“Cochrane Presents Information, which can be Trusted”
(April 27th, 2017) An interview with Britta Lang, Deputy Director of the German Cochrane Centre, about the interactions underlying one of the world’s largest medical research collaborations.
Cochrane is an independent, non-profit, non-governmental organisation, consisting of around 37,000 volunteers and contributors in more than 130 countries and 500 paid staff (for more details, see our article in issue 6-2016). The Cochrane Collaboration is widely acknowledged as one of the world’s leading health organisations with a reputation for producing high-quality, credible systematic reviews of medical research studies and clinical trials. Lab Times asked asked Britta Lang about the day-to-day operation and functioning of such a large voluntary global research organisation.
Lab Times: The first Cochrane Centre was founded by Iain Chalmers in Oxford, England, in 1992. By 1999, the call for an international Cochrane Collaboration had inspired the worldwide creation of 13 other Cochrane centres. The German Cochrane Centre was registered in Freiburg in 1997. What is the relationship of the German Cochrane to the UK centre? Is there a hierarchy of command from the UK or are you fully independent?
Lang: We are fully independent. Each Cochrane Centre is responsible for its local (national) funding and has to report its activities and funding situation every two years to the Cochrane Central Executive in London.
What are your major costs and how does the German Centre pay for its activities?
The major costs are personnel costs, mostly covered by scientific projects. Since 2014, Cochrane Germany is a central unit at the University Medical Centre Freiburg and a designated academic institute with an annual budget of around 480,000 Euros.
The Cochrane organisation says it is 'independent', but several centres (e.g. UK, Australia) appear to be mostly government-funded. Do you think this funding has influenced Cochrane's public presentations, for example, by avoiding open criticism of government health policies?
I can not judge the situation in other countries but, as far as I know, there have been no influences by the public funding bodies on the work of Cochrane. In Germany, Gerd Antes (the centre’s director) has often openly criticised public health policies but our financial means have not been restricted as a consequence. Overall, our funding from the Ministry of Health is always in the form of ‘project funding’, i.e. we apply for clearly defined tasks, which are not directly influenced by the Ministry.
However, the Cochrane Reviews are not organised by the Cochrane Centres but via the Cochrane Review Groups (53 in total). There are several Cochrane Review Groups based in Germany. For example, the Haematological Malignancies Group in Cologne that “sums up evidence for diagnosis and treatment of adults with haematological diseases”, especially leukaemia and lymphoma. What is your relationship to these Review Groups? Do you coordinate their activities or provide training for German collaborators, e.g. through workshops?
We collaborate with these groups by exchanging tutors for courses, applying for funding or doing workshops together. But they are independent entities with their own coordination.
Gerd Antes, the Director of German Cochrane, has taken a public position calling for all clinical trials to be made public and attacking the rise of 'Big Data'. You have also been active in promoting 'Evidence-based Medicine'. Are these positions directly associated with your work at Cochrane? How do you decide in the context of Cochrane what to criticise or advocate?
In principle, the topic of Evidence-based Medicine has the strongest connection to Cochrane. The other topics arose from the ongoing methodological developments. The call for public access to ‘All Trials’ means that authors of Cochrane Reviews will be able to incorporate all existing trials into their systematic reviews. But, of course, centre directors sometimes have their special focus on a topic or have their personal agenda. Cochrane grew up on the shoulders of people with a strong personal committment to this idea of transparently synthesising research evidence. They formed a strong group of individuals (pioneers) and some are still in charge as centre directors. They decide individually on their public performance and I think there have been tensions over how some of them represent Cochrane or, vice versa, how Cochrane develops in their eyes.
The Cochrane refuses to accept financial support from the pharmaceutical industry. Do you think there is still a significant risk that commercial interests can influence the outcome of Cochrane Reviews to favour their products, e.g. by influencing key members of Reviewing Groups? Some Cochrane Reviews have played a big part in political scandals, for example, with Tamiflu.
Cochrane has never accepted any commercial funding. This is to ensure that reviews are free of conflicts of interest. There are some research papers that show that there is a significant bias towards overestimated effects in papers, which have been industry-funded. I think this is one of the unique features of Cochrane and results in its reputation for presenting information, which can be trusted.
Cochrane has been very active in developing new analytical methods for, for instance, systematic literature research. Is German Cochrane responsible for part of these developments, whether alone or as part of a larger Methods Group? Presumably these are both used in training and standardising the work of Review Groups?
Cochrane was and is one of the major pacemakers regarding methodological developments in the field of systematic reviews. Colleagues of mine are engaged in several Methods Groups. The Handbook for Sytematic Reviews is used wherever Cochrane methods are taught and people are trained in conducting systematic reviews. We did a lot in adapting and transferring these methods into both the German language and the German healthcare system (e.g. the Manuals for guideline development). For us in Germany, the barrier from English to German is still an issue.
In 2013, Mark Wilson became CEO of Cochrane in the UK. He called for transformations of the 'brand', launching, for example, 'Strategy to 2020' and the Project Transform (organised by Cochrane Australia). Have you noticed other significant changes?
Mark Wilson is the CEO for Cochrane, globally. The Cochrane Central Executive is located in London. But as Cochrane internationally is a network of volunteers, it is very difficult for the CEO and his team to lead Cochrane through the actual process of getting more professional and consistent across all the existing entities. It is not like in an enterprise, where you launch ‘top down’ new branding or strategies for the future. In Cochrane, everything has to be agreed on ‘bottom up’, which is very tiring sometimes. Of course, we have noted changes in branding, in processes and the will to be more user-friendly in our main information products.
Interview: Jeremy Garwood
Photos: Archie Cochrane Library (Cardiff University), Britta Lang