The Cochrane Tapes
By Maryanne Demasi, PhD
Three years ago, a scandal erupted within the Cochrane Collaboration, the world’s most prestigious scientific organisation devoted to independent reviews of health care interventions.
One of its highest profile members, Prof Peter Gøtzsche, was sacked from the Governing Board, amid growing tension over Cochrane’s shift towards a commercial business model approach, away from its true roots of independent, scientific analysis and open public debate.
The controversial decision to revoke Gøtzsche’s membership, a position in which he had been democratically elected, provoked the immediate resignation of four other Board members.
Thirty-one 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.
In 2019, Gøtzsche published a tell-all book detailing what he described as Cochrane’s “moral collapse.” At the root of the problem he blamed the CEO Mark Wilson, who has since resigned after 9 years at the helm, citing “personal reasons”.
There has been continued speculation about what really happened in the boardroom that day in Edinburgh. Leaked audio recordings reveal the events that unfolded, raising questions about the conduct of Cochrane’s Board, and the legitimacy of Gøtzsche’s expulsion.
This is what can be revealed on The Cochrane Tapes.
Gøtzsche faces the Board
A meeting of the Trustees of Cochrane was convened in Edinburgh, to resolve an ongoing dispute between Gøtzsche and Cochrane’s CEO, Mark Wilson.
Cochrane had hired an independent Counsel to conduct an internal investigation into the dispute. The findings of that report are about to be discussed.
As the meeting commences, co-chair Martin Burton instructs Board members on how to audio record the meeting on their computers.
Co-chair Marguerite Koster acknowledges the “time crunch”, referring to the expeditious nature of the investigation by Counsel, whose report was delivered to the Board members only twelve hours prior to the meeting.
All Board members are expected to have properly reviewed the case. However, they have not, with one Board member saying they had not received all the documents.
Nonetheless, the meeting continues.
The co-chairs have been instructed by Cochrane’s lawyers to ask Gøtzsche one question and then give him “five minutes” to respond before asking him to recuse himself. The question is a direct one:
“Peter, do you accept the contents of this report?” asks Koster.
But, it is not a simple ‘yes or no’ answer for Gøtzsche. Koster repeats the question a couple more times before compelling a response.
“No”, says Gøtzsche who proceeds to point out his areas of disagreement.
After two minutes and two seconds, Koster interrupts Gøtzsche and continues to do so until she receives a stern rebuke from one of the other Board members:
“Given that Peter has not been able to speak more than 30 seconds without being interrupted would you at least allow him to ask a few questions?” says the Board member to Koster.
Gøtzsche continues to plead his case to the co-chairs. “It’s not prudent of you to treat me this way. I’m just the messenger”, he says.
Gøtzsche fires off more questions, provoking Burton to respond:
“I intend to say nothing on this. I wish as the Chair to record my objection to this. The lawyers advised that we should ask him the question, we’ve asked him, given him five minutes. It is now 10 or 15 minutes and I think this is an abuse of process,” says Burton.
“You must understand, Cochrane is in deep trouble and the world is watching what you’re up to,” Gøtzsche warns the members.
Koster demands that Gøtzsche recuse himself from the discussion while the other Board members vote on how to move forward.
Gøtzsche complies, but not before saying, “This is looking more and more like a Kafkaesque process, don’t you realise this?”
The secret deliberation
Gøtzsche leaves the room and twelve Board members remain.
Burton, who was part of the dispute was not required to recuse himself, for reasons that remain unknown.
Koster provides an ‘Executive Summary’ of Counsel’s report and then opens for discussion.
Some Board members raise a complaint about the “selective” nature of the evidence that was submitted for investigation.
“Counsel did not see all the information and he doesn’t know what has been going on in Cochrane”, says one Board member in Gøtzsche's defence.
“They have a very narrow view of the documents”, adds another.
The discussion continues for several hours with intermittent breaks.
It is frank, robust and at times, tense.
It becomes evident however, that Counsel’s report will not give grounds for censuring Gøtzsche, so without this point of reference, the conversation turns to his “behaviour”.
“We have to do something about Peter’s behaviour. We cannot let it continue, it’s too costly,” says one member.
Much of the blame is put squarely on Gøtzsche’s public criticism of Cochrane’s HPV vaccine review. Gøtzsche and colleagues claimed Cochrane's review of the HPV vaccine was "incomplete and ignored important evidence of bias."
