Intended for healthcare professionals

Rapid response to:


HPV vaccine safety: Cochrane launches urgent investigation into review after criticisms

BMJ 2018; 362 doi: (Published 09 August 2018) Cite this as: BMJ 2018;362:k3472

Rapid Response:

Cochrane HPV vaccine review severely compromised by conflicts of interest

Further to my previous comment re the Cochrane HPV vaccine review and the undisclosed conflicts of interest of the CDC's Lauri Markowitz.

On 17 August 2018, Cochrane Editor in Chief Dr David Tovey responded to me saying "Dr Markowitz withdrew as an author on the review between the protocol and review stage".

However, under the Contributions of Authors section of the Cochrane HPV vaccine review, Lauri Markowitz is listed for her participation in the conception of the systematic review, writing of the protocol, and critical review of the manuscript. In the Acknowledgements, Lauri Markowitz is specifically acknowledged for "her invaluable advice and contributions by reviewing the results and discussion sections".

I suggest the Acknowledgements show that Lauri Markowitz has in fact been a very influential participant in this Cochrane HPV vaccine review, if not a listed author.

Questions remain unanswered by Cochrane, i.e.

- How and why was Lauri Markowitz's original participation in this Cochrane review approved by Cochrane?

- Who initiated the Cochrane HPV vaccine review protocol?

Lauri Markowitz has significant conflicts of interest via her employment with the Centers for Disease Control & Prevention (CDC), her involvement with the promotion of HPV vaccination, and her publication of papers on the subject of HPV vaccination.

In the protocol for this Cochrane review, published in December 2013, Lauri Markowitz formally declared "no conflict of interest" in the Declarations of Interest section. I suggest this was misleading as Lauri Markowitz demonstrably does have conflicts of interest in regards to HPV vaccination.

In their comment on the 2013 protocol, published in 2014 (which now appears to be difficult to access online), Catherine Riva et al pointed out Lauri Markowitz's conflicts of interest, i.e. her employment with the CDC and her support of HPV vaccination, including via her participation as an author in continuing education programs for medical practitioners, i.e. HPV Vaccine: A Shot of Cancer Prevention, supported by Merck.[1]

It's notable that Lauri Markowitz's conflicts of interest have still not been disclosed under Declarations of Interest in the recently published Cochrane HPV vaccine review.

As I argued in my previous comment, this Cochrane HPV vaccine review is severely compromised. It is demonstrably not independent and cannot be trusted.

It's remarkable that Cochrane have got this so spectacularly wrong. They've really undermined their whole ethos, i.e. to provide unbiased information.

As a citizen interested in HPV vaccination, I do not trust this Cochrane review.

It's unconscionable that an important review so open to suspicion of bias or conflicting interest might influence vaccination policy.

The Cochrane HPV vaccine review should be withdrawn.

1. In their comment on the Cochrane HPV vaccine protocol, Catherine Riva et al include reference to CME/CE HPV Vaccine: A Shot of Cancer Prevention, as hosted on Medscape, 2012-2013:

Competing interests: No competing interests

17 September 2018
Elizabeth Hart
Adelaide, South Australia