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The Crisis in Cochrane

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"The mission of the Cochrane Collaboration, established in 1993, was to systematically review medical evidence with a view to producing the best quality and trustworthy evidence. Twenty-five years later, it is in a crisis that centres on the dismissal (of) one of its founders and the question of access to clinical trial data. The original mission aimed at improving health. In the face of stalling life expectancies, the stakes in the current crisis could not be higher." —David Healy

Read MoreThe Crisis in Cochrane

Hospital’s Suspension of Evidence-Based Medicine Expert Sparks New Controversy

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“In response, more than 3,500 health care professionals, scientists, and public health advocates signed a letter protesting the hospital’s move to the Danish minister of health. ... The letter states that Gøtzsche’s work has ‘played a pivotal role in favor of the transparency of clinical data, the priority of public health needs and the defense of rigorous medical research carried out independently of conflicts of interest.’”

Read the articleHospital’s Suspension of Evidence-Based Medicine Expert Sparks New Controversy

Letter From John Ioannidis to the Danish Minister of Health in Defense of Peter Gøtzsche

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“I write this letter to express my unconditional support for maintaining Professor Peter Gøtzsche as chief physician at the Nordic Cochrane Centre in the Rigshospitalet. ... Peter is undoubtedly a giant, one of the greatest scientists of our times and one of the most influential, impactful, and useful voices in medicine at large.”

Read the letterLetter From John Ioannidis to the Danish Minister of Health in Defense of Peter Gøtzsche

Comments on 190116

25 Comments

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Matthieu Dubreucq
October 27th, 2019 at 11:49 am
Commented on: Letter From John Ioannidis to the Danish Minister of Health in Defense of Peter Gøtzsche

Great to see that some still believe in discussion rather than elimination. That portion of the letter is what I like the most. Even if he disagrees with Peter Gotzsche on some points, he wants his input. More should think that way.

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Matthieu Dubreucq
October 27th, 2019 at 11:41 am
Commented on: The Crisis in Cochrane

It is hard to believe that the organisations that claim to be safeguarding our health are the one that fall for the easy profit and $ trap.

Thanks CrossFit for making sure that we know! I wasn't aware of the problem of ghostwritten studies and inaccessible data.

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Katina Thornton
January 26th, 2019 at 2:31 am
Commented on: Hospital’s Suspension of Evidence-Based Medicine Expert Sparks New Controversy

The governing board suspends him because they no longer have confidence in his leadership, yet 4 board members resign in protest and are able to garner 3,500 signatures from busy medical professionals in a mere 3 days that express disapproval of the suspension. Sounds like Peter Gí¸tzsche is a fine leader, indeed.

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Julie Platt
January 17th, 2019 at 2:48 pm
Commented on: 190116

F/49/183 lbs/5'10"

I did banded pullups and knee push ups


30:20

2000 m @ 8:02

1000m @ 4:04

500 m @ 1:59


I hope to one day get ba k to unaided pullups and strict pushups... but for now the dicey shoulders need the help.

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Lee Welton
January 17th, 2019 at 1:28 am
Commented on: 190116

Largo was fantastic, thanks!

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Js Smith
January 17th, 2019 at 1:22 am
Commented on: 190116

Row intervals

6x :20/2:00

2490m

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Js Smith
January 17th, 2019 at 1:23 am

Hadn’t heard Largo in a long time. Thanks HQ!

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Jeff Chalfant
January 17th, 2019 at 12:05 am
Commented on: 190116

Tabata from 3 weeks ago rx’d but gamed it to try to stick with recommended numbers. Went out a little too easy on pistols and jumping lunges but the lunges got so hard I actually collapsed on the final round but picked myself up for one more rep. Good pump.


Hspu: 5-4-4-4-4-3-2-2=28

Pistols: 6-6-6-6-6-6-6-8=50

Pushups:10-8-8-8-8-8-10-8=68

Jumping lunge: 10-16-12-12-12-12-13-15=102

248 reps total

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Christopher Jacobs
January 16th, 2019 at 10:34 pm
Commented on: 190116

10 min. 50rpm pace Assault Bike

10 min. 2:00 pace C2 rower

20 min. Sauna session

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Shakha Gillin
January 16th, 2019 at 10:18 pm
Commented on: The Crisis in Cochrane

The crisis in Cochrane is the falling of another pillar in medicine. For those of you not familiar with Cochrane, it has been the trusted, gold standard reference for us physicians seeking a review on a medical topic. Cochrane conducts THE systematic reviews of medical interventions. We expect that Cochrane has reviewed the studies in detail, scrutinizing and bringing forth a thorough and unbiased conclusion.