Some members of the Board were offended that Gøtzsche was “publicly trashing” Cochrane’s publication, saying that he “undermines the reputation of Cochrane” instead of keeping his scientific criticisms in-house.
Notably, there is no equivalent objection to Gøtzsche’s co-authors, Lars Jørgensen and Tom Jefferson in the Boardroom.
“[Gøtzsche] is going to push ahead and he’s going to say that Cochrane’s evidence is not trusted evidence,” says one member, strengthening the resolve to “get rid of him from the Board”, as Burton puts it.
Other members in the room disagree, saying that publicly debating science is necessary to “enrich the reputation of Cochrane” and that the impact of Gøtzsche’s criticism was a “drop in the ocean” compared to the “tidal wave” of mainstream media support for Cochrane’s HPV review.
Burton wants to avoid the perception that Gøtzsche is being ousted from Cochrane because of his criticisms of the HPV vaccine review, so he workshops ideas with the Board.
“We have the option to say [publicly] that there were a series of other events and that it is absolutely not just the HPV review”, says Burton.
Gøtzsche has opponents on the Board. They accuse him of being a “bully”, saying that action needs to be taken to “protect employees and enable a safe working environment”.
No evidence is presented to the Board to substantiate bullying allegations but there are threats of resignation if Gøtzsche is not properly dealt with.
After several hours of roaming the hallway, Gøtzsche becomes impatient and knocks on the door.
Burton opens the door but blocks it and tries to prevent Gøtzsche from saying anything to the Board. Gøtzsche barges one step into the Boardroom, accidentally bumping into Burton on the other side of the door.
“Don’t push me” says Burton with an accusatory tone.
“I’m sorry. I have a question," says Gøtzsche making inquiries about how long it would take.
"This is unacceptable. I have been out the door for four and a half hours,” he says before telling the Board he would return to his hotel room.
Burton shuts the door and complains of a bruised arm. It’s not clear if he will escalate the situation.
“There’s no reason why we can’t call the police”, says one member in support of Burton.
“They would laugh at us”, replies another, signalling its triviality.
There’s some sympathy for Gøtzsche in the room.
“We have to keep in mind how much we’ve been pushing him in the last couple of years. If you push me that far, I’d lose my temper,” said one member.
The member points out the double standards being applied to Gøtzsche and proceeds to tell the Board about a physical altercation that they had six months earlier with Cochrane’s CEO Mark Wilson.
“Mark [Wilson] lost his temper, he shouted at me, he assaulted me, he called Peter a liar and we’re excusing that?” recollects the Board member. Nothing comes of it.
Gøtzsche’s enormous contribution to science is acknowledged.
But then the conversation takes a dark turn. Board member Catherine Marshall, [now current co-chair] on more than one occasion, assimilates Gøtzsche to the MeToo movement, referencing the history of influential men whose “bad behaviour [is] overlooked and indulged”.
Burton even draws parallels between Gøtzsche and Kevin Spacey, an accused sexual predator who did “wonderful work” but says that sometimes, “you’ve just got to call them out”.
Some Board members warn Burton against implying that Gøtzsche had “criminal” behaviour.
These warnings went unheeded. The defamatory insinuation made its way into Burton's speech at Cochrane’s Annual General Meeting a few days later.
Burton made an announcement about Gøtzsche, to over a thousand people in an auditorium;
“We are living in a world where behaviours that cause pain and misery to people, are being ‘called out’”, leaving many with the impression that Gøtzsche’s “bad behaviour” might have been criminal in nature.
Gøtzsche rejected the claims unreservedly and sought legal advice for damages.
A distraction from the real issues at Cochrane?
As the deliberations at the Board meeting continue, several members refuse to get drawn into the distraction from the “real issues” like the move to impose greater restrictions on Cochrane Centres and the organisation’s lack of pluralistic, scientific debate.
One member delivers an impassioned speech to the Board:
“Every single conflict between the central executive board and Peter is about an issue where the central executive board takes the side of the pharmaceutical industry. And I can document this,” says the Board member.
Gøtzsche’s track record of publicly condemning the drug industry’s criminal behaviour has attracted a “history” of complaints to the Board and punishing Gøtzsche for expressing his scientific views plays right into the hands of the drug industry.
