Trip Database Blog

Liberating the literature


September 2018

A post from Tom Jefferson…

The following post is not a Trip Database post, I have been asked to host it by Tom Jefferson, a colleague/friend who I have a huge amount of respect for….

The Crucifixion of Brother Peter

By Tom Jefferson

I write from Edinburgh, at the 25th Cochrane Colloquium where events are still unfolding.
Given the visibility that the story of the drumming out of Peter Gøtzche from the Cochrane Management Board and the lack of a single source on the story, I shall give a brief account of it and then suggest a way for Cochrane to get out of the pickle. If it pulls together. I have also selected a few sources where readers can go and check up on some of the details. When reading this summary, you must remember that I am a co-worker and friend of Brother Peter and am also one of the two Cochranites who nominated him for election, so my views are probably not impartial.

Peter is Peter. His apparently brash style hides the reality to most of who do not know him well. It also hides his notable accomplishments such as a realistic reassessment of the benefits of mammography and the opening up of the European Medicines Agency regulatory submissions. This last enables independents to incorporate regulatory data in our reviews (

At some stage in the past Peter developed a personality clash with Cochrane’ CEO Mark Wilson. Whatever its merits, the clash has been allowed to degenerate into an open confrontation against a background of growing discontent in the organisation about changes: the dropping of the suffix “Collaboration” and the introduction of market terms such as ”brand” are just two examples.

Peter was elected to the Cochrane Management Board over a year ago and probably the confrontations got more frequent and involved other members of the Board.

Peter may not have fallen into line with whatever he was asked to do and this led to an administrative procedure to expel him from the organisation and the Board. In June the Board commissioned a legal review of what evidence there was. This is still confidential. The charge of bringing the organisation into disrepute is vague but we are told that no more information has been released (for the moment) for legal reasons. At the end of July Lars Jørgensen, Peter and I published an analysis of the Cochrane review on HPV vaccines, a delicate topic according to some. Our analysis did not go down well with Cochrane editors and although the Board denies it, our public criticism of the review appeared to be the straw that broke the camel’s back.
Everything came to a head on the 13th of September during a 5-hour hearing at which Brother Peter was given a few minutes to plead his case before being asked to wait in a separate room for the verdict. This was communicated later by email from the co-Chairs of the Board. Next day 4 Board members announced their resignation. Peter’s case was discussed in a heavily stage managed AGM on 17th where a nervous discussion took place. This should be soon available on video. The rump Board made it clear that it felt empowered to oversee elections to fill the vacancies and bring the Board to full strength.
Peter now has until midnight on the 19th to appeal, which he is doing. Both sides feel aggrieved and anyone present at the AGM could witness the emotions in play.

While all this was playing out, a media circus was gathering speed in the background, with delegates being bombarded by scores of emails and tweets by people wanting to know what was going on.
The dispute seems to be assuming large proportions, despite the Board’s efforts to limit available information. The damage to the credibility and unity of Cochrane, however is probably done.

So where to now?

In all the cut and thrust of the dispute those involved may have lost sight of the fact that the only winners in the confrontation are likely to be lawyers, the media and extremists peddling plot theories. There are other casualties, no less regrettable to old timers, such as friendships and relationships. However, resources which should be devoted to producing or updating Cochrane reviews are being used to fuel a war which threatens to split or debase Cochrane. Those that think that the issue may be over, do not take into consideration the strength of feeling between the parts and the personalities involved.
Amongst most of the people I spoke to the feeling is that the rump Board does not have the moral authority to run an election of make decisions on anyone’s behalf. Brother Peter also.

Here is what I would do with a magic wand:

1. Get everyone to step down and step away from the Board, Brother Peter included.
2. Suspend all legal and disciplinary actions currently underway.
3. Nominate a caretaker 3-month Board made up of people who were not in the fight and have not taken sides, including those who spoke at the AGM.
4. Hold elections for a brand new Board with members of the current dispute asked not to run for office.
5. Hold the elections under the auspices of a neutral body such as the Election Commission.
6. Start afresh from a webinar-based extraordinary meeting, if necessary over two days, giving any member the chance to input into policy making. Because of Charity Commission rules, this cannot take place instead of an AGM.

I hereby solemnly declare my undertaking not to run for any position in Cochrane for the next 50 years, only for the one I currently hold: author. So help me God.

Here are a few resources to give some back ground and try and understand what is going on (although they are probably not the full picture)

A statement from the rump Governing Board released before the Annual General Meeting:

It is not very informative, possibly for legal reasons.

