Haɗin gwiwar Cochrane yana buga bita na tsararren tsarin kula da lafiya a cikin Cochrane Library. Da zarar wata cibiya ce da ake mutuntawa sosai, amma wannan ya canza, kuma zan ba da labari mai ban mamaki game da tsarin mulki na Cochrane, kare muradun guild da kuɗi, rashin inganci, rashin iya aiki, sa ido, da fa'idar siyasa, wanda na yi la'akari da farkon ƙarshen Cochrane.
Kamar yadda abubuwan suka faru suna da sha'awar tarihi mai ɗorewa, na loda kuma na yi la'akari da takaddun da muka karɓa daga Cochrane da amsoshinmu lokacin da muka yi ƙoƙarin sabunta nazarin Cochrane da aka buga na gwajin mammography tare da ƙarin bayanan mace-mace.
Tarihi
A cikin 1999, bayan Sweden ta yi gwajin cutar kansar nono tsawon shekaru 14, wani bincike ya kasa samun tasiri kan mace-macen cutar kansar nono.1 Wannan ya sa Hukumar Lafiya ta Danish ta nemi in sake nazarin gwaje-gwajen bazuwar. Masanin kididdiga na, Ole Olsen, da ni mun yi mamaki sa’ad da muka fahimci cewa shaidun fa’idar tantancewa ba su da kyau kuma tantancewar na iya yin illa fiye da mai kyau saboda fiye da kima da kuma maganin sauye-sauyen sel marasa lahani da ciwon daji, wanda ke ƙara yawan mace-mace.
Mun lura a cikin rahotonmu cewa, sabanin abin da aka yi da'awar, tantancewar bai haifar da raguwa ba amma ƙara yawan amfani da jiyya masu tsattsauran ra'ayi ciki har da mastectomies saboda yawan bincike na 25-35%. Mun kuma lura cewa tantancewar bai rage yawan mace-mace ba.
Mun gabatar da rahotonmu mako guda kafin majalisar dokokin Denmark ta kada kuri'a game da gabatar da tantancewar amma daraktan hukumar lafiya ta kasar Einar Krag, ya soki rahoton namu kuma ya tabbatar da cewa ministan, wanda ya ki tantancewa, bai samu ba kafin kada kuri'a.2,3
A ra'ayin Krag, Danish ba su da damar koyo game da bincikenmu. Ra'ayina shine ya kamata duk duniya ta sani game da su, kuma mun buga sakamakonmu a cikin Lancet, a Janairu 2000.4 Takardarmu ta haifar da guguwar kafofin watsa labarai da kuma babbar fushi a tsakanin masu ba da shawara kan tantancewa.3
LancetEditan Richard Horton ya lura cewa masu gyara na Cochrane Breast Cancer Group sun yi watsi da aikinmu,5 suna nuna cewa bitar mu ba bita ce ta Cochrane ba kuma ba su sake duba su ba.6 Menene matsalar hakan? Lancet ba jarida ce mara kyau ba.
Cochrane Steering Group co-shugaban Jim Neilson ya koka da cewa bita namu ya ba da ra'ayi cewa bita ce ta Cochrane.7 A fili bai yi ba, kamar yadda ba a buga shi a cikin Cochrane Library kuma bai ma yi kama da bita na Cochrane ba. Abin da ya faru shi ne cewa wasu masu fafutuka masu fafutuka sun nuna shakku game da sakamakonmu kuma suka yi kuka ga Cochrane ba tare da bayar da wata hujja ta kimiyya ba.
