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An awful lot has been said and written about the conflict between Peter Gøtzsche and the Cochrane Collaboration – including by me. The final dramatic breakdown in September 2018 provided an opportunity to raise all sorts of grievances and issues people had – with the organization, individual protagonists, and/or evidence-based medicine (EBM). 

It was confusing, and like others, I was making my mind up about things quickly in a heated controversy. In the aftermath, I wanted to give this more un-pressured consideration, and be confident about historical accuracy. I was being very critical of Gøtzsche publicly, and felt a responsibility to be sure my position was justified, or course correct if it wasn’t. To look at the evidence trail systematically, I constructed a timeline of the relationship from its beginning, to try to get a perspective of what happened, and decide what was critical. I thought the timeline and the conclusions I drew from it might be helpful to others, so I posted it (in the days after Gøtzsche published his book on vaccines).

The timeline describes key developments and actions that I think propelled Cochrane and Gøtzsche along this path, including relevant context. I have tried to be fair in several ways, with enough detail and sources to enable people to follow the trails of different interpretations and narratives at points along the way. And later there is a collection of links to places where the protagonists speak for themselves, and to viewpoints by others who come to different conclusions than I do. (There are links to all my related published writing as well.)

Gøtzsche posted many documents online at his personal website, often confidential ones that he has released without permission of those involved. That poses ethical dilemmas. I decided to read it all, and I bought a couple of his books that I needed to try to understand his point of view about what he considered key events. However, I don’t want to add to the damage done by publication of personal correspondence, confidential papers, and serious unsubstantiated allegations and character slurs from Gøtzsche, so I rely as much as possible on other public records to support the statements in this timeline. On a few occasions, where I had no other option and thought it was too important to leave out, I note the source without linking to it: those are references [in square brackets].

First, some context that I think is critical to understanding the Cochrane/Gøtzsche relationship. When we formed the Cochrane Collaboration (CC), we established various types of structures. Cochrane review groups were the editorial groups responsible for producing Cochrane reviews, for example – you can think of Cochrane’s journal really as 53 separate subject journals, sharing some methods, software, and a publishing platform.

Another structure was “Cochrane Centres”. Gøtzsche was the director of one: the Nordic Cochrane Centre (NCC). Centres had a dual role. One was a training and support service function for individuals and Cochrane groups in their geographic region. The other was “outreach”. A Cochrane Centre was a base to promote systematic reviews in health care, and recruit people and resources to the cause.

The Centres had the Cochrane name and right to use the logo, but they functioned autonomously. They were expected to make a contribution of some kind to the organization centrally. For example, when I worked at the Australasian Cochrane Centre in the early days, I produced Cochrane News, the organization’s international newsletter, and the local Cochrane Centre Director raised the money to pay me to do it, and to print and mail the thing out. There weren’t many Cochrane Centres for most of the organization’s life: only 14 in 2014.

There wasn’t a term limit for a Centre, or for being one’s director. Several previously little-known people achieved positions of power and influence, especially locally, from being Centre directors. The Centres have been self-governing principalities with their own agendas, but they are often seen from the outside as branches of the organization. They weren’t in the usual sense, though. They had a lot of influence on the Collaboration, including its governance, but there wasn’t much influence in the other direction.

As you would expect from such a loose arrangement, Centres and their directors developed very differently. Some have never really had much funding; others have had a lot. The directors and Centre staff caucus, having had separate meetings since soon after the organization began. Centre staff members are a tiny minority of the Collaboration, which had 17,000 full members and 37,000 supporters in 2018

However, people employed at Centres are one of the biggest cadres of people employed full-time in the Cochrane world, with lots of people therefore able to devote single-minded attention to things Cochrane. That resource also brings in perspectives from different parts of the world. But it is a big problem if the power and role of Centre directors is being considered. At the time of Gøtzsche’s expulsion, people from Cochrane Centres held 5 of the 13 seats on Cochrane’s board.

Disclosures: Like Gøtzsche, I am one of the co-founders of the Cochrane Collaboration. My relationship with the organization first fractured over the issue of independent consumer advocacy, and we eventually parted ways in 2012/2013 when Cochrane decided not to negotiate an alternative funding path that would have enabled fully open access to Cochrane reviews and the trials register. I have not been a member of the organization since, although I participate in some activities. For example, I am currently participating in discussions and planning about a Cochrane review of which I have been critical. I have recently written both critical and supportive pieces about the organization and specific Cochrane reviews. I have collaborated with Peter Gøtzsche (last in 2013), and I have had agreements and conflicts with him. Previous further disclosures are at my PLOS Blog.

Hilda Bastian

8 February 2020

[List of what I've written updated on 28 February 2020, when a journal published a commentary they invited from me to accompany the systematic review on HPV vaccines co-authored by Gøtzsche.]



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