Cochrane signs up to AllTrials initiative to campaign for registration and reporting of all clinical trials
April 19 , 2013
The Cochrane Collaboration, the international not-for-profit organization that produces systematic reviews of healthcare evidence and the largest database of randomized controlled trials, published online in The Cochrane Library, has today formalized its commitment to the AllTrials: All Trials Registered | All Results Reported initiative to campaign for the registration and reporting of all clinical trials.
The AllTrials campaign aims to draw attention to the crisis of unreported trial data. Hundreds of thousands of clinical trials have been conducted from which no or limited data have been made available; data critical to enabling doctors and regulators to make informed decisions about which treatments to use and fund. This is a serious problem for evidence-based healthcare researchers including The Cochrane Collaboration, because all the evidence about a treatment is needed to understand its risks and benefits. Without a complete picture of trial results available, information is lost; bad treatment decisions may be made; financial investment into ineffective treatments are approved by governments and regulators; opportunities for better and more effective treatment are missed; and trials are repeated unnecessarily, duplicating effort and wasting resources.AllTrials was launched in January 2013 by Ben Goldacre, bestselling author, broadcaster and medical doctor, whose exposé on scientific inaccuracy Bad Science  reached #1 in the UK paper back non-fiction charts; along with the charity Sense About Science; the Centre for Evidence Based Medicine in Oxford; the James Lind Initiative; and the BMJ. In the three months since its inception, AllTrials has gathered more than 47,000 signatures for its petition calling on governments, regulators and research bodies to implement trial registration and reporting measures; as well as the support of hundreds of organizations and institutions working in research, patient advocacy and health care. The Cochrane Collaboration was one of the earliest organizations to offer support, and to further demonstrate its commitment to the goals of the AllTrials initiative, has today formalized its involvement as one of the initiative’s principal supporters and organizers…
As much as I’m interested in knowing how these recent events and Ben’s particular style became the kindling that finally seems to have ignited a blaze so long overdue, I’m even more interested in how we got this far off of the track in the first place. When I arrived in medical school, I fell in love with the literature. I had been a product of that post-Sputnik age where the only question was what kind of scientist were you going to be and had lived a life surrounded by text-books, but the medical literature was so much more. It came weekly or monthly, and you could even sometimes feel science moving. Later, in a fellowship, I was involved in a project that involved looking back through the old literature with a new idea to see if its roots were previously apparent – and they were. They had been dutifully recorded for years, awaiting our data from a new electron microscope technique to make sense of a piece of it. I couldn’t imagine anything more interesting than that kind of continuity.
I personally left the thread of the contemporary psychiatry literature thirty years ago. Maybe I should say it like it felt. It felt like it left me as it became rapidly and monotonously biologified after 1980, and I was focused on other things. But coming back to it in recent years, I’m afraid that my attitude of wonder has changed. I don’t trust it anymore, or the process that creates it. In former days, there was plenty that I thought was wrong, but not wrong on purpose. There are so many clinical trials that are misrepresented. All the old graphs, tables, and statistics are there, but they have to be read in a different way. After the title, the next most important parts are the funding source, the acknowledgements, the disclosures, the authors’ affiliations (and worse, there was a period where that information wasn’t even available). Beside the monotonous trials, there were reviews and perspectives that were thinly disguised commercials. And in the psychiatric literature, there has been an absence – a dirth of a medical skepticism that I’d become used to. Everything was just great. My impression is that this b.s. factor in the psychiatric literature is unique, or at least much more prevalent than elsewhere in medicine.
So as we move forward hopefully with a new resolve to make our scientific literature actually scientific, I think we’re duty-bound to figure out why it hasn’t been for such a long time. Why would the JAACAP publish Paxil Study 329 over the objections of the peer reviewers? Why, in light of the abundant available evidence would the editor refuse to retract it even now? Why would a terminally flawed meta-analysis like that published in the Archives of General Psychiatry last year by Robert Gibbons et al be published at all, or still be there? Why would a requirement to publish trial results on clinicaltrials.gov within a year of a trial’s completion be ignored most of the time with no apparent consequences?