2001 Cochrane Review Scandal
Hukumar Lafiya ta ba mu kuɗi don yin bita na Cochrane amma ta yi ƙoƙarin tsoma baki tare da aikinmu ta hanyoyin da ba su dace ba don tabbatar da cewa mun isa ga kyakkyawan sakamako na siyasa.2,3 Kuma lokacin da muka ƙaddamar da bitar mu ga Ƙungiyar Ciwon Kankara ta Cochrane na Ostiraliya - wanda ke da rikicin kudi na sha'awa, kamar yadda cibiyar ta ba da tallafin nono a Australia - mun shiga cikin shingen hanya. Editocin sun ki yarda da haɗa bayanai kan mafi mahimmancin illolin tantancewa, fiye da kima, da cutar da mata masu lafiya, duk da cewa an jera waɗannan sakamakon a cikin tsarin mu ƙungiyar ta yarda kuma ta buga. Mun bata lokaci mai yawa muna tattaunawa da kungiyar amma babu inda muka samu.
Ita ce babbar badakala a tarihin Cochrane a lokacin.2,3 Kamar yadda muka yi la'akari da shi ya fi muhimmanci a sanar da mata da gaskiya fiye da kare Cochrane guild da kudi, mun aika da cikakken nazari, ciki har da illa, ga Lancet. Horton yayi aiki tare da saurin rikodin kuma ya tabbatar da cewa bitar mu ta fito a cikin Lancet8,9 a daidai lokacin da stymied bita ya bayyana a cikin Cochrane Library.10 Daya daga cikin editocin Cochrane, John Simes, ya ce wa Horton cewa mun amince da sauye-sauyen da suka dage a kai, amma na ba Horton imel na cikin gida don nuna cewa Simes na karya. Daga nan sai Horton ya rubuta wani babban edita game da lamarin da ke da illa ga sunan Cochrane.5
Ya ɗauki ni shekaru biyar, tare da maimaita korafe-korafe ga Cochrane Steering Group da Cochrane arbiters kafin a bar mu mu ƙara illar nunawa ga mu Cochrane review.2,3,11
Cochrane ya ƙi Sabunta na Hudu na Bita na Cochrane ba tare da Kyakkyawan dalili ba
Na sake sabunta nazarin Cochrane a cikin 200912 da 2013.13 Wannan bai faru ba. Amma lokacin da, a cikin Janairu 2023, na ƙara ƙarin mutuwar waɗanda aka buga a cikin mafi kyawun gwaji biyu, na yi tsammanin manyan matsaloli tare da tantancewar Cochrane, da kuma tsarin edita a hankali, saboda abubuwan da na samu a baya tare da Cochrane.7 Don haka na buga mafi yawan bayanai bayan abokin aikina ya duba su a watan Mayu 2023 akan gidan yanar gizona don amfanin jama'a:14
Bayanan mace-mace da aka sabunta sun nuna ko da a sarari fiye da da cewa duban mammography baya ceton rayuka. Mutuwar cutar kansar nono wani sakamako ne mara dogaro wanda ke nuna son zuciya wajen tantancewa, musamman saboda rarrabuwar kawuna na sanadin mutuwa. Don haka muna buƙatar duba jimlar yawan mace-macen cutar kansa da kuma yawan mace-mace a maimakon haka. Gwaje-gwajen tare da isassun bazuwar ba su sami tasirin tantancewa akan yawan mace-macen cutar kansa ba, gami da kansar nono (rabin haɗari 1.00, 95% tazarar amincewa 0.96 zuwa 1.04). Ba a rage yawan mace-mace duka ko dai ba (rabin haɗari 1.01, 95% CI 0.99 zuwa 1.04).
Damuwana game da hanyoyin Cochrane sun dace. Bayan da muka ƙaddamar da sake dubawa na Cochrane, ya ɗauki watanni shida kafin mu sami wani ra'ayi, a cikin Fabrairu 2024. Binciken abokan hulɗa da muka samu - daga mutane 11, 8 daga cikinsu sun kasance daga Cochrane - sun wuce kima, tare da maki 91 daban-daban da ke kewaye da shafukan 21 da ke buƙatar amsa.15
An gaya mana cewa ana buƙatar manyan bita; cewa zagaye ɗaya kawai na manyan bita ne aka halatta; kuma za a ƙi yin bitar mu idan har yanzu ana buƙatar manyan bita. Wannan wata hanya ce mai sauƙi ga Cochrane don binne bita da ke barazana ga akidar da ke da rinjaye ko guild ko sha'awar kuɗi: Kawai a ce ana buƙatar babban bita.