I have read Gotzsche’s criticism of the Cochrane HPV review. I am a Pediatrician and I think it’s exactly the questions we should be asking. He addresses important points that are lacking in the review (proper control arm, inclusion of side effects, and bias). Physicians have been cautious and slow at jumping on this vaccine. HPV administration rates are 49%. By comparison, the Tdap is almost 90%. A thorough, transparent review would be of great value.


One of the biggest concerns for the HPV vaccine has been safety. The Cochrane Review concluded “we did not find an increase risk of serious adverse effects”. Great! Oh wait, except as Gotzsche points out, it’s because no one looked. When searching the database, the search criteria were limited. This is critical when doing a review.


There has been ongoing concern about the risks for POTS and CFS. This is something I counsel patients on. In fact there have multiple studies and reports about the possibility of increased incidences related to the HPV vaccine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209415/


So Gotzsche’s criticism is spot on.


When the Cochrane Review was released, it gave a false sense of security. As if all the side effects we were hearing about were just rumors....because Cochrane reviewed it, and if they said it’s not increased....


I’m not opposed to the HPV vaccine. I don’t find Gotzsche’s criticism antivax. I find his criticism is against false reviews. There needs to be checks and balances to ensure the highest quality care. Not just a poorly done review to tell us what we want to hear.

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Brittney Saline
January 16th, 2019 at 9:11 pm
Commented on: The Crisis in Cochrane

Ghostwritten studies, inaccessible data, cherry-picked results–just a few of the flaws of the research system.


This reminds me of former BMJ editor Richard Smith's writing on peer review, another flaw in the process: "In addition to being poor at detecting gross defects and almost useless for detecting fraud it is slow, expensive, profligate of academic time, highly subjective, something of a lottery, prone to bias, and easily abused."


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1420798/


Smith–who at least at one point was the chair of the Cochrane Library's oversight committee–once compared Gí¸tzsche to the "boy who sees the emperor has no clothes" (https://richardswsmith.wordpress.com/2018/09/17/is-peter-gotzsche-the-boy-who-sees-that-the-emperor-has-no-clothes-and-says-so/) and seems to be on Gí¸tzsche's side (https://twitter.com/Richard56/status/1061349355561594880).

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Clarke Read
January 17th, 2019 at 11:36 pm

Thanks for linking to Smith's paper. First time I'd read it, and it's fascinating. Might warrant its own post in the future.


There’s a ton to chew on in here, and this passage stood out to me in particular:


~~~

The Lancet has tried to get round the problem by agreeing to consider the protocols (plans) for studies yet to be done. If it thinks the protocol sound and if the protocol is followed, the Lancet will publish the final results regardless of whether they are positive or negative. Such a system also has the advantage of stopping resources being spent on poor studies. The main disadvantage is that it increases the sum of peer reviewing–because most protocols will need to be reviewed in order to get funding to perform the study.

~~~


This seems to echo some of the same foundational principles as efforts like the Open Science Framework:

https://www.osf.io


That is, we would be better insulated from bias (and more able to highlight legitimately excellent studies) if we made that determination based on each study’s methodology, prior to its implementation, rather than on its results. After all, if we assume researchers implement their studies competently, the study’s design, methodology, and the significance of the hypothesis it is testing should tell us all we need to know about how seriously to take its results. Right?


I’m also very curious if his description of peer review as the “least bad option” has evolved over the decade since this was written. Has peer review become less bad? Have alternatives been seriously discussed? Have any journals tested alternative methodologies, for better or worse? Is our endpoint to continue improving peer review or replace it? (Do things like PubMed Commons play a role here, too, or could they be making the problem even worse?)


For many of the same reasons discussed in the original post’s articles on Cochrane, the answers to these questions have an outsize impact on what our scientific and medical communities will subsequently believe and implement.

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William Whittle
January 16th, 2019 at 6:29 pm
Commented on: 190116

Play golf on rest days active recovery? Yes that’s why I follow one week behind like to hit CrossFit at 5am then do some compound lifting to compliment CrossFit apart from that I’m retired so resting and eating lol

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William Whittle
January 16th, 2019 at 6:13 pm
Commented on: 190116

Bit of a newbie been going about 6 months 48 yo tracking wods by a week so can put in some extra strength work is this ok? Think I’ve found what I’ve been looking for amazing sport amazing people . Took a while to pluck up courage to comment as there seems some awsome athletes on here! Last wod was Db clean and jerks strict pull ups and ghd sit ups 22:15:9 rx in 18:46 tough wod but loved it!

