Trial By Error: The Cochrane Controversy

David Tuller


By David Tuller, DrPH.


Cochrane–formerly called the Cochrane Collaboration–is respected worldwide for its systematic reviews of medical treatments. These reviews are often cited as the definitive source of information about treatment efficacy and safety. In taking on the thankless task of assessing the data on commonly used interventions, Cochrane performs an invaluable public health service and has advanced the cause of evidence-based decision-making in medicine.

But like any organization, Cochrane can get things wrong—as it has in the case of chronic fatigue syndrome. (Cochrane generally uses the term CFS, so I will also when referring to these systematic reviews.) Cochrane’s review of cognitive behavior therapy for CFS was published in 2008, pre-PACE. The most recent review of exercise therapies for CFS, which mainly included studies of graded exercise, was published in 2014. These systematic reviews and previous versions, all of which reported benefits from the treatments, were conducted by Cochrane’s Common Mental Disorders group.

Last month, The Times and The BMJ covered the growing international concerns about the PACE trial. Both publications ran articles about Virology Blog’s most recent open letter to The Lancet, which cited PACE’s “unacceptable” flaws and called for a fully independent reanalysis of the trial data. The letter was signed by 114 experts, ten members of Parliament, and 70 patient and advocacy organizations. To counter this sort of public criticism and support their unwarranted claims, the CBT/GET ideological brigades and their enablers regularly cite Cochrane’s systematic reviews.


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