Mun yi tambayar dalilin da ya sa ake buƙatar babban bita tun da mun ƙaddamar da sabuntawa tare da ƙarin mutuwar bita da aka buga sau huɗu a baya kuma mun kasance ƙwararrun masana kimiyya. Ƙididdigar digiri na game da meta-bincike;7 Na buga 19 Cochrane reviews; sun ba da gudummawa sosai don haɓaka hanyoyin da aka yi amfani da su a cikin sake dubawa na Cochrane; sun kasance edita a cikin Rukunin Binciken Hanyar Hanyar Cochrane na shekaru 17; sun buga jagororin don kyakkyawan rahoto na sake dubawa na tsari (PRISMA);16,17 kuma ya zama farfesa na ƙira da bincike na asibiti a Jami'ar Copenhagen saboda ƙwarewar dabarata.
Mun mayar da martani ga takwarorinsu reviews18 kuma an ƙaddamar da sigar da aka bita. Bayan watanni uku, mun sanar da Liz Bickerdike, Babban Manajan Edita, Sabis na Edita na Tsakiya, cewa, idan aka yi la'akari da yanayin da ke faruwa cikin sauri a wannan yanki inda manyan ƙungiyoyin jagorori guda biyu, Hukumar Kula da Kayayyakin Kariya ta Amurka da Ƙungiyar Task Force ta Kanada kan Kula da Kiwon Lafiya ta Kanada, sun ba da shawarwari masu karo da juna a cikin watan da ya gabata, mun ga yana da matukar mahimmanci ga muhawarar jama'a da aka sabunta kuma an yanke shawarar yanke shawara. Don haka mun yanke shawarar loda bita, wanda aka gyara kamar yadda aka yi sharhin bita, zuwa sabar da aka riga aka buga.
Bickerdike bai ji daɗi da wannan ba: "A halin yanzu Cochrane ba shi da takamaiman ƙayyadaddun manufofin bugu, don haka, muna ba da shawara ga marubutan da kada su ɗora abubuwan da ba a buga ba a sabar sabar kan layi."
Mun ba da amsa cewa an riga an buga wasu sabuntawa da yawa na sake dubawa na Cochrane kuma an ɗora nazarin mu.19 A ranar 7 ga Yuni 2024, na yi tweet:
An sayar da gwajin cutar kansar nono tare da mammography ga jama'a tare da ikirarin cewa yana ceton rayuka da kuma ceton nono. Ba ya hana kuma yana ƙara mastectomies. A cikin sha'awar jama'a, mun ɗora sabunta bitar mu azaman preprint https://bit.ly/4c6r9K7.
An yaba wannan sosai a wajen Cochrane. A cikin kwanaki biyun farko, sama da mutane 50,000 sun ga tweet dina. Ya zuwa yau, rabin miliyan sun gani.
Mun yi tunanin ba za a iya samun ƙarin al'amura tare da sabunta bitar mu ba, amma bayan watanni uku, mun yi mamaki. Mun sami shafuka 34 na sharhi, an raba su akan maki 38.20
Wannan abin ban tsoro ne kuma da yawa daga cikin maganganun sun kasance mahaukaci. Wannan ba Haɗin gwiwar Cochrane I wanda aka kafa a cikin 1993 ba inda muka taimaka wa marubuta su sami ko da mara kyau sake dubawa maimakon ƙi su bayan sun ɗaga shingen da ba za a iya shawo kansu ba. Wannan, na kuma dandana lokacin da Cochrane ya ƙi ka'idata game da janye magungunan rage damuwa a cikin marasa lafiya da ke son fitowa daga su.21 Madadin haka, Cochrane ya buga wani nazari mara kyau na janyewa wanda ke cike da saƙon tallace-tallace na masana'antu game da yadda magungunan ke da kyau.21
Wani abu ne mai ban tsoro cewa wasu daga cikin masu bitar takwarorinsu ba su fahimci tushen binciken cutar kansa ba ko kuma bita da tsarin, wanda abin takaici, bai hana su neman sauye-sauye masu ban sha'awa ga bitar mu ba.2 Matata, Helle Krogh Johansen, wacce farfesa ce a ilimin ƙwayoyin cuta na asibiti, ta haɗa 8 na sake dubawa na Cochrane, kuma ta bayyana shekaru da yawa da suka wuce cewa Cochrane ita ce aljannar masu son. Lallai haka ne.
