Has Cochrane lost its way?

The dust is not yet settling on Cochrane after it expelled one of its most high profile scientists and founding fathers. Peter Gøtzsche’s sacking and the resignation of four fellow Cochrane board members in protest has been held out by some as a symptom of a wider malaise at the heart of the international network. Cochrane, they say, has lost its way, its members increasingly disenfranchised from a corporate centre focused on income generation and “message control.”

The Cochrane Collaboration was founded by Iain Chalmers in Oxford in 1993 as a loose knit, international network of 77 researchers1 to help clinicians and others make informed decisions about drugs, surgery, and other interventions. It aimed to do this through “high-quality, relevant, accessible” systematic reviews of randomised controlled trials. Unpaid scientists would produce the reviews, governed by 10 principles, including “fostering good communications, open decision-making, and teamwork” and “minimising bias.” The questioning of orthodoxies and opposition to centralised control was fundamental to Cochrane’s ethos: Chalmers wore a T shirt bearing the words, “Challenge authority.” The international collaboration, he said, should be “committed to opposing any tendency for it to become dominated by any nation, institution, or individual.”

A quarter of a century later and Cochrane seems to be thriving. Membership is at 12 500 people2 and growing. Its income has doubled in the past four years to more than £8m (€9m; $10m). New Cochrane centres are opening in Asia and South America, expanding the collaboration’s global reach. The Cochrane Library boasts 7500 reviews, half of which are accessible without charge (up from 0.05% in 2013 and increasing by 1% a month), with the entire library free to 3.6 billion …