“Industry will be elated,” says the concerned member, warning that Cochrane was setting a dangerous precedent whereby industry representatives only had to “write a complaint to Cochrane and then Cochrane caves in under the pressure”.
When Burton suggests that Gøtzsche has breached the Code of Conduct for Trustees, one member requests clarity about what behaviour warranted the breach.
“Can we be more specific?” asks the Board member but Burton dismisses the request and replies, “We don’t need to be more specific.”
As the discussions continue, two things become clearer. One, there will be no further detail to the generic claims against Gøtzsche. And two, despite this, the co-chairs appear resolute in their objection to Gøtzsche’s continued service to Cochrane.
The leaked recordings reveal much about the process applied to Gøtzsche.
Board members had insufficient time to digest and assess the independent report. Gøtzsche is prosecuted in the room with generic and ambiguous claims made about his character, without an opportunity to contest.
Burton’s position is clear. He says Gøtzsche needs to go or else he will continue to “misbehave”.
One Board member suggests a formal mediation or arbitration to handle the dispute peacefully, to which Burton responds, “personally, I don’t think that’s an option”, pointing to the burden of costs.
Amidst the discussion about Gøtzsche’s alleged “bad behaviour”, a procedural issue goes unnoticed.
Gøtzsche was required to recuse himself after levelling complaints against Wilson and Burton.
Yet, Burton remains in the Boardroom, he takes an active part in the discussions and is offered untimed opportunities for defence of claims made against him. He is also afforded access to ‘on call’ legal assistance.
Burton is inexorably involved in the conflict. He was interviewed by Counsel and conclusions were drawn about Burton’s character and credibility as part of the investigative report, which mentions Burton 42 times.
Why did Burton not recuse himself during those deliberations? Why did Cochrane’s in-house lawyers not advise Burton to recuse himself too? Or did they?
The public punishment
Considerable time is spent discussing how Cochrane can publicly explain Gøtzsche’s sudden exit. The co-chairs suggest a way to “force retirement” in order to “save face” with an agreement that is “legally robust” and one that Gøtzsche cannot “wriggle out of”.
Some members try to warn Burton that the punishment is “disproportionate”. One says Gøtzsche is a “scapegoat” and objects to the Board taking “the nuclear option”. Another member says “this is like capital punishment” and some are concerned that this level of censure is usually reserved for people who commit crimes in the workplace.
The co-chairs maintain they have been “scrupulous” and “impartial”, but this is likely to be challenged. Koster accuses Gøtzsche of being part of the “old regime”, “a dinosaur” who needs a “baby sitter” to manage him.
Burton addresses the Board:
“We can have as much huffing and puffing as we want, but as far as I’m concerned, he needs to leave the collaboration and have his membership taken away,” says Burton.
The final vote
Gøtzsche’s fate is sealed, he loses by one vote. But Burton is still troubled.
“So it’s a majority of one. Very disappointed with that indeed,” says Burton annoyed with the support for Gøtzsche in the room.
If Burton had abstained, which might have been expected in this case, the final vote would have been tied. In the event of an ‘equality of votes’ under the Articles of Association the ‘Chair’ has a second or casting vote.
Koster would have cast the deciding vote. However, the outcome of such a vote will never be known since it is not possible to quantify Burton’s influence on the Board’s decision that day.
The day after Gøtzsche’s ousting, four more board members resigned in protest, but not before they all received an email Mark Wilson’s senior advisor. It read:
“Martin [Burton] has asked that if any of you recorded the meeting yesterday, you give me the recording when you next meet and delete it from your computers”.
One Board member refused to comply with the CEO’s instructions to delete a record of the meeting, and now a transcript of The Cochrane Tapes is available here.
It is difficult to quantify the damage to Cochrane’s reputation in the wake of this scandal, but a review of Gøtzsche’s book sums it up;
It’s a “dark period in medical science where, a once trusted institution, carried out one of the worst show trials ever conducted in academia. The CEO and his collaborators went about their task in a manner that mirrors how the drug industry operates.”
DISCLOSURE: I was a researcher at the Nordic Cochrane Centre, a collaborator with Prof Peter C. Gøtzsche and was present in Edinburgh at the time of the Board meeting.