T.The Cochrane Collaboration was once one of the most trusted institutions in healthcare. People trusted Cochrane’s systematic reviews, even those of psychiatric drugs. However, in 2018, Professor Tom Jefferson, a highly skilled Cochrane researcher, said in an interview within his article:Cochrane – A sunken ship?”: “If your review consists of biased studies, possibly ghostlit, or if the studies are hand-picked and you don’t take that into account in your review, that’s garbage. It’s going to be in and out of trash… it has a nice little Cochrane logo on it. “
Regarding the lack of scientific integrity of Cochrane reviews, Cochrane’s primary funders announced in 2019: Otherwise, your review will be garbage. Four months later, the funder announced that he would end funding the UK-based Cochrane Study Group at the end of March 2023. I have discussed these issues in my book. free books available, Decline and collapse of the Cochrane empire.
Most of the UK-based Cochrane review groups are now closed. Many people believe that this is because they care little about scientific rigor and too much concern about protecting guild interests and other economic interests. too close to the industry.
As demonstrated in my book Almost all Cochrane reviews of psychiatric medications are garbage in and garbage out, as you’ll see in articles and articles. This was also confirmed by a recent Cochrane meta-analysis of antidepressants in children. The lead author of this meta-analysis is Sarah Hetrick, coordinating editor of the Cochrane Psychiatric Disorders Group.
I would like to give another recent example that Cochrane is not an open-minded institution seeking truth, but an institution that champions the common beliefs of psychiatrists, no matter how stupid they may be. increase.
Short-term drugs may help people who are acutely confused by psychotic symptoms and need to calm them down and get them to sleep. But which drug? Benzodiazepines or neuroleptics? Neuroleptics are routinely used, but is this desirable?
in 2017 Cochrane review For benzodiazepines on psychosis-induced aggression or agitation, the authors wrote in their abstract that there was no observed effect of benzodiazepines when compared with haloperidol. This was seriously misleading. Confidence intervals include the possibility that benzodiazepines are as effective as haloperidol, and we cannot say that benzodiazepines are not effective without placebo controls in the study.
In June 2018, I wrote to Hadar Zaman, the original author of the review, asking him to correct the misleading summary. He forwarded my comments to the Cochrane Schizophrenia Group and said he would come back with guidance.
they didn’t. Three months later, I wrote to Zaman again, imitating Claire Irving, editor-in-chief of The Cochrane Schizophrenia Group.
“I have patiently waited for a response for three months and have not heard from the Review Group. Therefore, I submitted my criticism today through the comment feature. [Cochrane] library. Copy editor-in-chief. Apart from this, the minor corrections to the review I asked for could have easily been done by yourself without going through an editor before making the corrections. “
A unique feature of Cochrane Reviews is that comments and criticisms are solicited and published with the review so that the review itself can be improved.
But once again Cochrane ignored my comment. Irving replied that the group would respond “as soon as possible.”
Three years later, I still haven’t heard from the group.
So I sent a comment to the group again on August 25th, 2021.
Misleading slander of benzodiazepines when compared to antipsychotics
In this review of benzodiazepines for psychosis-induced aggression or agitation, the authors wrote in the abstract:
“No sedative effects up to 16 hours were observed with benzodiazepines when compared with haloperidol (n = 434, 8 RCTs, RR 1.13, 95% CI 0.83 to 1.54, low quality evidence).”
I think this is misleading. If haloperidol works, so do benzodiazepines. Benzodiazepines cannot be said to be ineffective unless the comparator is a placebo. In fact, we already know that benzodiazepines can calm people down. They have been used in many trials of drugs for depression as a remedy when patients become agitated by the drug (1). Therefore, the summary should be changed.
