Most Cochrane members will have felt at best uneasy about the recent events in Cochrane. We also felt uncomfortable and wondered what caused our feelings. The biggest problem we felt was the lack of transparency. Who had been doing what? Who makes the decisions in Cochrane? What can I do as a member of a Cochrane Centre or a Review Group? Many questions were also triggered by the statement of the Governing Board that there will be ‘zero tolerance for bad behaviour’. We fear this will easily lead to ‘zero tolerance for different opinions’.
We are all members of Cochrane because we believe that evidence-based health care is an important asset for public health. Evidence that can be trusted is what we all want to create. We believe that the lack of transparency and trust which we experience at the moment is detrimental to Cochrane and we have to do something about it.
There are four major policy issues that we would like to improve.
- Create a culture of open discussion
First of all, we need a culture of open discussion. At the moment, many people don’t dare to speak out because they fear that it will be used against them. We ask the Governing Board and the Cochrane Central Executive Team (CET) to create a forum where interactive discussions can be held. Modern organizations commonly have a freely accessible online discussion platform that can be used by all members.
- Refocus on the heart of Cochrane
Authors, members of methods and review groups put enormous effort in producing Cochrane Reviews without payment. The revenues of these reviews finance a large Cochrane CET. In the past, many good investments have been made such as the Game Changer project. We would like to see an increase in support to the heart of Cochrane by for example financially supporting review production, methods development and stakeholder interaction worldwide. Cochrane CET and Cochrane members in various groups around the world should work together to achieve this.
- Increase the involvement of Cochrane members
We as Cochrane members are very motivated to do our reviews, train our authors, develop methods, assist with difficult analyses or other important tasks for getting our high-quality reviews published. However, our involvement in the governance of the organization is minimal. At the Annual General Meeting only 240 members voted out of a potential 11 250 voters (2%). To support the democratic process in general and to increase ownership in the implementation of new policies in Cochrane, voter participation rates should be increased. The members are the basis of the organization according to the constitution of Cochrane. A good start would be to have a lively debate among members during the coming Governing Board elections and to organize general meetings more effectively.
- Find a better business model for Cochrane
Cochrane reviews are sold to subscribers. The European Union has decided that science funded by public money should be published Open Access, which means that it is freely available for the end-user. Cochrane does not have such an Open Access model. Even though content is freely available to a large part of the world, important new reviews are behind a paywall. Also, content that is older than 12 months is free but this is largely not up-to-date. This is different from our promise to be the most reliable, up-to-date and accessible source of evidence. We conclude that in the long run the current business model is untenable and we must find better solutions.
Signed by the following Cochrane Members:
- Jos Verbeek, Coordinating Editor, Cochrane Work
- Gerd Antes, former Director, Cochrane Germany
- Matteo Bruschettini, Director, Cochrane Sweden
- Jani Ruotsalainen, Managing Editor, Cochrane Work
- Chris Del Mar, Coordinating Editor, Cochrane Acute Respiratory Infections
- Mark Jones, Centre for Research in Evidence-Based Practice (CREBP), Bond University, Australia
- Caroline Struthers, UK EQUATOR Centre, University of Oxford
- Lotty Hooft, Director, Cochrane Netherlands
- Tianjing Li, Co-ordinating Editor, (US Satellite) Eyes and Vision
- Gerald Gartlehner, Director, Cochrane Austria
- Nicole Skoetz, Senior Editor, Cochrane Cancer
- Barbara Nußbaumer-Streit, Associate Director, Cochrane Austria
- Nancy Santesso, Deputy Director, Cochrane Canada
- Philipp Dahm, Coordinating Editor, Cochrane Urology
- Malgorzata Bala, Director, Cochrane Poland
- Joerg Meerpohl, Director, Cochrane Germany
We asked people to sign this petition if they wanted to join us. By the start of voting, when we closed the petition, 620 people had signed it. We think this is great and totally new in Cochrane. Thank you to everyone who signed!