Peter Gøtzsche’s statement: “I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board”. Four other members of the Board have resigned.

The 4 Board members who have resigned: Gerald Gartlehner, David Hammerstein, Joerg Meerpohl, Nancy Santesso explain their motives in a statement.

Two other members of the Governing Board (Rae Lamb and Catherine Marshall) resigned because of governance issues.

Cochrane – A sinking ship? By Maryanne Demasi.

This dispute has been going on for some time but the trigger may have been our critique of the Cochrane review of HPV vaccines (not of the vaccines, but of the methods used):

And here is the Cochrane Editor in Chief’s response to our critique:

Our response to this is in BMJ-EBM.

Cochrane HPV vaccine review: BMJ journal defends “inconvenient criticisms”

There is coverage in BMJ, Science, The Lancet and other main stream journals.

Part of what Martin Burton said at the Cochrane AGM
There is a lot more but these are all the public facts, up to now.


Ugly scenes in the Cochrane Collaboration as Peter Gøtzsche is expelled

Updates from 17/09/2018

Posts from Ray Moynihan Let’s stop the burning and the bleeding at Cochrane—there’s too much at stake and Trish Greenhalgh The Cochrane Collaboration—what crisis?

Cochrane have also released just released Statement from Cochrane’s Governing Board. This starts with “These are extraordinary times and we find ourselves in an extraordinary situation.” – one can’t really argue with that.

This has been a really interesting day as the story developed. A decent number of people have contacted me expressing disquiet about the situation. My view is that this will quickly blow over. Those who love Cochrane will still love Cochrane and Cochrane will carry on being Cochrane – with perhaps some modifications.  People who are critical of Cochrane will still be critical of Cochrane.  Where the truth is, I’m not sure we’ll ever fully know and then, what we do know, will be clouded by our own values/perspectives.  Good old complexity.

I will try to keep things updated and I’ll continue to reflect on what’s been an “extraordinary situation”.

Richard Smith has written Is Peter Gøtzsche the boy who sees that the emperor has no clothes and says so? where he doesn’t discuss the incident but is full of praise for Peter.

Updated at 9.33 am 16/09/2018 It appears a further 2 members of the Governing Board (Rae Lamb and Catherine Marshall) have resigned.

Update at 1.14 pm 16/09/2018 This was reported to me via Twitter “This situation required further changes in the composition of the Board in order to comply with Cochrane’s Articles of Association, and as a result Rae Lamb and Catherine Marshall, two appointed trustees, volunteered to step down.

Update at 4.47 pm 16/09/2018 Organización Civil Internacional published Cochrane Regeneration which sheds more light on the goings on which includes this section “The “independent review” did not find that Gotzsche has violated the spokesperson policy….No recommendations were made by this Counsel to discipline Peter Gotzsche nor was he found to have violated the spokesperson policy which was the main accusation made against him by the Cochrane leadership.

Update 7.16 pm 16/09/2018 BMJ EBM blog posts Cochrane – A sinking ship? which paints a really damning picture. To be clear, although I’ve been a strong critic of Cochrane I get no joy from how this is unfolding. It’s nothing but a mess.  I hope Cochrane can re-group, learn some lessons, and move forward on a more positive path.

I have also heard that David Tovey (Cochrane chief) has resigned but I’ve not been able to corroborate that.


As Cochrane meet in Edinburgh for it’s latest Colloquium they seem to have got off to a bad start as they have kicked out Peter Gøtzsche from the organisation. Peter was a high-profile and prominent member of Cochrane; occasionally outspoken and controversial – but always passionate and driven by a desire for obtaining good evidence to support decision making.

I found out via this tweet from Trish Greenhalgh:

The link in the tweet points to this article from Peter A moral governance crisis: the growing lack of democratic collaboration and scientific pluralism in Cochrane.

Subsequently a note has been released by the board members who resigned in support of Peter:

I have been asked (alongside others) to highlight this story.

The official and detailed reasons why Peter Gotzche was sacked are not known, the speculation is that the critique of the Cochrane HPV review was the last straw. Monday at the AGM a clearer motivation might be revealed.

Without all the details it’s not clear what’s going on but I think it’s indicative of the direction Cochrane are taking.  Gone are the early ideals of ‘collaboration’ (they jettisoned the term ‘collaboration’ from Cochrane Collaboration a number of years ago) and they’ve now become more of a large corporate publisher, keen to protect the Cochrane brand. Two quotes from Peter’s letter set this out quite nicely:

This growing top-down authoritarian culture and an increasingly commercial business model that have been manifested within the Cochrane leadership over the past few years threaten the scientific, moral and social objectives of the organization.