I also wonder why the authors did not cite a similar Cochrane review. Benzodiazepines for schizophrenia. Cochrane Database System Rev. 2012;11:CD006391. ”
“There is currently no convincing evidence to support or refute the practice of administering benzodiazepines as monotherapy,” the review authors wrote. I commented on this review in my book on psychiatry (1):
“In practice, benzodiazepines should be used instead of antipsychotics. In 14 trials comparing them, benzodiazepines produced significantly more desirable sedation. Eight trials compared benzodiazepines with placebo. were compared and the authors reported that the rate of treatment failure was not significantly lower with benzodiazepines than with placebo (6 trials, 382 patients, relative risk 0.67, 95% CI 0.44 to 1.02). My interpretation of the data is quite different.Of course, benzodiazepines calm patients, but this also means a relative risk of 0.67.Whether it’s statistically significant or not doesn’t matter.A few more patients. If there were more, it would have been important.So why aren’t psychiatrists using benzodiazepines instead of antipsychotics? Didn’t they do better trials themselves?”
During my talks, I often ask my patients whether they would prefer a benzodiazepine or a neuroleptic next time they are hospitalized for acute psychosis. So far, nobody likes neuroleptics. This will give you something to think about.
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- Gesche PC. Fatal Psychiatry and Systematic Denial. Copenhagen: People’s Newspaper. 2015.
More than a year has passed since then, and I still have not heard from the Cochrane Schizophrenia Group. I therefore felt I had no choice but to send a complaint to Cochrane Editor-in-Chief Carla Soares Weiser, and filed a complaint on 8 December 2022. I explained that my criticism was highly relevant. That the review was misleading. And although the review group refused to publish my criticism, it was their duty.
Mr Soaresweiser replied that he intends to work with the Cochrane Schizophrenia Group aiming to publish my comments in early January 2023 and will let me know when that is done.
3 months later I checked the review and even though my comment was public there was no reply to it in the review and nothing in the seriously misleading summary has changed I noticed
So on March 6th, I reached out to Mr. Soares Weiser for further assistance. “Reliable evidence” is Cochrane’s motto, but this summary and the fact that the authors do not cite Dordo’s review mean that the review is far from reliable evidence. “
On May 25, John Hilton, Head of Content Publishing and Policy at Cochrane Central Executive, wrote me the following: Review modified and the answer has been published.
This was four years after I warned the original authors and the Cochrane Schizophrenia Group of the fact that I had published a seriously misleading summary. The only time I was contacted by this group, ironically, four years before him, was when the group responded “as soon as possible.”
Here is the response from ‘Editorial Base Cochrane Schizophrenia’ in the review:
“We thank Professor Peter Gøtzsche for his comments. We agree with him that this phrase can be misinterpreted as suggested. “There was no difference between haloperidol and benzodiazepines for sedation outcomes up to 16 hours (n = 434, 8 RCTs, RR 1.13, 95% CI 0.83 to 1.54, quality of evidence was low).”
Dold’s review (Dold M, Li C, Tardy M, et al., Benzodiazepines for schizophrenia. Cochrane Database Syst Rev 2012;11:CD006391) found that benzodiazepines had a sedative effect compared with antipsychotic monotherapy. Although found to be significantly higher, this result was measured at 20 and 40 min compared with 16 h data in this review.
Conducting clinical trials is a highly complex process that requires funding from competitive grants. While it is good to conduct high-quality trials, lack of resources may be the reason why no further trials are conducted in this area. “
There are 3 problems with this answer. First, editors downplay their mistakes by saying, “This phrase can sometimes be misunderstood.”No, as written, it will be everytime be misunderstood.
Second, the researchers do not believe it is appropriate to comment on the Cochrane review of faster sedation with benzodiazepines than with neuroleptic drugs, claiming that it evaluated only acute effects. . This is a nonsense argument. The review I criticized was about the treatment of acute psychotic aggression and agitation. It is therefore very appropriate to cite the Cochrane review of Dold et al.
Third, the comparison of benzodiazepines and neuroleptics for acute psychosis is not a question of funding. Practical trials are very cheap to conduct and do not require blinded drugs. Alternatively, a blinded observer can be used and, most importantly, have the patient assess the effect.
This lamentable tale shows that the Cochrane Mental Health Organization is committed to defending many of the fallacies it shares about psychiatric drugs, sacrificing scientific honesty and patient care to defend the psychiatric guild. It means that they are willing to do it. I explained in Mad in America that it was the same when I tried to publish a Cochrane review on withdrawal methods to help people get off depression medications.
Unfortunately, the PubMed summary of the Cochrane review I criticized is still the same and misleading in 2017.
