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  Posted By: Paige2psu @ 07/15/2009 11:36:24 AM

  I am a conservative and a health policy researcher and I am entering the field of comparative effectiveness research. I believe CER holds great promise for advancing the quality of medical care in the U.S. What I am concerned about, as are other conservatives, is the role of the Federal Coordinating Council on Comparative Effectiveness Research. If this council serves the same role as the Cochrane Commission, then I will support it. However, I worry that the Council will have the ability to make policy in the form of deciding what treatments will be covered by Medicare and the National Health Insurance Exchange (if created). Research should inform decision making but should not be used to limit care to patients.

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  Posted By: dkcundiff @ 07/14/2009 5:20:40 PM

  As the lead author of a published Cochrane review, the Cochrane outreach coordinator alerted me to Sharon Bigley???s article praising the work of the Cochrane Collaboration. I take issue with her statement, ???And only once since Cochrane was established in 1993 has one of its reviews been overtaken by events.??? My review titled, ???Anticoagulants versus non-steroidal anti-inflammatories or placebo for treatment of venous thromboembolism??? (http://www.cochrane.org/reviews/en/ab003746.html) was corrupted by changes written by the editor and peer-reviewers rather than the authors. In 2007, Medscape General Medicine, a peer-reviewed medical journal, published my commentary titled, ???Evidence-Based Medicine and the Cochrane Collaboration on Trial,??? detailing my complaint about this issue: http://www.medscape.com/viewarticle/557263. Cochrane has issued no response to date. From 2007 ??? 2008, I submitted feedback letters to the authors and editors of 57 Cochrane anticoagulation reviews and protocols concerning methodological errors, biases, and financial conflicts of interests. Only 13 replies have been published to date and none of my points has been rebutted. In January 2009, the Medscape Journal of Medicine (new name for Medscape General Medicine) published my, ???Systematic Review of Cochrane Anticoagulation Reviews: http://www.medscape.com/viewarticle/584084. The review said, ???The 58 Cochrane anticoagulation drug reviews, including mine, contained 9 categories of methodological errors (207 total instances) and 4 types of biases (18 total instances). It concluded, ???The efficacy of anticoagulants for treatment and prophylaxis for 30 current medical indications should be reconsidered by the scientific community and medical regulatory agencies. At least 50,000 people per year worldwide have fatal bleeding due to anticoagulant treatment or prophylaxis for these indications.??? My recently updated research shows that about 100,000 people per year worldwide bleed to death from anticoagulants used for these 30 disputed indications: http://doctormanagedcare.com/ChaptersMDM.pdf pages159 -180.
  
  To his credit, Dr. David Tovey, the newly appointed Cochrane Editor in Chief worldwide, has been conducting a comprehensive investigation of my challenges to the validity of the findings of these 58 anticoagulation reviews and protocols based on the critiques in my feedback letters. That investigation should result in replies by authors and editors to all my feedback letters and a transparent report to the public by Cochrane of the specific findings regarding each of my challenges. This is a chance for Dr. Tovey to reinforce and maintain the Cochrane Collaboration???s high standing in the area of evidence-based medicine.
  

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  Posted By: mschaafs @ 07/13/2009 11:35:58 AM

  Thank you for this article Sharon! To respond to the comment below about potential influence of drug company marketing: The Cochrane Collaboration is an independent, international network of health care experts and researchers that does not receive any funds from drug companies or any other health-care industry. They do it on minimal public infrastructure support - not for the money, but because they want to find and share the answers to "what works" in health care prevention, treatment and rehabilitation. See www.cochrane.org to find out more. (For transparency, I am a three-year member of The Cochrane Collaboration, at the Canadian Cochrane Network and Centre).