Evidence Hints Cochrane May Fail

After years of deterioration, Cochrane embraces OA — and puts most of its remaining revenue at risk

Cochrane is a British charity that produces systematic reviews of medical research findings to facilitate evidence-based choices for health professionals, patients, and policy makers.

Founded in 1993, Cochrane was central to the evidence-based medicine (EBM) movement back when it used the moniker. Its success spurred many medical journals and societies to start producing systematic reviews and guidelines of their own, diluting Cochrane’s position as a unique source of reviews, yet with its reputation intact.

That reputation has eroded somewhat over time, as reviews have come slowly and seemed relatively undifferentiated.

On top of that, controversies have emerged in recent years, including a “governance crisis” in 2018 in which one of the founders was expelled for criticizing reviews pertaining to mammography and the HPV vaccine (and perhaps for just being generally irascible). After the expulsion, four members of the Board resigned and two had to leave to restore a balance between appointed and elected members, throwing Cochrane into turmoil.

This came directly on the heels of a 2017 review of the UK National Institute for Health and Care Research (NIHR) investment in Cochrane, which found considerable differences in productivity and review quality between groups — reviews were slow to produce, and many reviews were out of date or did not address priority topics. The review also identified a conflict of interest as the same specialist group that helped authors to produce a review would decide whether it was fit to publish.

The 2017 review also notes that Cochrane was creating “empty reviews” due to:

. . . overly restrictive inclusion criteria concerning the types of studies, such as only RCTs, in situations where other types of studies addressing the question exist.

Basically, they weren’t including useful study designs that might help physicians and healthcare professionals, but being dogmatic about only including randomized controlled trials (RCTs).

In March, 19 of 52 groups that produce Cochrane’s systematic reviews closed after the NIHR stopped funding them, costing the organization £4.2 million (US$5.3 million). Cochrane generated £8.9 million in what it terms “core income” 2022. (The difference between grant and core incomes appears to be when the revenue is earned from an accounting standpoint, with government grants only earned when the activity being funded is completed.)

Now, the organization seems to be playing with fire, according to a story in Nature, aiming to make all its reviews OA by 2025, and putting at risk around £6.8 million of the £8.9 million core income coming from subscriptions to the Cochrane Library.