Cochrane

Cochrane (previously called the Cochrane Collaboration) is an independent, non-profit organization run by volunteers around the world which conducts systematic reviews of randomized controlled trials of health-care interventions and diagnostic tests. Cochrane reviews are frequently referred to as the gold standard of evidence in medicine and are highly influential in healthcare policy, although recently Cochrane has been criticized for abandoning its core values.

History
The Cochrane Collaboration was founded in 1993 as part of a movement that called for evidence based medicine. The name refers to the Scottish doctor Archie Cochrane who advocated the use of randomized control trials to make medicine more efficient. In origin, Cochrane is a British charity. It arose from the ground-breaking work of Iain Chalmers and colleagues who, in the late 1980s, created a database of systematic reviews on effective care in pregnancy and childbirth. This idea of forming a library of reliable and systematic reviews on clinical interventions was extended to other fields of medicine and became the basis of The Cochrane collaboration. Over the years, Cochrane has developed into an internationally renowned institute. At the celebration of its 20 years existence, it had more than 31,000 contributors from 120 countries and has published more than 5000 systematic reviews. , although some require a paid subscription or registration before reading.

Chronic fatigue syndrome
Cochrane lists chronic fatigue syndrome (CFS) under its "neurology" and "mental health" categories and its chronic fatigue syndrome reviews are produced by its "Common Mental Disorders Group".

Exercise therapy in CFS review
The Cochrane review on exercise therapy (graded exercise therapy) in chronic fatigue syndrome has frequently been cited as a justification for this controversial intervention in patients with ME/CFS. The review, however, has been criticized for having methodological flaws, and a formal complaint by a patient outlined significant flaws, leading to further revisions. Cochrane revised the exercise therapy for CFS review six times since 2015, publishing a final version with altered conclusions in October 2019. Cochrane stated that the review is "substantially out of date and in need of updating." On May 21, 2020, Cochrane made a new announcement committing to a full review: "In the last nine months, this Cochrane Review has been modified by the review’s authors and evaluated by independent peer reviewers and editors. It now places more emphasis on the limited applicability of the evidence to definitions of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) used in the included studies, the long-term effects of exercise on symptoms of fatigue, and acknowledges the limitations of the evidence about harms that may occur...

[T]oday we are committing to the production of a full update of this Cochrane Review, beginning with a comprehensive review of the protocol, which will be developed in consultation with an independent advisory group that we intend to convene."

Chronic fatigue syndrome publications
Cochrane has published several reviews assessing treatments for chronic fatigue syndrome:
 * 2008, Cognitive behaviour therapy for chronic fatigue syndrome in adults
 * 2014, Exercise therapy for chronic fatigue syndrome (individual patient data) - withdrawn as protocol no longer being progressed to a review


 * 2016, Exercise therapy for chronic fatigue syndrome


 * 2017, Exercise as treatment for patients with chronic fatigue syndrome
 * Exclusive: Science journal to withdraw chronic fatigue review amid patient activist complaints
 * 2019, Exercise therapy for chronic fatigue syndrome
 * Editorial note: Publication of Cochrane Review: ‘Exercise therapy for chronic fatigue syndrome’

Other withdrawn pages

 * Traditional Chinese medicinal herbs for chronic fatigue (Health topics noted CFS under "Mental health".)

Formal complaint to Dr. David Tovey, Editor in Chief of the Cochrane Library

 * Feb 12, 2018, This is a formal complaint with respect to the current version of "Exercise therapy for chronic fatigue syndrome" by L. Larun et al. (Cochrane Database Syste Rev. 2017; CD003200.)

Criticism & Undisclosed Conflicts of Interest
2016

Professor James Coyne has criticized Cochrane's work assessing exercise as a treatment for chronic fatigue syndrome, asking it "to consider the implications of having authors conduct a systematic review with the Cochrane collaboration brand attached who have ties to an industry which would benefit from particular conclusions. These same conclusions would personally enrich some of the authors professionally and personally", referring to the involvement of Trudie Chalder, Rona Moss-Morris, Michael Sharpe, Alison Wearden and Peter White who are also authors of the PACE trial.

