“This is like capital punishment what we’re doing” (Gerald Gartlehner, former Cochrane Collaboration Governing Board member who resigned in protest).
“Industry will be elated. Oh finally, we are offering Peter’s head on a platter … It’s the nuclear option.” (David Hammerstein, former board member who resigned in protest).
On 13 September 2018, during the Cochrane Colloquium in Edinburgh, the Cochrane Collaboration’s Governing Board expelled the first person ever from the organisation. That person was me. I co-founded the Cochrane Collaboration in 1993 and established the Nordic Cochrane Centre in Copenhagen the same year, which became the biggest such centre in the world under my directorship.
I have contributed immensely to Cochrane, both financially and scientifically. I have, for example, donated over 5 million USD to Cochrane’s software development. I was also well known for my science. A journalist found out that I was the only Dane who had published more than 70 papers in “the big five” (BMJ, Lancet, JAMA, Annals of Internal Medicine and New England Journal of Medicine), and one of my interviews, where I describe the organised crime in the drug industry, has been seen by over 400,000 people on YouTube.
I was also a symbol of integrity. In 2008, a co-chair of the Governing Board wrote to the then CEO: “In many ways, Peter is the ‘conscience’ of the Collaboration. We may find him irritating at times, but we should never ever be dismissive of him.”
So, why did Cochrane expel one of its best known scientists who had done a lot to get Cochrane started and to bolster its good reputation? What happened that day in Edinburgh?
My collaborator Maryanne Demasi from Sydney was with me in Edinburgh, and she has published a summary of the events, exactly three years after my expulsion. The show trial was intended to be kept secret, but four board members withdrew in protest over my expulsion and the recordings were leaked.
Here are some excerpts from Maryanne’s summary: “Every single conflict between the central executive board and Peter is about an issue where the central executive board takes the side of the pharmaceutical industry. And I can document this,” says a board member. “Industry will be elated,” says the concerned member, warning that Cochrane was setting a dangerous precedent whereby industry representatives only had to “write a complaint to Cochrane and then Cochrane caves in under the pressure.”
BMJ’s editor-in-chief agreed. She wrote that Cochrane should be committed to holding industry and academia to account, and that my expulsion from Cochrane reflected “a deep seated difference of opinion about how close to industry is too close.”
Why is this relevant to know for people who want a better and more humane psychiatry? Because the main reason for my expulsion was my criticism of psychiatric drugs. I have researched this area intensively, have had several PhD students, and have published numerous scientific articles and two books about psychiatry. My overall, firmly evidence-based, conclusion, which concords with what the general public thinks, that psychiatric drugs do much more harm than good, and should be used very sparingly, was not popular at Cochrane headquarters.
Three of the 52 groups in Cochrane are mental health groups, and even though it might be tolerated if you nibble at the edges of a medical discipline with criticism, it cannot be tolerated that you document that the entire specialty does more harm than good, which Bob Whitaker has also documented.
My 2019 book about Cochrane, Death of a Whistleblower and Cochrane’s Moral Collapse, cites from the Cochrane Tapes, which I have now released, with my comments. When UK child and adolescent psychiatrist Sami Timimi reviewed the book, he concluded: “This book carefully recounts this dark period in medical science where a once trusted institution carried out one of the worst show trials ever conducted in academia. The CEO and his collaborators went about their task in a manner that mirrors how the drug industry operates … Leading medical scientists from all over the world expressed their solidarity with Gøtzsche and outrage at what Cochrane had done. They universally praised Gøtzsche as a tireless advocate for research excellence, a fearless critic of scientific misconduct, and a powerful opponent of the corruption of research by industry interests, and criticised the unsupportable actions of Cochrane. History will recount this as the death of Cochrane rather than the whistleblower.”
In 2015, I pointed out in a BMJ article that long term use of psychiatric drugs does more harm than good and that they should be used very sparingly. As a courtesy, I had sent BMJ’s press release four days in advance to David Tovey, Cochrane’s editor-in-chief, and to the editors of the three Cochrane mental health groups. They did not return my kindness. All four of them joined forces and published an embarrassing letter as a rapid response in BMJ connected to my article where they seriously undermined my scientific credibility. This was not a contribution to a sound scientific debate but was about protecting turfs and the excessive use of harmful drugs.
