The colloquium in Edinburgh
It all started at the Colloquium in Edinburgh. Three of the four members of the board who had resigned because of the expulsion of Peter Gøtzsche stood in the large lobby and looked disappointed and forlorn. I felt that this is not how it should be: the most motivated Cochrane members that were on the board were expelled. The Board moved them aside as people who don’t take responsibility and forced them to take away their statement about why they resigned. I was still in a state of, like the Germans say so nicely, “nicht ärgeren nur wundern” (impossible to translate but means something like don’t get irritated, just be amazed) about what was happening. It changed when I heard Martin Burton’s speech at the Annual General Meeting. He answered my question about what the bad behaviour was for which Peter Gøtzsche was expelled with that they were still working on it. Three months later I am still waiting for him to define it. Also Gerd Antes commented at the AGM that he had witnessed Peter Gøtzsche’s behaviour for 20 years, together with many others, and that this never had led to the idea of expelling him.
In the days after the Colloquium the situation grew only worse. The Board’s attitude was: ‘We have done everything correctly and we now continue business as usual”. Even though I applauded the webinars they organised, the Board and the CEO behaved exactly the same: nothing serious has happened, business as usual. No discussion was needed, and only written questions would be allowed. In their opinion no serious damage was done to Cochrane. As evidence, the Board presented the count of news pieces: 250 about Cochrane and only (!) 65 about Peter Gøtzsche. All the major medical journals and all newspapers covered it. As the headline in the Süddeutsche Zeitung said: “Wenn sich professionelle Rechthaber und Besserwisser untereinander streiten, ist ihnen besondere Aufmerksamkeit gewiss” (Impossible to translate but it should sound something like: When professional know-alls and smart-asses are fighting you must take notice) and all newspapers did. It was very clear that, whatever you thought about Peter Gøtzsche, this was big damage to Cochrane, but the Board was in full denial. Informal feedback and questions directly from journalists very clearly showed that Cochrane had experienced substantial damage and that the reputation as THE organisation for transparency and integrity has been lost for many observers.
Discussions with many Cochrane members
I had talked to many people at the Colloquium who agreed that the way in which the Board had expelled Peter Gøtzsche was outrageous. Moreover, what had happened to him could happen tomorrow to anybody in Cochrane. I was not the only one thinking that surely the remaining board had to resign and that with new elections there could be a fresh start. But where should I go in Cochrane to make this happen? All information is top-down. Fergus Macbeth, the chairperson of the Council representing Cochrane groups, had already announced that the Council would first reflect on everything and then produce a statement. I failed to see how this could really be an action plan. That is when I turned to Twitter, the ideal medium for crying out. Funnily enough, Cindy Farquhar soon sent an email to the Co-Eds list to gauge the support for the board because there seemed to be only one Co-Ed criticising the Board on Twitter. About a dozen Co-Eds responded with “I support the board”. There I was pretty much alone except for Juan Evriti and Chris DelMar who also very much disapproved Peter Gøtzsche’s expulsion. Paul Garner and Clive Adams were the ones most supportive of the board and really applauded the expulsion. It took me, stupid me, a while to understand that Clive Adams was bitterly offended by Peter’s fierce criticism of the innocent travel fund the Schizophrenia group had maintained in the past with money from the pharmaceutical industry.
Lisa Bero called me to ask how come I supported Peter Gøtzsche because it should be clear to everybody how badly he had behaved over all those years. I could only reply that I did not see expulsion as a solution for whatever he had done and that this would backfire enormously to Cochrane. It didn’t seem to matter to anyone of the board’s supporters that the harms could far outweigh the benefits. Until this day I don’t understand how so many of my Cochrane colleagues feel so deeply and so personally about this that they are willing to do whatever it takes to get rid of Peter. I have read everything, and I have heard many stories. None of these stories have given me the idea that Peter has misbehaved in such away that he couldn’t be a member anymore. I do understand that some people found him extremely annoying but that is something completely different.
This all didn’t bring me very far in getting the Board to resign or Cochrane to change. Colleagues did not react to my emails or gave vague answers. I felt very much like Cindy Farquhar pictured me: the one Co-Ed ranting alone on Twitter (@OSHdoc).
I had put on our Cochrane Work Review group website my account of the affair around the expulsion of Peter Gøtzsche. It was surprising that this was allowed because all other websites were censored by the London CET. (I only recently understood that the CET which used to stand for Central Editorial Team had been changed to Central Executive Team. This is just one of these wonderful examples of how Cochrane is silently transforming from a grass-roots movement to a commercial firm.) I felt a bit uneasy about it, even though there were no rules and it was our own website. I had noticed what had happened to the Nordic Cochrane Center where the website looked like a forest after a war thanks to the CET.
