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September 19, 2018

This Cochrane board member has criticized pharma and psychiatry. Last week, he was expelled in a secret vote.

Daily Briefing

    The global clinical research review entity Cochrane last week voted to expel a board member who has been outspoken against the pharmaceutical industry—prompting four members to resign in protest a week before the group's annual gathering in Edinburgh.

    Understand what Cochrane does: Your cheat sheet to systematic reviews

    The board's controversial vote

    The vote to remove Peter Gøtzsche, director of the Nordic Cochrane Center in Denmark, who was elected to the board in 2017, occurred Thursday after a six-hour meeting that, Science Magazine reports, Gøtzsche was not invited to attend.

    During the meeting, Gøtzsche said the board's co-chairs, Martin Burton and Marguerite Koster, charged that Gøtzsche had caused the organization "disrepute." Ultimately, six of the 12 board members in attendance voted in favor of the expulsion, one abstained, and five opposed, according to a statement from the four members who resigned in protest.

    Although Cochrane initially provided few details on how Gøtzsche had caused "disrepute," a later statement from the Governing Board referred to "a 'zero tolerance' policy for repeated, seriously bad behavior." Without outlining any specific allegations, the statement said that complaints extended back to 2003 and included several new complaints in March of this year.

    Gøtzsche's controversial history

    According to STAT News, Gøtzsche has long been a "controversial" figure and is known for being critical of the pharmaceutical industry and the overuse of certain preventive care screenings, such as mammograms.

    In 2015, Gøtzsche argued that psychiatry had "gone astray" by encouraging patients to take potentially unsafe drugs, such as antidepressants, Science Magazine reports. "The way these drugs are used today cause[s] more harm than good. So it would be better for us if the drugs didn't exist," Gøtzsche said.

    Gøtzsche also has been critical of Cochrane itself, writing in his statement on his 2017 election to the board, "The Cochrane Collaboration is now run much more as a business with a brand than it was just a few years ago."

    This year, Gøtzsche, along with Lars Jørgensen from the Nordic Cochrane Center and Tom Jefferson from the University of Oxford, challenged a Cochrane review that supported the efficacy of an HPV vaccine in preventing precancerous lesions in girls and women.

    The criticism, which raised safety concerns about the vaccine, was published in BMJ Evidence-Based Medicine and said that the Cochrane review "missed nearly half of the eligible trials" and "ignored evidence of bias," Science Magazine reports.

    Gøtzsche in a statement released Friday wrote that Cochrane is experiencing a "moral governance crisis" and alleged that his criticisms of the pharmaceutical industry and growing displeasure with Cochran's "industry-friendly direction" caused the organization to "fac[e] pressure, criticism, and complaints" from funding foundations—and ultimately led to his expulsion.

    He wrote, "This unprecedented action taken by a minority of the Governing Board is disproportionate and damaging to Cochrane, as well as to public health interests."


    Four board members resigned in the wake of Gøtzsche's expulsion, writing in a statement that the decision could cause "great damage to the reputation of the Collaboration" and could have negative implications for the way scientific reviews are conducted.

    Other experts also expressed concern that Cochrane's decision could undermine free speech in science.  John Ioannidis of Stanford University said he is "disturbed" by the expulsion and said "it is important to make sure that people who disagree with us will get the most opportunity to express and support their views with arguments and evidence."

    However, some experts say the board made the right decision in expelling Gøtzsche. Allen Frances, chair of the Department of Psychiatry at Duke University, said that the move itself "ha[d] nothing to do with freedom of speech," but rather it protected Cochrane's dedication to remaining an "impartial evaluator of evidence."

    In its statement addressing the controversy, Cochrane's Governing Board wrote, "This Board decision is not about freedom of speech. It is not about scientific debate. It is not about tolerance of dissent. It is not about someone being unable to criticize a Cochrane Review. It is about a long-term pattern of behaviour that we say is totally, and utterly, at variance with the principles and governance of the Cochrane Collaboration" (Marcus/Oransky, STAT News, 9/16; Chustecka, Medscape, 9/17; Enserink, Science Magazine, 9/16).

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