Intended for healthcare professionals

Rapid Response:

Cochrane: Time for an overhaul

Dear Editors

There are ongoing concerns involving the conduct of the Cochrane’s Governing Board relating to Peter C Gøtzsche's expulsion from the Board as well as the governance of its branding and products purporting to support evidence-based medicine.

Melanie Newman has done an excellent analysis of the current issues with Cochrane's credibility as well as future direction.

Her article reminded me of the classic episode of Yes Minister The Compassionate Society (Ref 1) in which the Civil Service (and the Union) are more interested in keeping the 'overworked' administrative staff employed churning out memos when there are actually no patients in a fictional St Edward's Hospital.

Similarly the core business of Cochrane in production of systematic reviews has been relegated to becoming "a machine, churning out reviews," in part due to how Cochrane is assessed (by the UK's National Institute for Health Research responsible for its funding) based "on how many reviews it produced rather than their impact".

Tom Walley's assertion that “Cochrane should focus less on quantity and more on methodologically high quality reviews in areas of importance to patients" rings true for many clinicians, particularly those who feel that the nature of the review does not address their (and their patients') practical concerns, hence the alienation and disengagement of these key stakeholders in healthcare.

No doubt many of the recent systematic reviews are performed to essential core standards but the delivery of the messages regarding the findings could have been far more engaging and practical at the grassroots level than it has been so far.

This, coupled by the 'ivory towers' perception of Cochrane by various healthcare providers at the coalface, has already weaken its credibility; the civil war involving governance, corporatisation and conflicts of interest in the manner involving industry interaction now suggest the spirit of 'Collaboration' is now replaced by disillusionment, disenchantment and discontentment amongst its key supporters.

Trish Greenhalgh may not think there is "a crisis of either morality or democracy" but suggests "it gets its house in order" (ref 2); she does not appear to have openly changed her stance since her blog in Sept 2018.

I, on the other hand, think Cochrane's branding had taken a serious blow (and one which may prove to be fatal if the current direction its Board has taken is not corrected).

Certainly, Cochrane will need to sort itself out through a rebirth to its core before it can seek to lead again in the pursuit of Evidence Based Medicine.

References:

1. https://en.wikipedia.org/wiki/The_Compassionate_Society
2. https://blogs.bmj.com/bmj/2018/09/17/trish-greenhalgh-the-cochrane-colla...

Competing interests: No competing interests

07 January 2019
Shyan Goh
Orthopaedic Surgeon
Sydney, Australia