Four Issues movement
Luckily, there were a couple of other people who were willing to act and after a couple of Video meetings we had a plan: start a members’ movement based on four issues that we felt were the root causes of the expulsion of Peter Gøtzsche. In addition, we would get more democratic people in the Board through actively engaging in the elections.
Cochrane sponsored website
The board started immediately organising new elections which left us very little time to get organised. The invitation for candidates for the elections by the board read as if they were looking for extra members to a board of directors of a commercial firm. It was a nice idea to make a plain language summary of this invitation and really invite Cochrane members to stand as candidates. After we put this on our website and tweeted it around, finally the CET in London understood what we were doing in Finland. David Tovey emailed: “I notice that you have posted items on your Cochrane Work website that express highly inflammatory and inappropriate comments in relation to the removal of Peter Gøtzsche’s Cochrane membership and also the upcoming election. There are appropriate ways by which you can express your views, in particular by contacting your representatives on the Council, or voting in the election, but this is an unprofessional way to use a Cochrane sponsored website that is open to anyone. It is very disappointing to see two people in leadership roles within our community insulting the Cochrane Governing Board and therefore publicly criticising three highly respected Co-ordinating Editors. I do not wish to see this escalate, so please remove this content immediately.”
I responded that the website is maintained by our group and very much paid for by the Finnish Institute of Occupational Health. In addition, in the written agreement about collaboration between Cochrane CET and Cochrane Work Review Group, there is nothing about what we are allowed to put on our websites. Then we talked some more about this, but the conversation continued very much along the same lines as in the email. If texts were not removed things would happen. It made me feel very uncomfortable. Would they do the same to me as they had done to Peter Gøtzsche? I was pretty sure it would be virtually impossible because Peter’s case had already stirred so much that they could not risk another case. Nevertheless, I discussed with my wife the risks I was taking, and we decided that I would continue. Then the next conversation between David Tovey and myself was postponed for almost a month until the 11th of December when the election results would be available.
At the same time and at the very last moment, we decided to turn our four issues statement into a petition. We had the very good example of the petition that David Hammerstein had started that resulted in more than 8000 signatures in support of Peter Gøtzsche. It was still very much unclear how much support we would get and boldly we aimed for 1000 supporters with the petition.
David Tovey’s threats made it very exciting to see how much support there really was. It took ages to reach the first 100. After 200 I started to feel a bit safer and with more than 500, I understood that we were safe. Thank you so much to all these brave Cochrane members and external supporters for your willingness to be there with your names revealed!
The most important way of communication in Cochrane is email and then there is videoconferencing. Sometimes it seems as if people have forgotten that you also can talk on the phone. During the petition Jani tweeted jokingly that Mark Wilson had signed the petition, which was literally correct, but this was another person than the Mark Wilson CEO of the Cochrane secretariat. The crux of the joke was that there is a completely different person, a Canadian bioethicist who is a supporter of change in Cochrane and it was he who signed. This resulted in another angry email from David Tovey and another Cochrane leader in which they both argued what we are doing is very “damaging” to Cochrane because it demotivates David’s (!) team because they don’t belong to the heart of Cochrane; funding is already given to groups in the form of Network support; open access is simply impossible because David and his team have worked on this for five years already but to no avail. Another senior Cochrane official added that she did not want her comments known publicly but that she had to say that she had to correct many of the factual errors in the petition to external stakeholders. In her opinion our petition had been quite destructive, and she asked rhetorically “Is this what you want to achieve?”. She added that she had spent enormous effort to Cochrane and that this was now denigrated and dismissed. She could see why many within Cochrane have been demoralized by our effort. She advised us to take the petition down. We didn’t.
I had also started talking to Jeremy Grimshaw, because during a previous colloquium he had praised the early days of sex, drugs and rock and roll and I thought that he could not possibly agree with Martin Burton’s “zero tolerance for bad behaviour”. He was immediately willing to talk and mostly agreed with the four issues but found that the way in which they were put on paper was too confrontational. About Peter’s expulsion we disagreed very much. He belonged to those that were willing to accept the consequences of Peter’s expulsion. We had a nice conversation and he supported my idea to talk directly to the board. So, I contacted Marguerite Koster, Cochrane’s co-chair. She very nicely and positively reacted to my request. I expressed my concerns about what was happening and that it could not possibly be ‘business as usual’ anymore. We agreed very much about the lack of member engagement in Cochrane. I told her about my idea that we should have a discussion forum where we should be able to express our opinions on anything and everything. She agreed that this was a good idea, but she feared that it would be difficult to realize in the short-term. I asked how this could be difficult with a 70-person staff and seven million pounds in the bank. Now that I write this it is still not realized. I think the reason is that the CET wants to control all information streams and is genuinely afraid of discussion.