Mun gabatar da amsar mu ga masu bitar takwarorinsu22 da kuma sake dubawa.23 Ɗaya daga cikin abubuwan da masu gyara suka buƙaci, tare da la'akari da Littafin Jagoran Cochrane,24 shi ne ya kamata mu rubuta cewa nunin "na iya nuna kadan ko babu bambanci dangane da raguwar mace-macen ciwon nono." Wannan wauta ce, domin ita ce ta zahiri ko bambancin ƙanƙanta ne ko a'a. Haka kuma, ba a sami raguwar mace-macen cutar kansar nono ba a cikin ingantattun gwaje-gwaje, waɗanda ke da isasshen bazuwar.19
A ranar 20 ga Fabrairu, 2025, na rubuta wa Bickerdike:
Watanni uku yanzu sun wuce tun da muka loda bita na mu kuma muka ba da amsa ga sharhin bita na tsara. Da yawa, ina tsammanin, ganin cewa bita namu ya kasance tun daga 2001 kuma an sabunta shi sau da yawa a baya, kuma akwai ƙananan sabbin bayanai.
Bai kamata ya dauki tsawon haka ba. Jinkirin Cochrane shine babban dalilin da yasa duk kudaden da kungiyoyin Burtaniya suka bace a cikin 2023. Na gane wannan ya kara wa Cochrane wahala amma na gaskanta yakamata kungiyar ta zama kasa mai bin tsarin mulki, amma ina iya ganin hakan bai samu ba.
Adadin maganganun da muka samu kuma muna buƙatar amsawa sun wuce gona da iri kuma sun haifar mana da ayyuka marasa fa'ida. Na kafa Cochrane a 1993. Wannan ba shine Cochrane da muka halitta ba. Ya fi tasiri a zamanin da.
Da fatan za a iya karɓar sabuntawar mu yanzu kuma a buga shi? Kuma gaya wa shugabannin Cochrane cewa suna buƙatar amfani da ƙa'idodi marasa ƙarfi?
A ranar 26 ga Fabrairu, kwanaki shida bayan na rubuta wa Bickerdike, an ƙi sabunta mu, wanda muka yi tsammani duk da cewa mun yi iya ƙoƙarinmu don biyan duk buƙatun da ba su da tushe. Ta rufe wasu comments25 amma sun lura ba su ƙare ba - duk da cewa sun ɗauki shafuka 62! – kuma kada mu mayar musu da martani.
An gaya mana cewa za mu iya daukaka kara kan wannan hukuncin, wanda muka yi a ranar 24 ga Maris, sama da shafuka 9 tare da hadi 5.26 Ba wai don muna tsammanin za a soke ƙin yarda ba amma saboda dukan al'amarin ya kasance marar hankali sosai cewa muna so mu ga yadda Cochrane zai amsa ga hujjoji na tushen shaida.
Ɗaya daga cikin mafi mahimmancin rashin fahimta shi ne cewa ba a ba mu izinin kiran binciken binciken abin da yake ba: overdiagnosis. Sauran sake dubawa game da duban cutar sankarar nono, sanarwar hukuma daga hukumomi, da sake dubawa na Cochrane na sauran gwaje-gwajen ciwon daji duk sun yi haka, misali game da ciwon huhu, ciwon gurguwar prostate da namu bitar yin gwajin cutar melanoma.27
Mun kuma lura cewa babban editan Cochrane ya yi amfani da kalmar overdiagnosis; cewa manyan ƙungiyoyin jagororin sun yi amfani da shi don haɓakar abubuwan da suka faru a cikin gwaji masu dacewa kamar yadda muka yi; da kuma cewa kalma ce ta Jigon Jigon Kiwon Lafiya (MeSH) da aka yi amfani da ita a cikin bayanan bincike na PubMed don bayyana mafi mahimmancin cutarwar nunawa.
