By Peter C. Gøtzsche at Brownstone dot org.

The Cochrane Collaboration publishes systematic reviews of healthcare interventions. This once magnificent organisation has now reached a point of no return from which it will disappear into oblivion because of excessive bureaucracy, protection of guild and financial interests, inefficiency, incompetence, censorship, and political expediency. This is a great shame because Cochrane was very much needed.

On Sir Iain Chalmers's initiative, we were 77 people who gathered in Oxford in the UK in October 1993 and agreed to start the Cochrane Collaboration. I opened the Nordic Cochrane Centre in Copenhagen the same month.

We were very enthusiastic and successful. We formulated Cochrane's key principles, which include cooperation, teamwork, open and transparent communication and decision-making, maximising economy of effort, scientific rigour, avoiding conflicts of interest, and being open and responsive to criticism.

However, as I shall illustrate, based on my own experiences and those of close colleagues, it didn't last long before Cochrane abandoned its ideals, and the moral decline worsened over time.

Somatostatin for Bleeding Oesophageal Varices

In 1995, I published a clinical trial report with a meta-analysis of the only three placebo-controlled trials that existed. I analysed the data blindly and did not find any effect. But many hepatologists believed somatostatin worked, and when I submitted a review to the Cochrane Hepato-Biliary Group, and updated it later when more trials had been published, I faced trouble. The peer-reviewers asked me to do 15 subgroup analyses.

It is inappropriate to do this when the overall result is negative; we call it torturing your data till they confess.

Moreover, our review was flawed. It was based on published, industry-sponsored trials, and the biggest trial, which did not find any effect, has never been published. I asked the investigator, Andrew K. Burroughs, to share his data with us but to no avail.

In our most recent update, we had 21 trials (2,588 patients) and concluded that it is doubtful whether saving one-half unit of blood per patient is worthwhile.

Somatostatin is still being used, but I don't think it has any effect. It would be odd if a hormone had important effects on a bleeding that is often fatal.

Of Mites and Men

Some people with asthma are allergic to house dust mites. We showed that none of the many physical and chemical methods that had been tried had any effect and quickly got our review accepted for publication in the BMJ. But the Cochrane Airways Group's editor, Paul Jones, said he needed total certainty that our data extraction was correct. We needed to review all the trials again and to go to the group's office in London to work there while "consulting" the editorial staff, as it was called.

We didn't need help from people who were less qualified than us, and the extra work was a waste of time. It delayed publication of our review considerably, which was likely intended because in the meantime, a large trial achieved public funding amounting to £728,678.

After we had agreed on the version to be published, Jones secretly changed our abstract. Our conclusion, that the interventions "seem to be ineffective and cannot be recommended," was changed into, "There is not enough evidence to show …," which suggests that if we could have included the large UK trial, we might have shown an effect.

However, we had shown, with narrow confidence intervals, that we could not have missed a worthwhile effect. In our most recent update, there is still no trace of an effect, and the large UK trial made no difference. With my statistical background, I knew this would be the case.

We complained about the editorial misconduct, but some years later, Jones secretly changed our abstract again.

Even today, allergy "experts" and authorities recommend treatments they must know cannot work. The reduction in allergens is far too small to be effective, and ...