A quarter of a century on from the founding of The Cochrane Collaboration the network appears to be thriving, with 13,000 members and a 2017 income of over £8.6 million. The Cochrane Library, a collection of databases containing systematic reviews that can be used for healthcare decision-making, now boasts over 7,900 reviews. However, following the expulsion from the Cochrane board of one of the founding members — Prof Peter Gøtzsche — four further board members have resigned. Prof Gøtzsche has since published a book entitled, “Death of a whistleblower and Cochrane’s moral collapse”. An article by Melanie Newman in The BMJ explored the history of Cochrane, from its conception to its recent conflict, and examined the question: “Has Cochrane lost its way?”.
The vision of Cochrane is a “world of improved health”, whereby “high-quality, relevant and up-to-date synthesised research evidence” informs healthcare decisions. Work to achieve this is based on ten key principles, including “Collaboration” and “Minimising bias”. Recent growth would suggest success of this model; however, critics interviewed by Newman argue this growth may not be something to celebrate. Former Cochrane board member David Hammerstein suggests that “more does not mean better” when it comes to healthcare. Another critic concurred that Cochrane should shift its focus from “quantity” to producing “methodologically high-quality reviews in areas of importance to patients”, so that it becomes “more of an advocate for evidence based medicine”.
Newman suggests that Cochrane’s current struggles are the culmination of members’ disagreement over the network’s centralisation. Over the years, Cochrane has evolved from a grassroots organisation to what some critics now describe as a “corporate centre focused on income generation and ‘message control’”. A group of members concerned about a “lack of transparency” received over 600 signatures in a petition calling for four major policy changes, described as: 1) Create a culture of open discussion; 2) Refocus the heart of Cochrane; 3) Increase the involvement of Cochrane members; 4) Find a better business model for Cochrane. However, Mark Wilson (CEO) insists it is “not the case” that Cochrane’s strategy is failing, and argues that the “community has grown hugely”. Newman concludes that resolution of the current debate may take some time and must be navigated carefully to retain enthusiasm of Cochrane’s many voluntary members.
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