Evidence-based medicine group in turmoil after expulsion of co-founder

A bitter dispute with one of its co-founders has plunged Cochrane, an international network of scientists promoting evidence-based medicine, into a crisis on the eve of an international gathering that marks its 25th anniversary. Late last week, a narrow majority of the organization's Governing Board apparently decided to end the Cochrane membership of Peter Gøtzsche, director of the Nordic Cochrane Centre in Copenhagen and a member of the board himself, for causing "disrepute" to the organization. Four other board members then resigned in protest.

Gøtzsche announced his own expulsion in a three-page statement issued on Friday that said Cochrane was going through a "moral governance crisis."

In a phone interview with Science , Gøtzsche speculated that some foundations funding the collaboration had pressured it to get rid of him because of his highly critical views about pharma. He says he had become increasingly unhappy with what he describes as a "more commercial and more industry-friendly direction" in the organization. Gøtzsche had also launched a broadside against a favorable Cochrane analysis of vaccines against human papillomavirus (HPV), charging it may have overlooked side effects—a position embraced by antivaccine groups.

"As most people know, much of my work is not very favourable to the financial interests of the pharmaceutical industry," Gøtzsche said in his statement. "Because of this Cochrane has faced pressure, criticism, and complaints. My expulsion is one of the results of these campaigns." Gøtzsche says he does not have "a personal issue" with Cochrane CEO Mark Wilson but says many of the problems have gotten worse since Wilson arrived in 2012.

Wilson did not respond to an interview request today; neither did the Governing Board's two co-chairs, Martin Burton and Marguerite Koster. Burton referred the inquiry to a Cochrane spokesperson, who did not answer emailed questions today. A short statement from Burton and Koster on Saturday did not mention Gøtzsche by name or the expulsion, but it said the board had "considered … the findings of an independent review and additional complaints related to the conduct of a Member." They said this was "an ongoing process" and that more details would follow.

Gøtzsche's expulsion was confirmed by the four resigning board members in a statement sent to Science by one of them, Gerald Gartlehner of Danube University in Krems, Austria. "We consider the Board’s use of its authority to expel Peter from Cochrane to be disproportionate," says the statement, which did not explain what Gøtzsche was punished for. "We believe that the expulsion of inconvenient members from the Collaboration goes against Cochrane ethos and neither reflects its founding spirit nor promotes the Collaboration’s best interests."

The drama unfolded just as almost 1300 scientists from 57 countries were beginning to gather in Edinburgh for the Cochrane Colloquium, an annual scientific meeting that officially opened today. Cochrane, formerly known as the Cochrane Collaboration, is a nonprofit organization that produces literature reviews on medical interventions and diagnostics, which are published in the Cochrane Library to help medical professionals make evidence-based decisions. Gøtzsche helped found the organization in 1993 and started the Nordic Cochrane Center that same year. Today, Cochrane has a network of many thousands of volunteer reviewers as well as independent Cochrane Groups in 43 countries; it does not accept industry money, but it is supported primarily by government agencies, including the U.S. National Institutes of Health and the U.K. National Institute for Health Research.

If they can't tolerate a few disagreements or a few headaches, that is a problem. David Hammerstein Mintz, former Cochrane Governing Board member

Both within and outside of Cochrane, Gøtzsche is widely known for his fierce attacks on the pharmaceutical industry and his criticism of medical interventions he deems useless or harmful. He wrote a controversial book about what he says is the overuse of mammography in breast cancer screening, and, in another book, likened the pharmaceutical industry to "organized crime."

He has often been critical of Cochrane as well. In a statement written for his 2017 election to the board, Gøtzsche listed a litany of "pretty widespread concerns" he wanted to address, including the concentration of power at the Central Executive Team in London and the fact that "collaboration" had been dropped from the group's name. "The Cochrane Collaboration is now run much more as a business with a brand than it was just a few years ago," he wrote.

Gøtzsche says the co-chairs convinced a majority of Cochrane’s board of the "disrepute" charge during a 6-hour meeting on Thursday that Gøtzsche was asked not to attend. All other 12 board members attended; of those, six supported a decision to remove Gøtzsche, five opposed it, and one abstained, according to the statement by the four departing members. One source with knowledge of the proceedings wrote in an email to Science that co-chairs justified his expulsion "in a very generic, general manner by his 'behaviour' that hurt the image of Cochrane."

Gøtzsche says the decision is likely related to a frontal attack on a Cochrane review about vaccines against HPV, a cancer-causing virus, that he and two co-authors published in July. The review, published in May in the Cochrane Library by researchers from Belgium and the United Kingdom, supported the mainstream view that such vaccines can prevent precancerous lesions in adolescent girls and young women. In their criticism, published in BMJ Evidence-Based Medicine , Gøtzsche, together with Lars Jørgensen of the Nordic Cochrane Centre and Tom Jefferson of the University of Oxford in the United Kingdom, argued that the review "missed nearly half of the eligible trials," "ignored evidence of bias," and did an incomplete assessment of the vaccine's side effects. The review didn't constitute the "trusted evidence" promised in Cochrane's official motto, they said.

After an investigation, Cochrane Library editors acknowledged in a 30-page response that the review had missed some trials, but said this made little or no difference to the main outcome and that the criticism was wrong on many other points. "There is already a formidable and growing anti-vaccination lobby. If the result of this controversy is reduced uptake of the vaccine among young women, this has the potential to lead to women suffering and dying unnecessarily from cervical cancer," they wrote. In a response published on Friday, the editors of BMJ Evidence-Based Medicine defended publishing the trio's broadside, saying it "provokes healthy debate."

"Academic freedom means communicating ideas, facts and criticism without being censored, targeted or reprimanded," they argued.

Within a scientific organization such as Cochrane, discussion and dissent should be possible, says David Hammerstein Mintz, a consumer advocate, former member of the European Parliament from Spain, and one of the four departing board members. "If they can't tolerate a few disagreements or a few headaches, that is a problem," he says.