BMJ  2006;333:916 (28 October), doi:10.1136/bmj.333.7574.916-a

Letter

Cochrane reviews v industry supported meta-analyses

Has Cochrane really achieved its goals?

EDITOR—I am amazed that the BMJ chose to publish this review, given its small sample size yet broad conclusions.¹ I believe that if the results had been in the other direction it would be less likely to have been published.

It is true that Cochrane reviews report specific items more thoroughly than journal based reviews. However, much of this is due to the insistence of addressing methodological issues which are specious at times and the fact that Cochrane reviews are not limited by page length. For example, the issue of reporting allocation concealment, although it makes sense, does not mean that if not reported it was not done,² nor does it even consistently demonstrate that it is an important methodological issue to report.³

It is disappointing that the Cochrane Library has become an ivory tower, given that many of the reviews are out of date and methodologically weak. The Cochrane Library was established to be a clinically useful resource, but is that really true? There are many Cochrane reviews that would not be published in a paper journal, as they contain zero or just a few trials. There are far too many Cochrane reviews stating that, although upwards of 10 trials were found, the reporting is poor and therefore more research is required before a clinical recommendation can be made. Do you really think it is useful to say that several trials do not permit an inference on effectiveness?

The pharmaceutical industry is an obvious target for attack, and this amounts to little more than bullying. Pharma has an obvious conflict in wanting to publish favourable results. Why does the Cochrane group not go after the agencies claiming to promote health for the goodness of all, but mismanaging money and misusing evidence, such as the World Bank or World Health Organization^{4 5}—not targets that are so uniformly accepting of criticism.

Mount Sinai Hospital, New York, NY 10029, USA mtostad{at}mail.com

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Competing interests: None declared.

References

1. Jørgensen AW, Hilden J, Gøtzsche PC. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review. BMJ 2006;333: 782-5. (14 October.)[Abstract/Free Full Text]
2. Devereaux PJ, Choi PT, El-Dika S, Bhandari M, Montori VM, Schunemann HJ, et al. An observational study found that authors of randomized controlled trials frequently use concealment of randomization and blinding, despite the failure to report these methods. J Clin Epidemiol 2004;57: 1232-6.[CrossRef][ISI][Medline]
3. Balk EM, Bonis PA, Moskowitz H, Schmid CH, Ioannidis JP, Wang C, et al. Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials. JAMA 2002;287: 2973-82.[Abstract/Free Full Text]
4. Attaran A, Barnes KI, Bate R, Binka F, d'Alessandro U, Fanello CI, et al. The World Bank: false financial and statistical accounts and medical malpractice in malaria treatment. Lancet 2004;363: 237-40.[CrossRef][ISI][Medline]
5. Attaran A, Barnes KI, Curtis C, d'Alessandro U, Fanello CI, Galinski MR, et al. WHO, the Global Fund, and medical malpractice in malaria treatment. Lancet 2006;368: 247-52.[CrossRef][ISI][Medline]

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Related Article

Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review

Anders W Jørgensen, Jørgen Hilden, and Peter C Gøtzsche
BMJ 2006 333: 782. [Abstract] [Full Text] [PDF]