EBM is at risk of becoming just the latest dogma if doctors do not get properly supported.

 

This is partly what I mean about new medical dogma. We need educated and resourced doctors to be problem solvers, not priests.

 

This is what the Centre for Reviews and Dissemination do at York University (as well as train other people): https://www.york.ac.uk/crd/about/

I thought that NICE commissioned reviews and that this was how they got them done (though I may be wrong about that).

 

Haven't heard this yet, but will have a listen later. The theme is interesting, perhaps particularly as one of the authors of this Cochrane review, Signe Flottorp, is known for a biopsychosocial approach to ME. She is a colleague of Larun & co who wrote the Cochrane reviews about ME and GET.
https://twitter.com/user/status/1042716557204443137


ETA: They were co-authors in
Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): A systematic review (2014)

 

I think NICE have their own reviewing procedure. That probably includes picking up what Cochrane has done. I have no heard of NICE getting reviews done by others but it is possible.