Several editors of Cochrane groups told me they were dismayed that these four editors, in Schopenhauer’s words, had appealed to “authority rather than reason” to denigrate my research, which they felt shouldn’t happen in Cochrane. I needed to defend my reputation, and in my reply in the print version of BMJ, I wrote that journalists and others had interpreted the Cochrane editors’ denigration of my research as a thinly disguised attempt at protecting psychiatry’s guild interests, and some even suspected that they also tried to protect the drug industry. The Cochrane editors did the patients a great disservice, but Cochrane’s CEO Mark Wilson forced me to publish an apology in BMJ and threatened to close my centre if I didn’t.
Wilson, who is a journalist, once said to me that it wasn’t good for Cochrane that I bathed in blitz light about other things than marketing Cochrane reviews. But I am not a salesman. It didn’t impress him that my international visibility and influence meant that I gave a lot of good publicity to Cochrane.
Tovey is a doctor and his view on my work was very different to Wilson’s. He wrote to me two weeks after the BMJ debate: “We do not differ anywhere near as much as you think. I read your last book from cover to cover and have recommended it to many people since. I am entirely committed to the view that the benefits of psychotropic medicines have been systematically overestimated, and the harms underestimated … it seemed to me that the nature of the debate and the brevity of the article did not permit you the opportunity to make the case sufficiently strongly. I hope that we will get a chance to discuss this issue in a friendly and mutually respectful fashion when we meet.”
Another of Cochrane’s many unfortunate interventions to protect the psychiatric guild, and thereby also the drug industry, happened in 2018. It was described this way by Ryan Horath:
“One of the recent ‘complaints’ made against Dr. Gøtzsche is that he sent a request to Fuller Torrey [a US psychiatrist from the Stanley Medical Research Institute] asking about a trial of antipsychotics where children died … Cochrane leaders became obsessed about Gøtzsche using Nordic Cochrane letterhead to send this request. And a very large number of people seem to agree with the board’s obsession. I will use all caps to emphasize the point: JESUS CHRIST, WHAT IS WRONG WITH YOU PEOPLE. A researcher is making inquiries about the suppression of information regarding children who died in a clinical trial and everyone is worried about what letterhead it is written on? … Even worse, it is clear the outrage over use of Cochrane letterhead is feigned outrage, as this was a private letter.”
There is a good reason why there is not much in the Cochrane Tapes that reveal I was kicked out of Cochrane because of my consistent criticism of psychiatry. Cochrane hired a law firm in early 2018 and sent them an extensive report of my so-called wrongdoings 15 years back in time. They must have been disappointed when Counsel wrote in his report that he did not find it served any useful purpose to go several years back in time because any issues had been resolved. Furthermore, he exonerated me and did not find any reason to censure me.
In my response to Counsel, I explained why the allegations raised against me had no merit. I also documented mismanagement of Cochrane, which included serious acts of tampering with evidence by manipulating minutes of meetings and other evidence by the CEO, his staff, and the co-chairs of the Governing Board. I highlighted how important minutes of meeting are: “They are the quasi-legal record of proceedings and can be produced in court as evidence of decisions and resolutions made. Falsifying such a record, for whatever reason, is therefore comparable to committing perjury. Knowingly producing and then passing off minutes as accurate and true, when you know them to be demonstrably false, is not simply a matter of maladministration, but is potentially a criminally fraudulent act.”
