Monday, December 8, 2014

Cochrane vision undermined?

Email to the Cochrane Collaboration

Claire Allen,

The Cochrane vision statement:

Our vision is a world of improved health where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesised research evidence.

On 31 May 2013, Cochrane published the following summary:

Results from three large randomised controlled trials conducted in Africa have shown strong evidence that male circumcision prevents men in the general population from acquiring HIV from heterosexual sex.

Unfortunately, this Danish Statement on the Nordic Cochrane Center’s website doesn’t conform to this vision:

The Statement is a commented report of a hearing on a proposed ban on circumcision at the Danish Parliament. “Shah argued, on the other hand, strongly for the appropriateness of circumcision on the basis of the “wondrous evidence" that exists for its many medical benefits, however, there are actually none....” (Shah argumenterede derimod stærkt for berettigelsen af omskæring pga. den ”fantastiske evidens” der er for de mange medicinske fordele, men det er der jo netop ikke….). I identified five other misinformative sentences similar to this in the Statement. The author concludes by calling for a ban and by urging doctors to refuse to participate in the operation. He also includes the terms “mutilation (lemlæstelse)” and “barbaric (barbarisk)” to describe the medical procedure. Most of this Statement also appears as an article in the national newspaper Politiken on the 14. Nov. 2014. The author is identified as “Peter Gøtzsche, professor,, Det Nordiske Cochrane Center.”:

In 2007, an educational conference on male circumcision and HIV prevention, prepared by WHO, UNAIDS, UNICEF, UNFPA and The World Bank, was held at the Red Cross headquarters in Copenhagen. From the introductory information: “Male circumcision has now been assessed as a potential means to limit the spread of HIV.” The Global Fund to Fight AIDS, Tuberculosis, and Malaria, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), The Clinton Foundation, and the Bill & Melinda Gates Foundation are among the donors of an effort to perform 20 million circumcisions in the high risk countries by the end of 2016. Last month, Gaven Yamey, MD, MPH, MA, MRCP(UK), from the University of California, San Francisco, was the keynote speaker at a public health meeting at the University of Copenhagen. He commented that male circumcision was the most important scientific advance of the last decade in the fight against AIDS.

I fail to see how the Cochrane vision is compatible with the cited Statement on the website of the Nordic Cochrane Center. Not only does it fail to cite the relevant findings of the Cochrane Collaboration, but it includes claims that are in contradiction to well known scientific findings. The public debate in Denmark has included the statements, “Jews/Muslims mutilate babies.” The language in the Statement appears to support such usage. Ethnic tensions have been escalating in Denmark as elections approach and this type of language will likely increase attacks. It appears that there has been a breakdown in presenting the research evidence on this issue. I hope the Cochrane Collaboration will ensure that such evidence is made available, even though I doubt whether this will be able to compensate for the damage done to the decision making process in Denmark and to the reputation of the Cochrane Collaboration.

Unfortunately, the damage resulting from this type of activity is not limited to Denmark. A male circumcision denialist movement, “Intactivists,” has emerged, which has many similarities to the once popular AIDS denialism movement. The organizations use emotional appeals, comics, and a movie is being made to promote their viewpoint. In Denmark, several NGO’s have been undermined, including the International Planned Parenthood Foundation affiliate “Sex og Samfund.” These organizations have ensured that public health professionals no longer participate in public discussion, since the professionals have learned that no amount of explanation has any effect on the fanatics’ behavior. Scientists that publish “incorrect” views have had their homes picketed. Meetings of foundations providing funding for circumcisions in high risk countries have been disrupted.  Denialism in the face of the ongoing pandemic has been declared unethical and immoral [Banerjee, et al. 2011. Circumcision Denialism Unfounded and Unscientific. Am J Prev Med 2011;40(3)e11– e12]. I presume that sharing responsibility for 300,000 preventable deaths over the next 10 years is something that the Cochrane Collaboration would prefer to avoid.

You can find a slide set supporting my arguments, a draft of a scientific dishonesty complaint,  etc. on this page: