http://bmj.bmjjournals.com/cgi/eletters/331/7525/1148#122053

Cochrane, research bias and Dr Wakefield  22 November 2005
Previous Rapid Response Top
John Stone,
none
London N22

Send response to journal:
Re: Cochrane, research bias and Dr Wakefield



I have had passed on to me an article of March 2004 by John Grimley Evans,
the retiring Coordinating Editor of the Cochrane Dementia and Cognitive
Improvement Group (CDIG): 'Morality and Respectability, The Face and the
Mask'. The article considers how the funding by the Department of Health
for the British Cochrane Groups might be replaced. And it places the
immediately preceding events of February 2004, in which Andrew Wakefield
was pilloried by government and in the media for alleged non- disclosure of
interest in a revealing light:

"CDIG has always taken the view that it is in their own interest that
employees of drug companies should not be authors of a Cochrane Review.
They would inevitably be at risk of accusations of either bias or
disloyalty, whatever the scientific quality of their work. As the witch-
hunt over MMR illustrates, the mob goes for the man not the ball. But we
also believe that a global ban on funding from pharmaceutical companies
would be neither just nor wise. It would not be just because there are many
other sources of potential conflict of interest in Cochrane reviews that
escape similar damnation. Charities have donors wih pre-conceived notions
who must be kept sweet. Government research money is now heavily under
political influence; it would be a brave academic hoping for future grants
who used govenment funds to conclude the latest Downing-Street- trumpeted
health sevice initiative was garbage..." [1]

This puts the contradictions and lacunae of the present Cochrane Review and
its rather patchwork effect in alarming context. As John Grimley Evans
points out Cochrane is heavily dependent for its future survival in finding
favour with the industry, and industry funded institutions. It would also
be naive to suppose that the charities he refers to are also not dependent
on government and pharmaceutical industry backers: in reality it all goes
back to exactly the same sources, and the linkage is there irrespective of
a lack of specific connections between particular products and their
reviews. The apparently easy going attitude of Evans contrasts notably with
the recent House of Common's Health Committee report 'The Influence of the
Pharmaceutical Industry'[2].

In the meantime it is revealing to read that a medically senior observer
regards the contemporaneous MMR episode as a "witch-hunt". And though not
in the same breath he talks about the influence of Downing Street in
determining the outcome of research:

"...it would be a brave academic hoping for future grants who used
govenment funds to conclude the latest Downing-Street-trumpeted health
sevice initiative was garbage...".

In this context it ought not to be forgotten that one of the first voices
to be heard in the "witch-hunt" was that of the Prime Minister:

"There's absolutely no evidence to support this link between MMR and
autism...I hope now that people see that the situation is somewhat
different to what they were led to believe, they will have the triple jab
because it is important to do it." [3]

The catastrophe, I suggest, is that government has given up more than the
pretence at seeking objective science in determining policy. The present
study actually gives no basis at all for confidence in the safety of the
MMR. All we have is the empty mantra:

"The safety record of MMR is possibly best attested by its almost universal
use; it evaluation cannot be divorced from its effectivenes and the
importance of the targeted diseases"

and the admission that the real work has never been done. What a terrible
dereliction after 17 years. The public, however, have been told something
different.

[1] CDIG Newlsetter 10, p.8:
http://www.cochrane.org/newslett/CDCIG_Mar_2004.pdf

[2]http://www.parliament.the-stationery-
office.co.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

[3] BBC News, 'Top doctor wades in to MMR
debate':http://news.bbc.co.uk/1/hi/health/3512195.stm

Competing interests: Autistic son