“All effective treatment must be free” — Archibald Cochrane
Cochrane Members for change 
Great to see that it is possible to agree with a group of diverse Cochrane members about where to go from the current crisis.
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Can you add the link to the petition in the document? So we don’t need to point to two resources
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Hi Rene. That is a good idea. Implementing straight away.
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#5 Should be .. put the Collaboration (word and deed) back into Cochrane
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Now that this blog post has been up for a number of days, I am surprised to see so few comments. I did hear comments however and I will try to respond.
Some colleagues commented on the introduction to the four issues for debate.
They felt that there wasn’t a lack of transparency in the organisation nor in the decision-making process around the expulsion of Peter Goetzsche. These are all feelings and one can only respect these. However, I can explain mine a bit better. For example, the board said that expulsion was the only possible solution. That sounds odd to me. I can easily think of many other solutions for a workplace conflict than firing a person. I can’t think of any commercial organisation that would risk it’s reputation by firing a person in such a way. Like I have been saying for more than 58 days now, why not choose arbitration, why not hire a proper mediator, why not install an independent review committee etc. What was the urgency with which Peter had to be expelled? I haven’t seen any change in his behaviour recently. This was perfectly managed for 25 years.
Then we have the way this was further handled by the board. The reasons for expulsion changed from one day to another. First, it was called personal harassment and later it became ‘bad behaviour’ and again later it was because of complaints made by people from outside Cochrane (of which one was on Twitter!). The first would be a good reason for expulsion but I haven’t seen any facts underpinning personal harassment. This is the only formal information that the board has given us and I find it very non-transparent.
Other people commented that they do not feel any fear when voicing a different opinion in Cochrane. I can only express my own feelings and experiences here. I felt uncomfortable when I expressed my opinion at the AGM to begin with because apparently no one else dared to talk about the issue. I felt uncomfortable when I put my opinion on our website, through which we communicate with our members, because I knew that my opinion would not be appreciated. I felt very much under pressure, yes afraid, when the Editor-in-chief ordered me to take the ‘inflammatory’ texts in which I criticized the board’s decisions immediately from ‘a Cochrane sponsored’ website. This is clearly not a culture of open debate.
In discussions that I had with senior Cochrane staff I asked for a discussion list where we can express opinions and discuss things. It met with a consistent: “No that is not possible”. If you want to express your opinion you can ask the council to do so or you can vote. There are no other options, was the message.
So, that is why I am writing my opinion about Cochrane, that I had much rather voiced on an internal Cochrane Community page, on this blog with the beautiful name cochranemembers.org. That URL was, not surprisingly, still free.
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I have been meaning to comment on this blog for a few days, but like Jos, felt a bit intimidated by the whole situation. So, here goes…
I am very happy to be part of the group proposing change through adopting four simple policies.
I have another preoccupation which is the lack of progress made by Cochrane on advocacy:
Advocacy for better primary research to benefit the public who are the people who need it most. At the moment Cochrane synthesises the best available evidence mainly in the form of reports of randomised trials published as journal articles. The best available evidence is usually very poor, and there is no discernible centralised effort or support for people who want to make more evidence available, or make the available evidence better. Much inconvenient evidence is not made available either through non publication, or selective publication. Much evidence is poor because of the way it’s conducted and reported, either because of researcher bias, or methodological incompetence, or both. At the moment, Cochrane reviews almost without exception conclude that there is not enough good evidence to support any particular treatment approach over another one. Many review teams go into a lot of detail about what future research should look like, including advocating for patient and public involvement and using reporting guidelines (CONSORT). But there is no systematic communication channel with research funders and others to help make sure these helpful prescriptions for good future primary research are followed. Advocacy is one of the four goals in the strategy for 2020, yet by Cochrane’s own admission, the progress towards this goal has been minimal.
The current governance set up at Cochrane and lack of transparency and clarity about how policy decisions are made, and how to get important issues like this taken seriously and discussed at council and board level is very frustrating.
