Intended for healthcare professionals

Editor's Choice

Reinvigorating Cochrane

BMJ 2018; 362 doi: (Published 20 September 2018) Cite this as: BMJ 2018;362:k3966

Conflicts of interest and objective evaluation of medical products

In regards to the Cochrane crisis, Ray Moynihan says: "The much bigger crisis here is the threat to the reliability of healthcare evidence and public trust posed by the unhealthy financial entanglement between industry and those who evaluate and use its products."[1]

Exactly. Consider for instance the recently published Cochrane HPV vaccine review which is compromised by conflicts of interest.

Lauri Markowitz, an employee of the US Centers for Disease Control and Prevention who is involved in the promotion of HPV vaccine products, was an author on the original protocol for this Cochrane review, and reviewed the results and discussion sections of the final review.

I have challenged David Tovey, Editor in Chief of Cochrane, about Lauri Markowitz' involvement in this review since February 2016.

The CDC is a US government agency. As I detail in my recent rapid responses published on The BMJ, the US government benefits from royalties from the sales of HPV vaccines, via the US National Institutes of Health (NIH). (See my detailed Rapid Responses on Nigel Hawkes' BMJ article: HPV vaccine safety: Cochrane launches urgent investigation into review after criticisms: )

It's alarming that Cochrane reviews of vaccine products such as the HPV vaccines are being influenced by the promoters of these products, e.g. Lauri Markowitz of the US CDC.

With the ever-increasing number of vaccine products and revaccinations being added to vaccination schedules around the world, we desperately need independent and objective evaluation of these products. Vaccines more than any other product demand scrutiny as governments move to compulsorily impose these products on the community, as is happening in Australia, the United States, Italy and elsewhere.

While Ray Moynihan says "To see the future of Cochrane threatened foreshadows a disaster for all of us", I suggest we face a greater disaster if Cochrane is allowed to continue to give the green light to vaccine products via biased reviews, and thereby unduly influence vaccination policy.

In fact, does Cochrane plan to protect vaccine products from scrutiny in future? In November 2015, Cochrane announced it had closed the section which undertook systematic reviews of vaccine products.[2] It's remarkable that Cochrane decided that vaccine products do not merit objective evaluation, who at Cochrane decided to let vaccine products off the evaluation hook?

And how interesting that the recently favourable - and conflicted - Cochrane HPV vaccine review made it through to publication...

Cochrane is in crisis.

Can this compromised organisation be salvaged to return to its stated mission, i.e. to reliably provide the community with accurate and unbiased information to support informed decision-making?[3]

1. Ray Moynihan. Let's stop the burning and bleeding at Cochrane - there's too much at stake:
2.Closure of the Vaccines Field, November 18, 2015:
3. Cochrane - About us:

Competing interests: No competing interests

21 September 2018
Elizabeth Hart
Adelaide, Australia