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Chris Sinagoga
January 16th, 2019 at 6:24 pm

Hey William, good to see you comment on here! Your call what to do on rest days. I would recommend going out to play a sport and try to stay out of the weight room. Not only the athletic benefits, but I can't tell you how many times I've tried to do something on a rest day only to see it pop up in the next workout!


Obviously doing strength stuff won't kill you. I think you'd find a lot of good things if you try and apply your CrossFit to something outside of the gym.

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Jeremy Meier
January 16th, 2019 at 4:29 pm
Commented on: 190116

5 rounds of:


20 Bike Erg Calories

50 Single Unders

-- then --

5 rounds of:

20 Row Calories

30 AbMat Sit-ups

-- then --

5 rounds of:

10 Deadlifts, 135 lbs

10 Box Jumps, 20 in


Total Time : 27:50 | Rx'd

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Patrick Doyle
January 16th, 2019 at 3:42 pm
Commented on: 190116

10K Row C2

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Mike Andridge
January 16th, 2019 at 3:32 pm
Commented on: 190116

"Largo" is sooooo relaxing. Mental workout today--lots of info to take in.

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Keri Mucha
January 16th, 2019 at 2:12 pm
Commented on: The Crisis in Cochrane

"ghost-writing has become commonplace because it provides substantial benefits to three parties: drug companies, researchers and medical journals. By managing the publication of articles about their products, it is easier for drug companies to spread positive results and bury negative results. This often provides a big boost to drug sales."


The lack of transparency in such trials is dumbfounding. How it has become possible to release a study but not the data upon which the articles is based is more than frightening.

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Juan Acevedo
January 16th, 2019 at 12:42 pm
Commented on: 190116

Check out @dotcomscaled on Instagram for scaling options

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Romain Grelier
January 16th, 2019 at 11:58 am
Commented on: 190116

Half marathon rowing 1:24

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Patrick Doyle
January 16th, 2019 at 3:41 pm

Great time on that row !!

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Xiaonan Guo
January 16th, 2019 at 3:50 am
Commented on: 190116

WORKOUT 16.5

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Alex Broadbent
January 16th, 2019 at 3:08 am
Commented on: The Crisis in Cochrane

It's fantastic to see Crossfit diving into this stuff around medical research, and hopefully working its magic of bringing it to public consciousness. The complexity and fragility of the evidence on which many of our health decisions are based is huge and rarely acknowledged.


Some related pieces that interested readers might enjoy include Ionnadis's classic "Why most published research is false" and John Worrall's paper "What Evidence in Evidence Based Medicine?".


There's a big debate among physicians and philosophers about evidence-based medicine. On the one hand its goals seem laudable. On the other, it invokes ideas that are just way too simple, e.g. "evidence hiearchy" where some kinds of studies trump others. The problem with this hierarchy is that it always favours pharmaceutical interventions over lifestyle ones such as diet and exercise. So - don't believe all the rhetoric - but it's a fascinating movement in recent medical thinking, and the general area of how we decide what to believe about these things is fascinating. (I did write a book about it but hesitate to link it in case I'm perceived as pushing for personal profit... which, by the way, is miniscule from an academic book!).


Great stuff and I'm interested to see how Crossfit's move into health develops.

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Clarke Read
January 17th, 2019 at 11:04 pm

Alex, once again thanks for your comment.


I see you and Shaka may be getting at an underlying point from different angles. It's practically impossible for any individual (certainly not a physician, and likely not even a full-time researcher) to read all the literature relevant to their field with a fraction of the time and diligence required to do it justice. So it seems a modern (maybe pre-modern) necessity for us to put our trust in some sort of external authority to help make these judgments where we lack the time to make them ourselves - whether that's an entity like Cochrane or a methodology that implies certain expectations like EBM. If anything, these are only going to become more necessary over time as the volume of published research increases.


Your statement on the complexity and fragility of these evidence sources resonates. A lot of this discussion is bringing to light how assumptions or choices in research summarization methodologies systematically bias their outputs - which should influence how we treat those outputs.


Obviously we can't throw them out entirely. And there are some equally obvious improvements, as Gí¸tzsche and his colleagues have highlighted. But a key question, which I don't have an answer to, is how we handle conclusions knowing they might be biased or misguided, including in some ways we don't yet appreciate. How do we prevent the sort of errors Shaka referred to with the HPV vaccine without being equivocal to the point of ineffectiveness? If we can't trust Cochrane, where do we go from here?


Motivated individuals can do their own work and synthesize broad guidelines and individual (supportive and discordant) pieces of evidence to get a sense of what we know and how confident we are that we know it. What do we do about the rest?

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