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This is confusing and contradictory. Most of this is happening already in Cochrane e.g. open debate, an online forum for all members (OK so hardly anyone uses it, but that’s not the provider’s fault), move towards open access (yes we all want it now, but it is bound to take time), mandated stakeholder involvement in priority-setting. Perhaps all these things could be done better, but certainly the above doesn’t provide a robust evidenced-based critique or any references, nor are there estimates of how much funds could be made available to authors from the revenues (which would dry up on becoming open access of course). Nor is the above piece transparent – assume “recent events” relate to Peter Gøtzsche, but it’s not clear. You’ve asked people to sign up, but to what? For example what is the proposed next stage for this petition or changing the organization? How does the group propose to tackle the charity legal aspect?
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Hi Emma
We really appreciate you taking the time to comment. I guess what we’re putting forward is a broad manifesto for change and we wanted to gauge people’s support for that. We obviously hope that whoever is elected to the Governing Board will also support these four goals and work to engage and involve the whole Cochrane membership to achieve them. Only 4% of members voted last time, and this petition has been a way to try and increase the numbers engaging, having their say and voting, which can only be a good thing. In an organisation which relies so much on the goodwill, skills and time of thousands of volunteers for such an important goal of improving healthcare, they should have more say on who governs the organisation, and what issues are prioritised. Jos explained of course that this is related to the expulsion of Peter Gotzsche, as it is that which has led to the need for an election. And the need for open and honest discussion amongst Cochrane members about where to go next. As you say, this has not been happening, despite members being provided with a forum.
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I think it was a wise decision to expel Peter Goetzsche. He has caused much harm to the Collaboration and patients.
PS. I have chosen to be anonymous because I have noticed that this opinion caused violent reactions. Talking about openness and freedom of speech…
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Dear anonymous person. Thank you for your comment. Please let us know if something happened to cut you short so that we can post the full comment.
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Dear Anonymous Person, I disagree with you that the decision to expel Peter Goetzsche was a wise decision. I think it was the opposite of a wise decision whichever way you look at it. As you have noticed, it has completely poisoned the debate with only black or white views. It will take a long time before that will be repaired. Even when you disagree with Peter’s opinions, you must see the enormous collateral damage that this decision has caused to Cochrane. Many people doubt if Cochrane is still a trusted source of evidence now that a fierce critic of the pharmaceutical industry has been expelled. I wonder if that can be repaired.
Whatever you would like to call the decision, it is most certainly not wise.
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Thank you for your reply. I agree that things now have become more black or white, but still I think it was wise to expel Peter Goetzsche, because he was harming the Collaboration. He had been warned before regarding inappropriate behaviour.
The way he argues with people is not appropriate and not respectful, and there is never room for a scientific discussion. To me he acts like a tabloid researcher promoting his books and creating fear among patients. He acts far beyond his clinical skills: he has not been in clinical medicine for the last 25 years and has no experience with psychiatry. Nevertheless, he calls in severe psychiatric patients and tells them to drop all their psychiatric medication. This is potentially dangerous, and this he should leave to a psychiatrist. I agree that Cochrane told him not to spread the message that all psychiatric patients should drop their medication as a ‘Cochrane’ recommendation.
I do not know why Peter Goetzsche never mentions his competing interests.
He has been full-time employed by Astra for several years, has received travel grants from GSK, and currently sells many books for his own profit and therefore is clearly biased towards ‘sensational results’.
Just a few points why I think the Cochrane Collaboration benefits from moving on without Peter Goetzsche.
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And Cochrane should continue expelling those with bad behaviour. It would be easy with a list of examples of what they are. Zero tolerance for nose-picking is warranted. We want a strong Cochrane, we need to protect the brand.
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I am happy to reply to Emma Dennett. Thanks very much for responding to the blog of the 4 issues Emma. This is highly appreciated. Yes, you are right we could have been more straightforward about the recent events meaning the expulsion of Peter Goetzsche. However, we were quite frustrated with this debate as it was a sort of black or white, for or against him or for or against the board. Our feeling was that this wasn’t very helpful. Instead of discussing persons, we would like to discuss issues.