Prof. Coyne also wrote an open letter to Cochrane in March 2016 regarding the upcoming Cochrane review and conflicts of interests.

In March 2016, the 2014 Cochrane Intervention Protocol was modified to include previously undisclosed conflicts of interest for Peter White: "PDW has undertaken consultancy work for a re-insurance firm. He has also undertaken voluntary consultancy for the Departments of Health, Work and Pensions and is a member of the Independent Medical Experts Group, a non-Governmental organization which advises the Ministry of Defense regarding their Armed Forces Compensation Fund."

It was admitted in the information tribunal of April 2016 on page 31 that "Professor Chalder states that disclosure to the Cochrane review does not count as disclosure to independent scientists as all three of the PACE principal investigators sat on the review panel."

2017

On April 14, 2017 Prof James Coyne submitted a very early request for the data to Cochrane along with an open letter.

A liaison psychiatrist publishing in the British Journal of Psychiatry has criticized the 'Exercise Therapy for CFS' for being heavily influenced by the PACE trial.

According to Coyne, one of the authors of the controversial Cochrane Exercise therapy review, Kjetil Gundro Brurberg, misrepresented the conflicts of interest of himself and his reviewers regarding his article A PACE-gate or an editorial without perspectives after being given a number of opportunities to do so. This was an article he was invited to publish in the Journal of Health Psychology, and Coyne describes Brurberg's actions as "scientific misconduct". According to Coyne, Brurberg had been invited to publish about the PACE trial by the Journal of Health Psychology but his manuscript was rejected after a negative peer review. Coyne states Brurberg appealed he was given opportunity to nominate reviewers without conflicts of interest, but two had clear conflicts of interest and a third reviewer responsed declaring a conflict of interest - that Michael Sharpe (second author of the PACE trial) had previously been his supervisor; Brurberg's article was rejected and then published in the Mental Elf website.

2018

On September 3, 2018, Dr David Tuller examined in 'The Cochrane Controversy' the systematic reviews which relied upon the flawed PACE trial and associated CBT/GET studies and even its wrongful categorization in the Common Mental Disorders group.

On September 14, 2018 the Cochrane Collaboration had a mass resignation of its board after it decided to expel a founding member who had written a review which stated that "‘The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias’ and published in the BMJ Evidence-Based Medicine".

October 8, 2018, Mark Vink and Alexandra Vink-Niese reanalyzed the Cochrane's review of GET for ME/CFS concluding there is no evidence GET is effective and "failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe." Their reanalysis also stated that all four Cochrane reviewers were proponents of the biopsychosocial model.

On October 17, 2018 it was announced that Cochrane would be temporarily withdrawing its exercise therapy for CFS review from the Cochrane Library. The Cochrane Editor said that the review had several issues which needed to be addressed and “This not about patient pressure”. Dr Tuller reported on the withdrawal decision and the background to the Cochrane review. Forty-one international scientists signed a declaration supporting Cochrane's decision.

2019 A new revision and editorial note were published in October 2019, with significant alterations to the conclusions.

In May 2020, Cochrane published a note stating that they were committing to a new review and protocol. Concerning the old review, it said:
 * "It now places more emphasis on the limited applicability of the evidence to definitions of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) used in the included studies, the long-term effects of exercise on symptoms of fatigue, and acknowledges the limitations of the evidence about harms that may occur."

2020 In March 2020, Cochrane announced a new conflict of interest policy, due to take effect later in the year.https://www.cochrane.org/news/cochrane-announces-revised-conflict-interest-policy-cochrane-library-content

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Learn more

 * 2016, My response to an invitation to improve the Cochrane Collaboration by challenging its policies
 * 2016, Cochrane and conflict of interest