We sent our petition to the board saying that we were currently gauging how much support there was for our statements. To my surprise this all led to a positive response from the Governing Board about lack of member engagement and that this will be discussed at the Krakow meeting in April 2019. Also, the discussion platform is mentioned as being investigated. The policy proposals sound promising but basically these are still promises. However, any discussion has to go through the council as the main platform to inform the Board about opinions of the members which sounds as a very tiered democratic approach to me.
Altogether there were a surprising 18 candidates for four posts, which is maybe not so surprising after all our efforts to get people to stand as candidates for the board. At least it was some reflection of the urgency to do something that many members felt.
Because we didn’t want candidates elected who were just there to boost their career, we made a voter guide that explained which candidates had mentioned one or more of our four issues in their strategic plan. It was only fair to ask the candidates if the information I had extracted from their statements was correct. But then, big surprise, the election officer, supervised by CEO of the Cochrane Secretariat Mark Wilson, emailed the candidates: “I have been made aware that some or all of you may have received an email from Co-ordinating Editor Jos Verbeek about a ‘voter guide’ related to ‘four policy issues for Cochrane’ that Jos has compiled. I also know that some of you have raised concerns about it. Please do not respond to his email. Your Candidate Statements and ‘Questions & Answers’ are sufficient to inform voters’ choices and this will be made clear to all eligible voters. Please let me know if you have any concerns related to this issue or receive further correspondence about it.“ When I asked on which rules this was based, I got no answer.
We also sent the Voter Guide to our colleagues on the Co-Eds email list and on the ME’s email lists. This resulted in a message from the elections officer, supervised by Mark Wilson, to these email lists saying: “Your correspondence today to Co-ordinating Editors, Managing Editors, and the candidates themselves, seeks – whether directly or indirectly – to give advantage or disadvantage to candidates based on criteria they have not been asked to respond to. Further, it may encourage voters to disregard relevant information contained in the Candidate Statements. I request that you stop using Cochrane’s official email lists or websites to disseminate your correspondence on this issue. I have also delayed the opening of voting by 24 hours while I take external advice on whether the integrity of this election has been compromised.” After we responded that all we did was perfectly according to the rules, there was an email only to me on Friday afternoon saying that: “I agree with you that our collective priority should be that these elections are open, fair and widely participated in. If your voter guide helps inform your decision on whom to vote for, then that is a matter for you and you are welcome to use it. However, the Cochrane email lists should not be used to promote it.” Then the elections started whilst it was left hanging in the air if the Voter Guide was an activity that could have compromised the integrity of the elections. I felt that without any correction of the previous emails to all Co-Eds and MEs this was an unfair treatment of the candidates who supported the four issues and I demanded a message to correct this. However, Lucie, the election officer went missing for the weekend until next Tuesday, when I mailed Mark Wilson to ask where she was. That resulted in a long exchange of emails in which Mark Wilson stated that he did not owe any apologies to anyone. When I asked for the legal advice on the elections, he asserted that this was ‘legally privileged’ information. This is a non-sense statement because it relates to legal advisers who are not allowed to make public the advice to their clients as a measure to protect their clients. In this case Mark Wilson was the client and he could just let me know what our lawyers had advised him about my actions. In spite of another dozen emails with the Board, I did not succeed in finding out what the legal advice was. So much for transparency in Cochrane. At the time of writing this, there is a promise that all information will be in a soon-to-be-published elections report.
I am in no doubt that our activities led to the very high voter turn-out of more than 1200 voters. However, it is difficult to say what the candidates who were elected will do. If they all operate on an individual basis, there is not much hope that things will change.
Interestingly David Tovey finally cancelled the appointment to further discuss the content on our website. Apparently, we all are now free to inform our community as we see fit and to put on our websites what we see fit.
What did we achieve?
It is difficult to say what if anything is different now. Thanks to the support of many Cochrane members, it seems that business will not be continued as usual. That is an achievement.
Also many people did not like what we did and I found that they were very intimidating. I extensively cited their emails to illustrate what happens when you ask for discussion and debate in Cochrane. The four issues statement was formulated as a point of departure for discussion not as demands that we wanted to be realised immediately. Even that was too much already and was considered destructive by some.
Will things really change? Will there be real member engagement? That would mean that members really get a say in Cochrane policy. For example, that we have real Annual General Meetings where we can discuss and then vote about policies or that we would elect the new Editor in Chief from a number of possible candidates or that we would have lively debates about controversial reviews or methods. Well, it hasn’t even been possible to organise a discussion platform, so it might be that this all will still take years before it is realised. Nevertheless, it feels like a big step to have opened the discussion and it will be very difficult to get the genie back into the bottle. So, there will be more to come in the near future.
Acknowledgements: I am deeply grateful to all the people on our four issues group, with whom I have been able to share my doubts, fears and hopes. Without them nothing would have happened.