Wilson practised management by fear. He had total control over the board, and a board member burst into tears (during the only time in Lisboa in March 2018 where Wilson was not allowed to be in the room) when she said that one of the two co-chairs of the board, Martin Burton, was afraid of Wilson. Since Wilson was Burton’s line manager, and also given Wilson’s bullying behaviour, I assume he could threaten Burton’s job security as director of the UK Cochrane centre. Five hours into the show trial against me, it was still uncertain if the board was willing to expel me, even though Burton had lied about me repeatedly and had invented all sorts of false accusations and hints including that I should have harassed Cochrane staff, even sexually. It is highly likely that Burton had orchestrated letters of complaint about me immediately after I had submitted my reply to Counsel that documented his own maladministration, and he was close to cracking when a board member revealed this to the board. Burton got more and more desperate and said: “If we just stop here, what do we really think is going to happen? What do we really think Mark is going to say…”
The other co-chair of the board was Marguerite Koster from Kaiser Permanente in California. Both co-chairs lied profusely about me, also publicly, after my expulsion, and they refused to define what the board meant by my so-called bad behaviour when this became the official excuse for expelling me.
In one of his excellent analyses of the Cochrane scandal, Ryan Horath wrote:
“The ‘seriously bad behaviour’ is disagreeing with those who had the power to expel Gøtzsche and objecting to their behaviour. So, this appears to be the expulsion of a whistleblower arranged by those he accused of misconduct … In what world does it make sense to threaten to close an entire Cochrane centre because its director asked for information on how and why so many children died in a study? Who wants to be a part of an organisation that prioritises the letterhead used to ask questions over answers about dead children? … Dr. Gøtzsche’s work makes him ‘controversial.’ The CEO of Cochrane is not a scientist. He comes from the business world. And in the business world, controversy is considered bad for the brand. And employees who rock the boat and do not fall in line with orders from above do not last long. Corporations are dictatorships, not democracies. The CEO brought a dictatorial mindset to Cochrane, and he believes Gøtzsche is bad for the ‘brand.’ Not being a scientist, he has no recognition that the work Gøtzsche does IS the brand. The ideal of science is not sitting by idly while science is perverted by moneyed interests. The ideal is someone who thoroughly vets the science being produced and is willing to challenge corruption at great personal risk. So, in the CEO’s mind, any appearance of the Cochrane name next to Dr. Gøtzsche is bad for the brand.“
On 23 April 2021, Professor Ken Stein, Director of the Evidence Synthesis Programme, the UK National Institute for Health Research, spoke at a webinar about the work in the UK Cochrane groups (21 of the world’s total of 52) and their future funding. He criticised Cochrane quite substantially for much the same reasons as I had done and said the writing had been on the wall for 8 years, which is exactly the period when Mark Wilson ruled the organisation and destroyed it. In his quest for obtaining absolute power, Wilson disrespected other people and squeezed out several of those who had been key to Cochrane’s success. About the failing scientific integrity, Stein noted that “this is a point raised by people in the Collaboration to ensure that garbage does not go into the reviews; otherwise, your reviews will be garbage.”
Wilson suddenly left his job, in the middle of a month, seven days before the webinar where the UK funder announced that a major budget cut was likely in 2022. There was no farewell message from Wilson who was otherwise known to put himself in focus and take credit for what others had achieved through arduous work, as I describe in my book. I assume Wilson left Cochrane because he knew what was coming a week later.
This may be the beginning of the end for Cochrane. I believe the damage Wilson and Burton have done to Cochrane is irreparable, which is also what I heard in evidence-based circles before COVID-19 stopped my travelling.
The moral and scientific decline of what was once an idealistic grassroots organisation continues. Cochrane’s motto, “Trusted evidence,” which sounds like self-praise in an advertisement from a drug company, was invented by Mark Wilson, but virtually every Cochrane review of psychiatric drugs should be distrusted because the authors and editors do not pay sufficient attention to all the flaws in the trials. I have explained, for example, why the Cochrane network meta-analysis of depression pills in children, published in May 2021 with the editor of the Cochrane Common Mental Disorders Group, Sarah Hetrick, as first author, is not only garbage in, garbage out, but is so misleading that it is outright dangerous. It is similarly misleading as the 2018 notorious network meta-analysis by Cipriani et al. in Lancet, which I described on the Mad in America website as: “Rewarding the companies that cheated the most in antidepressant trials.”
As a commentator recently wrote on an email list, nothing will change unless the recommendations of previous critiques are actually implemented. To continue “flogging the Cochrane Review dead horse” won’t make it run.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.