You ask for evidence that these four issues are really issues. Ok, let’s have a look. Issue 1: Culture of open discussion. The statements made by the board at the AGM and later in the webinars, were in my view the opposite of this. I felt very uneasy, as apparently many other people did, in this debate.
Issue 2: Refocus on the heart of Cochrane reviews and methods. I haven’t seen financial support for our priority reviews or financial support for priority methods. I am struggling with the use of Covidence in my reviews which is Cochrane’s preferred tool for doing reviews. The data extraction and RoB features of this tool are not very user-friendly to say the least. How come that a tool that is not ready is Cochrane’s preferred tool. Can’t Cochrane make these things happen?
Issue 3 member engagement. In the latest elections 450 out of 11 500 members voted for the highest decision-making body in Cochrane. To me this sounds as that there is no basis for the board among the members, which is not good.
Issue 4: Find a better business model. Yes, I agree that this is not easy but that is then one reason more to discuss how we want to do this. Do we really want to be dependent on a subscription-fee model with a commercial publisher, where the whole world wants Open Access?
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I think it would be a wise decision if the remaining members of the Governing Board resign as soon as possible. They have caused much harm to the Collaboration and patients.
PS. I have chosen to be anonymous because I have noticed that this opinion caused violent reactions including people being humiliated by the governing board. Talking about openness, freedom of speech and zero tolerance…
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I don’t believe the Peter episode is undermining Cochrane. Thankfully that belief was confirmed when I was talking to some other people in publishing last week. I think people within Cochrane are scared to talk about how Peter has treated them personally, and are worried about undermining Cochrane further. This exactly mirrors what is going on in the wider world at the moment – people who have abused their platform to air their views are finding that their platforms are wobbling.
It’s easy to criticise people such as the Central Executive as is happening here, especially those who are seen as ‘bureaucratic’ in this world where academics rule the roost, but central Cochrane do a lot of work that was previously done unpaid (or not at all) as part of the unsustainable and wasteful committee structure. It is right that policies are made for all CRGs to implement and that open access is negotiated internationally by one dedicated team rather than individual CRGs. And we must keep contributing knowledge and asking searching questions within the structure we have made together.
Some good nominees for the Governing Board – so looking forward to the next exciting chapter.
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You are right, many individuals had run-ins with Peter but the majority of people within Cochrane don’t even know him personally. They know his work and they know him as a brilliant researcher. Cochrane, so far, has failed to explain to these people why Peter was expelled. The statements that Cochrane released are so vague that they raise more questions than provide answers. Most people who contribute to Cochrane are involved in Cochrane only peripherally. They are looking for a clear, quick and transparent answer why Peter was expelled. “Bad behaviour” is ridiculously vague and it just seems as if Cochrane is hiding something which, in turn, leads to all kinds of rumors and speculations about industry pressure.
So by now I think the crisis is larger than Peter, it is also about how Cochrane has been handling this. The communication strategy has been far from good and to persistently claim that the documents (e.g., the counsel’s report) are still confidential when they are all in the public domain by now, is simply odd and out of touch with reality.
I agree with you that we should not bash the CET. They work hard and have a lot on their plates. But there is a rift now within Cochrane. Acting as if everything is business as usual is the wrong approach. People want to see changes as a consequence of this mess and Cochrane really needs a fresh start to overcome this rift.
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I am Auxi, I new in all of this , but I dont understand why we are not free to speak ???? Anonymus if you think your comments cause violent reaction ,please try to said differently to try avoid this reaction .
I was thinking all work together to improve , but I am not happy if the people to express his/her opinion need to be anonymus .
And to make changes we need to think in the present the pass is PASS only to see what happen to learn ………..
I hope we could work together Lets see
Have a good , sunny day
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