Why the Cochrane Collaboration needs to clean up conflicts of interest (on GET for CFS review)

[Tom Kindlon]

Why the Cochrane Collaboration needs to clean up conflicts of interest
by James Coyne
https://jcoynester.wordpress.com/20...tion-needs-to-clean-up-conflicts-of-interest/

This discusses/criticises a Cochrane reviewer's reply to my comments on their exercise therapy for CFS review.

 

[A.B.]

I made a comment (on Coyne's blog) that Cochrane Common Mental Disorders group made a recent review on exercise therapy for CFS. This group is coordinated from Bristol in the UK and lists CFS among its major interests. Lillebeth Larun was author of that review.

These reviewers likely already consider CFS to be a mental disorder even if this has not been proven, and will probably be biased towards conclusions that support this view rather than conclusions that contradict it. Finding that psychotherapy and exercise are helpful for CFS undoubtedly supports the view that CFS is a mental disorder. This conclusion may also be good for the careers of the reviewers.

A fair review would include people from different fields, and also discuss the possibility that CBT and GET may appear to work only because of the placebo effect. Asthma medication would not be considered effective if it didn't objectively improve breathing, but claims are made about CBT and GET being effective despite a lack of objective improvement.

 

[BurnA]

This is my favourite bit

So, the both the systematic review under discussion and the other protocol were conducted among “families and friends”. In dismissing concerns about risk of bias for a particular trial, Lillebeth Larun is ignoring the obvious strong bias for her associates.

She has no business conducting this review nor dismissing the high risk of bias of inclusion of their study.

 

[Tom Kindlon]

I made a comment (on Coyne's blog) that Cochrane Common Mental Disorders group made a recent review on exercise therapy for CFS. This group is coordinated from Bristol in the UK and lists CFS among its major interests. Lillebeth Larun was author of that review.

That's the review that is discussed:

Exercise therapy for chronic fatigue syndrome

1. Lillebeth Larun1,*,
2. Kjetil G. Brurberg2,
3. Jan Odgaard-Jensen3,
4. Jonathan R Price4

Editorial Group: Cochrane Common Mental Disorders Group
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003200.pub4/abstract

 

[A.B.]

That's the review that is discussed:

Yes. I have concentration problems at the moment and wasn't sure which one Coyne was referring to exactly. Anyway I think I make enough sense to be understandable. There seems to be an implicit bias in the group that is producing this review (since they already consider CFS a mental health disorder), combined with low standards that are accepted as the norm.

 

[Sasha]

Latest:

https://jcoynester.wordpress.com/20...tion-needs-to-clean-up-conflicts-of-interest/

 

[alex3619]

This very much looks at some of the big issues with EBM, though not all of them. Rapid reviews of papers miss methodological and bias issues. As a result the outcome of an EBM review or meta-analysis risks reaffirming bias. I have been saying much the same thing.

What Coyne does not say is why this issue has arisen. I think there are two main issues other than the ones he cites. The first is that huge numbers of poor papers can get published by virtue of funding bias. This will distort a review. The second is that it is very time consuming to properly review papers. Which means someone is out a lot of time and often a lot of money. There seems to be an imperative in EBM methodology to get things done fast. Fast leads to poor review .. and yes, I think the months to a year in many reviews is too fast unless they are very well funded and resourced, and this does not happen.

 

[Yogi]

Cochrane have responded:

https://community.cochrane.org/news/cochrane-and-conflict-of-interest

Great bit for the ICO Tribunal that QMUL will be defending.

Another issue raised by Coyne has also been raised with me in personal correspondence: namely the perceived use of Cochrane as a rationale for withholding clinical trials data at the level of individual patients from other individuals and organisations. Cochrane is a strong supporter and founding member of the AllTrials initiative and is committed to clinical trials transparency. Cochrane does not believe that sharing data with its researchers is an appropriate rationale for withholding the data from alternative researchers. Each application must be judged independently on its merits. Cochrane has issued a public statement that details our position on access to trial data.