The Cochrane executive leadership almost always uses the commercial terms of “brand”, “products” and “business” but almost never describes what is really a collaborative network with the values of sharing, independence and openness.

Cochrane have invariably moved this way deliberately and people who are uncomfortable with this are now feeling pressured/unwelcome. Peter is perhaps at the more extreme end of the spectrum but what starts with him, where next?  Will people see this move from Peter as a broad crackdown on dissent?  One can imagine the effect on those left in Cochrane who may have legitimate concerns now not raising them for fear of sanction.

Cochrane is seen by many as being some lovely cuddly charitable organisation that does lots of ‘good’ and that is why it does so well in attracting volunteers. But the more it moves away from this position and into the ‘corporate’ (perhaps being seen as just another large ruthless commercial organisation) they may find their pool of volunteers evaporating rapidly – which would be a disaster.

This story will no doubt run and run but I leave you with two ironies:

  1. Cochrane have something called the Bill Silverman Prize.  “It is offered annually and explicitly acknowledges Cochrane’s value of criticism…
  2. The hashtag for the Colloquium is #CochraneForAll.  #CochraneForAllExceptPeterGøtzsche seems more appropriate.



Trip Evidence Service

We started Trip due to our work on clinical question answering.  We set up a number of responsive services whereby a health professional/manager could ask us a question and we would answer it using the best available evidence. We worked to clinical time frames (days, sometimes hours) and as such these were not systematic reviews. However, these were likely better than a busy health professional, with limited evidence skills, could achieve given their busy schedules.

Trip, and the main staff involved, have answered over 10,000 clinical questions.  These have been mainly for health professionals but we also have experience of answering questions for other sectors such as commissioners and policy makers.

All staff involved love this work and as the quotation goes “Find something you love to do and you’ll never have to work a day in your life“. It is therefore natural, and long overdue, that we are getting back in to this work.

The actual Trip Database continues to be driven by a desire to support clinical question answering but recognise that sometimes this is not enough. Search is fine but sometimes people require something more formal.  We’re not proposing to undertaken systematic reviews, there are other out there for that. Our offering is aimed at ad hoc evidence needs, covering areas such as:

  • Background work needed at the start of a project or before committing to it – has similar work been done before? If so, is this work needed or can you learn from the previous work?
  • A second opinion – have you seen a review and are not sure if you can trust the findings?
  • A general overview of a particular topic – have you been asked to look at a clinical area and need an overview to help you orientate you as to the state of play regarding the latest evidence and guidance?
  • A clinical Q&A – do you have a clinical question and need a rapid answer?

In fact, if you have any evidence need, let us know and we’ll see what we can do.

We have huge experience in this area, cutting edge evidence systems and a pragmatism that can see trusted answers delivered rapidly and cost-effectively. If you’re interested then get in touch via this link, even for an informal discussion.


Q&A – going back to our roots

The work on our automated system has taken around two years and much of our work has focused on that. But now it’s time to look back at the main purpose of Trip, to help health professionals find answers to their clinical questions!

This lovely equation is taken from Shaughnessy and Slawson’s work on Information Mastery:

So, each component is important, assuming you’re interested in useful clinical information:

  • Relevance – how relevant is the information for the clinical question?
  • Validity – how robust is the information? Is it based on good or weak evidence?
  • Work to access – do you get the answer quickly or does it take a long time?

So, for a given question Trip needs to maximise ‘relevance’ and ‘validity’ and reduce ‘work’.

Relevance: For a given set of search terms (which is how the searcher represents their clinical Q) we need to ensure the more useful documents are returned. We’re working on a new algorithm which should be boosted by learning about previous searches. This should improve relevance of results.

Validity: Our algorithm (current and future) will always favour higher-quality content. But we need to be aware that high-quality content is the tip of the evidence pyramid – it’s more robust but there’s lot less of it, so it answers fewer questions.

Work: Our search is quick and if we boost relevance then there are fewer articles for health professionals to look through. However, search returns articles likely to answer the Q, it doesn’t directly answer the Q. We’ve explored this with the answer engine but that is hampered by limited scalability.  So, how can we reduce the work?  If we can predict the question can we highlight the likely passage from the top articles so the user can immediately see that answer and/or judge the relevance of the document?  This seems like a rich seam to mine.

So much to think about…

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