Concerns about Cochrane

[Kalliope]

Because he's not expelled yet. He has a week for responding to the remaining central/main board. Seems like no-one really knows what will happen to the leadership of the Nordic group if the descision is final, it's not just out of the board, but the whole of Cochrane he will expelled from. Is my understanding?

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

 

[inox]

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...?

The international Cochrane does not own the Nordic Cochrane Center, it is partly financed by the Danish government and also receives other contributions. Therefore, Peter Gøtzsche's exit from Cochrane's board does not affect his work at the Nordic Center.

(google translation)

 

[Kalliope]

But then the situation will be truly absurd...?

Yes, I think that's safe to say!

 

[inox]

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

I'm baffled at this bit:

In this context, it may be a problem that the voting percentage is often low in these choices. In the 2016/2017 elections, for example, submitted 1,223 votes out of 44,387 voters. It is apparent from a report on the election from Cochrane itself.

(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.

 

[Kalliope]

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.

 

[Jonathan Edwards]

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.

 

[Esther12]

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!

 

[inox]

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.

 

[Jonathan Edwards]

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

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.

 

[Snowdrop]

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?

 

[Jonathan Edwards]

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.

 

[Esther12]

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

 

[Hutan]

I found this page on the membership of Cochrane interesting. It sounds as though they have a new scheme for membership, whereby the completion of tasks earns you a certain period of membership. But for the first year, they gave everyone who has been involved with Cochrane a one year membership. That might explain why the percentage of disinterested members was so high.

https://join.cochrane.org/membership-terms-conditions

Also interesting to see that people who are employed by pharmaceutical and medical device companies can't be members.

 

[Sean]

From Esther12's link:

Psychologist Hannah Rothstein of Baruch College in New York City, a meta-analysis consultant who collaborated with Bushman in producing the 2010 meta-analysis, says she has not lost faith in the method—but she has changed her expectations. “We used to make meta-analyses as objective as possible. Now, we try to make them as transparent as possible,” she says. “Anyone who disagrees with a certain decision will have to be able to redo it and see if that has an influence on the results.”

https://www.sciencemag.org/news/2018/09/meta-analyses-were-supposed-end-scientific-debates-often-they-only-cause-more

Transparency is critical. Not enough on its own, but absolutely necessary.

We have a right to both know, and criticise, the methods being used.

 

[Jonathan Edwards]

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.

 

[alex3619]

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.

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.

 

[alex3619]

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

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

 

[Sasha]

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.

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).

 

[Kalliope]

A bit OT but as the theme is Cochrane and this is a patient forum, I thought someone here might be interested to have a listen:

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.


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

 

[Jonathan Edwards]

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).

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.