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 considered the gold standard in medicine and are highly influential in healthcare policy. More than 5000 systematic reviews have been published in the Cochrane library, although some require a paid subscription or registration before reading.

The Cochrane review on exercise therapy (graded exercise therapy) in chronic fatigue syndrome (ME/CFS) has frequently been cited as a justification for this controversial intervention. The review however has been criticized for having methodological flaws, and a formal complaint by a patient has also been made outlining significant flaws. Cochrane has revised the exercise therapy for CFS review six times since 2015, publishing a final version with altered conclusions in October 2019. Cochrane states that the review is “substantially out of date and in need of updating.”

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. Cochrane reviews are frequently referred to as the gold standard in the field of medicine, although recently Cochrane has been criticized for abandoning its core values.

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". It has published some 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)


 * 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

Other withdrawn pages

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

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 14 April 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.

One of the authors of the Cochrane review, Kjell Gundro Brurberg, misrepresented the conflicts of interest of himself and his reviewers regarding the PACE trial after being given a number of opportunities to do so  for an article he was invited to publish in the Journal of Health Psychology in what has been described as "scientific misconduct".

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 14 September 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 17 October 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.

Online presence

 * Website
 * Twitter
 * Facebook
 * Cochrane Library

Learn more

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