Cochrane Nordic kerfuffle – HPV vaccine is still safe and effective

If you’ve been following the old dinosaur’s articles over the past few weeks,  you’d know the ongoing kerfuffle between the anti-vaccine group located within Cochrane Nordic and the parent Cochrane Collaboration. Cochrane Nordic attacked a well done systematic review, published by Cochrane, of safety and effectiveness of the HPV vaccine without merit.

In case you are unfamiliar with the organization, Cochrane Collaboration is a critically important source of evidence-based medicine and a useful tool in providing analytical evidence that can debunk pseudoscientific beliefs. Cochrane’s goal is to organize research data and publications in a logical way that helps physicians and researchers make appropriate decisions about a proposed new therapy, medication or clinical idea.

According to Cochrane, their mission is:

…to provide accessible, credible information to support informed decision-making has never been more important or useful for improving global health. In the Internet age, people have much greater access to health information, but little way of knowing whether that information is accurate and unbiased. We do not accept commercial or conflicted funding. This is vital for us to generate authoritative and reliable information, working freely, unconstrained by commercial and financial interests.

Mostly, Cochrane produces systematic reviews, which utilizes systematic methods to collect published data, critically analyze research studies, and then synthesize data from numerous published studies in an attempt to eliminate bias and increase the power of the data that includes a larger number of patients than one study alone.

In the hierarchy of biomedical research, systematic reviews rank at the very top. They are, without a doubt, the most powerful pieces of scientific research available in medicine. To be fair, Cochrane is not perfect. They have made egregious errors in systematic reviews of acupuncture quackery in the past. Like all scientific literature, one must examine a systematic review (whether published in Cochrane or any other journal) with a critical eye.

So this whole Cochrane Nordic kerfuffle may seem like an internecine feud of no importance to the world of science. And it would have been, except it has evolved into one of those tropes that the anti-vaccine religion uses to attack the cancer-preventing HPV vaccine.

Let me end this introduction with a simple statement backed by a mountain of science – the HPV vaccine is demonstrably safe and demonstrably effective.

Let’s take a look at this whole Cochrane Nordic nonsense.

A little bit about Cochrane Nordic

Before we get into what happened recently in the Cochrane Nordic vs. Cochrane mothership feud, we should spend a moment to explain how Cochrane Nordic went off the rails.

Although the group has produced some good work in the past, it’s hard to look beyond their anti-vaccine nonsense.

A few years ago, Cochrane Nordic attacked the HPV vaccine by presenting “evidence” to the European Medicines Agency (EMA, Europe’s FDA) regarding postural orthostatic tachycardia syndrome (POTS) and complex regional pain syndrome (CPRS) after HPV vaccinations. The EMA completely dismissed this nonsense, and no epidemiological studies have shown either POTS or CPRS to be more common after the HPV vaccination than in a non-vaccinated group.

Members of Cochrane Nordic then published a paper in BMJ Evidence Based Medicine that criticized the Arbyn et al. Cochrane systematic review of the HPV vaccine. This started the kerfuffle. Or feud.

Essentially, the anti-HPV vaccine article criticized the original Cochrane article for being biased and ignoring evidence. They wrote:

Part of the Cochrane Collaboration’s motto is ‘Trusted evidence’. We do not find the Cochrane HPV vaccine review to be ‘Trusted evidence’, as it was influenced by reporting bias and biased trial designs. We believe that the Cochrane review does not meet the standards for Cochrane reviews or the needs of the citizens or healthcare providers that consult Cochrane reviews to make ‘Informed decisions’, which also is part of Cochrane’s motto. We recommend that authors of Cochrane reviews make every effort to identify all trials and their limitations and conduct reviews accordingly.

Their major points were that they ignored a Gardasil9 trial, they ignored funding sources, and they didn’t include enough randomized, double-blind trials.

Several writers criticized the criticism, including other scientists at Cochrane. In response to the critique published in BMJ, they concluded that:

…the analysis “substantially overstated its criticisms” and that the allegations were “not warranted and provided an inaccurate and sensationalized report of their analysis.”

Moreover, the Cochrane Nordic criticisms were based on small, poorly-designed studies. And they completely ignored the extensive, global, large, high-quality studies that establish, almost to the point of beyond a reasonable doubt, that the HPV vaccine is safe and effective.

All of this leads us to…

What did Cochrane Nordic do now?

Peter Gøtzsche, one of the authors of the HPV vaccine criticism and a member of the board of the Cochrane Collaboration, was thrown out of the board (though, it is unclear whether his relationship with Cochrane was terminated). According to a whiny statement from Gøtzsche  (pdf):

I regret to inform you that I have been expelled from membership in the Cochrane Collaboration by the favourable vote of 6 of the 13 members of the Governing Board. No clear reasoned justification has been given for my expulsion aside from accusing me of causing “disrepute” for the organization.

On many points, Gøtzsche has become a crackpot. He is ridiculously opposed to psychiatric medications, expressing his opinion in a book, “Deadly Psychiatry and Organized Denial,” in which he claims that a half million Americans and Europeans have died from these drugs. He has also written books about Big Pharma, comparing them to the Mafia, and claiming that mammography is a useless procedure.

It’s hard to take Gøtzsche very seriously as a scientist in that he expresses a highly political, biased viewpoint about medical science. As Dr. David Gorski wrote in a conversation about him, “he’s always been a bit of an ideologue, and now he’s become a bit of a crank.”

It is difficult to take Cochrane Nordic seriously about their concerns with the HPV vaccine since they seem to be so highly biased against it. Moreover, their continued attacks on the vaccine were not supported by the Cochrane Collaboration, and their published criticism did represent an “official” point of view of the organization.

Vaxopedia, which has been tracking this kerfuffle too, wrote: “this could be it for the Nordic Cochrane Centre.” And maybe it should be.

It’s good that Peter Gøtzsche is gone from the organization. He does not represent the best characteristics of the Cochrane Collaboration. But I think a bit more housecleaning is necessary to rid Cochrane Nordic of the anti-vaccine pseudoscience that seems to have infected that group.

Citations

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!