BREAKING: Did Cochrane sacrifice its researchers to appease critics?

Authors of the latest Cochrane review angered by Cochrane's capitulation to pressure from critics

The recent Cochrane review on physical interventions (including face masks) and my subsequent interview with its lead author Tom Jefferson have - to put it mildly - ruffled a few feathers.

It is now the most downloaded review in the Cochrane Library with the highest altimetric score in Cochrane’s history.

The review concludes that wearing masks in the community probably makes little or no difference to influenza-like or covid-19-like illness transmission.

Put simply, Jefferson said, “There is just no evidence that they (masks) make any difference. Full stop.”

It was enough to stoke the ire of long-time mask advocate, and New York Times columnist, Zeynep Tufekci, who published a rebuke of Jefferson’s comments in her recent opinion article titled, “Here’s why the science is clear that masks work.”

Tufekci argued that despite no high-quality data, we could conclude, based on poor evidence, that masks do work.

Tufekci also reached out to Cochrane for comment, and presumably, pressured Cochrane into publishing a statement on its website.

In the statement, Karla Soares-Weiser, Editor-in-Chief of the Cochrane Library said that commentators had made “inaccurate and misleading” claims about the study and that wording in the summary of the review “was open to misinterpretation, for which we apologize.”

Cochrane’s statement was interpreted widely as an “apology,” and in some cases, tweeters believed the review was “retracted”.

Soares-Weiser indicated that Cochrane was engaging with the authors of the study to update the wording to “make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.”

Jefferson’s reaction

The release of the Cochrane statement was sudden and unexpected.

When I reached out to Jefferson for comment, he said he was given “little workable notice” before Cochrane published its statement and the authors had no clue what the statement would entail, prior to its publication.

“It was upsetting,” said Jefferson. “Cochrane has thrown its own researchers under the bus again. The apology issued by Cochrane is from Soares-Weiser, not from the authors of the review.”

An emergency meeting with the authors of the review was convened today, to discuss a plan of action. I am told they “all reached an agreement”.

“We’ve decided that we are going to write to Cochrane leadership and complain about the way this has been handled. We will answer legitimate comments on the Cochrane webpage, through our comments editor, which is the tried and tested way of handling criticisms,” said Jefferson.

“In this instance, Soares-Weiser has gone outside the normal channels and made decisions without any consultation with the authors of the review. It is unacceptable,” he added. 

“I will also be addressing the lies told in the media, for example, Forbes which falsely claimed that I was an employee of the Brownstone Institute,” said Jefferson.

“I will also contact the New York Times about the article where Tufekci used her platform to attack my credibility. She mentioned my name six times in her piece, despite there being multiple authors on the Cochrane review. She has no track record of publishing original research on acute respiratory illnesses, and it appears that if she does not like what’s in the review, it’s open season on the scientists,” said Jefferson.

The Cochrane authors say they will not buckle under the pressure of Cochrane leadership. 

“We are the copyright holders of the review, so we decide what goes in or out of the review.  We do not change our reviews on the basis of what the media wants,” said Jefferson on behalf of the authors.

“I think Soares-Weiser has made a colossal mistake. It sends the message that Cochrane can be pressured by reporters to change their reviews. People might think, if they don’t like what they read in a Cochrane review because it contradicts their dogma, then they can compel Cochrane to change the review. It has set a dangerous precedent,” added Jefferson.

Soares-Weiser was contacted for an interview, but did not respond.

I also contacted the Committee on Publication Ethics (COPE), which is a forum for editors of peer-reviewed journals to discuss issues related to the integrity of the scientific record.

I enquired about Cochrane’s handling of complaints related to the latest review, but they did not respond before the publication deadline. On reading COPE guidelines for handling post-publication critiques, it would suggest that Cochrane is in breach of the guidelines. It states:

…journals must allow for post-publication discussion on their site, through letters to the editor or on an external moderated site. Post-publication discussion typically starts with a reader’s critique of an article that a journal has previously published. When formally submitted for journal publication, such critiques are commonly known as ‘letters to the editor’, ‘commentaries’, ‘comments’ or other types of ‘correspondence’.

History repeats

Cochrane has a history of capitulating to pressure when researchers in the organisation come to scientific conclusions that are controversial.

In 2018, Danish professor Peter Gøtzsche was sacked from Cochrane’s Governing Board.

His critiques of mammography screening and the overuse of psychiatric drugs landed him in hot water with Cochrane’s leadership, but his criticism of Cochrane’s 2018 HPV vaccine review, was the final nail in the coffin.

Gøtzsche, together with Jefferson and another researcher, published a blistering critique of Cochrane’s HPV vaccine review, stating it excluded nearly half the relevant trials and incompletely assessed certain adverse events and safety signals.

They concluded:

Part of the Cochrane Collaboration’s motto is ‘Trusted evidence’. We do not find the Cochrane HPV vaccine review to be ‘Trusted evidence’, as it was influenced by reporting bias and biased trial designs. We believe that the Cochrane Review does not meet the standards for Cochrane Reviews or the needs of the citizens or healthcare providers that consult Cochrane Reviews to make ‘Informed decisions’, which also is part of Cochrane’s motto. 

Confronting an international uproar, with claims that the criticism would lead to thousands of deaths from reduced uptake of the HPV vaccine, Soares-Weiser co-authored a 30-page rebuttal with then, editor-in-chief David Tovey, and published it on Cochrane’s website saying that Gøtzsche and Jefferson made “unjustified claims” and “substantially overstated its criticisms.”

At the time, insiders speculated that Cochrane was motivated to appease its funders after being granted $1.15 million from the Bill and Melinda Gates Foundation, which widely promotes the use of HPV vaccines globally.

The controversial decision to revoke Gøtzsche’s Cochrane membership, a position in which he had been democratically elected, provoked the immediate resignation of four other Board members. All 31 of Cochrane’s Centre Directors from Spain and Latin America called for an independent investigation into the scandal. 

Coordinating editor of Cochrane Work, Jos Verbeek and other prominent scientists called for the entire Governing Board to resign and demanded that independent elections be held. 

But Cochrane remained defiant. Its leadership went on to ensure that Gøtzsche was stripped of his role as head of Denmark’s once famous Nordic Cochrane Centre, a legacy he built over 25 years.  I published an article in BMJ-Evidence Based Medicine titled, Cochrane: a sinking ship? detailing the events.

Cochrane has struggled to stay relevant throughout this pandemic and has experienced financial woes – ironically - Jefferson & colleagues’ latest Cochrane review has put the organisation back on the world map. With each download of the review, Cochrane is paid a small fee by its publisher, Wiley.

In August 2021, Cochrane’s major financial backer, the National Institute of Health Research (NIHR), announced that it would be withdrawing its infrastructure funding, which it provided to all UK Cochrane Review Groups.

The funding will cease on 31 March 2023, after which the groups’ editorial bases to support Cochrane Reviews to publication might disappear, so Cochrane is now shuffling the desks to adjust to the major change in activities.

Will this be what finally sinks this once grand institution? Time will tell.

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** UPDATE: The COPE responded to my media enquiry. It wrote in a statement:

The content of an article is the responsibility of the authors, and as such, any changes to that content should be done with their input and approval. Of course, superficial changes (copyediting) do not change the interpretation of the underlying content, and that is not a significant issue; however, changes to the interpretation and conclusions should not be done without consultation with the authors.