Mun ambaci cewa mun yi mamakin cewa masu gyara sun bukaci canje-canje da goge rubutu da kimantawa waɗanda ba su canza ba daga baya, juzu'in bitar mu da aka yi nazari sosai, kuma mai yiwuwa an ketare layi tsakanin gyarawa da tacewa.
Mun bayyana cewa masu gyara ba sa buƙatar yarda da hukunce-hukunce da fassarori na marubutan, kuma hakan zai zama barazana ga 'yancin ilimi, muhawara, da ci gaba idan masu gyara Cochrane suka yi aiki a matsayin alkalan ra'ayi. A kan wannan, babu wanda a duk faɗin duniya da ya yi nazarin duk shaidun da suka dace don bitar mu dalla-dalla kamar yadda ni da mawallafana daban-daban suka yi, waɗanda suka haɗa da ladabi da sauran rahotanni a cikin Yaren mutanen Sweden. Cewa mu ne manyan masana a cikin wannan al'amari Cochrane bai mutunta shi ba, wanda a fili yana da ajanda na siyasa, don kare gwajin mammography.
Wani ɗan bita ya taɓa tambaya: Me kuke nufi sa’ad da kuka ce kuna karantawa
santimita arba'in na adabi? (Ole Olsen, Tine Bjulf da Peter Gøtzsche)
Editan “Sign-Off Editor” ya lura cewa bita namu na iya haifar da mummunar guguwar gobara ta rashin fahimta. Wannan karya ce sarai. Mun yi imanin bitar mu game da tantancewar nono shine mafi rashin son zuciya kuma cikakke wanda akwai amma ba a ba mu damar gabatar da sakamakon kamar yadda suke ba duk da cewa duk abin da muka rubuta ya dogara ne akan ingantaccen kimiyya kuma ya bayyana a farkon juzu'in bita.
Wannan kuskure ne kai tsaye na edita da sahihanci, tare da kare muradun abokan aikin da suka ba da shawarar auna nono da kuma musanta rashin fa'idar mace-mace da illolinsa na bayyane.
Mun lura a cikin roko cewa riga na farko version na mu bita, daga 2001, yana da wani sashe a cikin Tattaunawa game da "Ƙarya tabbatacce ganewar asali, m damuwa da zafi," amma editoci sun hana mu yiwuwar hada da irin wannan bayani ko da yake yana da matukar muhimmanci ga mata yanke shawara.
Mun kammala a cikin taƙaitaccen bayanin cewa "Aunawar nono bai dace da ma'auni ba cewa gwajin yawan jama'a ya kamata a dogara ne akan gwaje-gwajen da aka yi bazuwar da ke nuna cewa amfanin ya fi illa" kuma "Mata, likitoci da masu tsara manufofi ya kamata su yi la'akari da cinikayya da rashin tabbas na shaida a hankali lokacin da suka yanke shawara ko za su halarci ko ba da shirye-shiryen nono." Editan Sa hannu ya ba da hujjar cewa mun yi nisa sosai kuma “tattaunawarmu ba ta daidaita ba kuma bisa ga shaida amma tana da ra'ayoyin da aka riga aka tsara na jagora watau babu fa'ida ta tantancewa, maimakon la'akari da cewa wataƙila ba a gano fa'idar ba."
Abin kunya ne cewa Cochrane yayi jayayya ta wannan hanya. Masu ba da shawara na madadin magani kuma suna jayayya cewa magungunan su na iya samun fa'idodin da ba a gano ba tukuna, wanda shine abin da muke kira tunanin fata. Bugu da ƙari, ba mu da ra'ayoyin da aka riga aka yi game da tasirin lokacin da muka yi bitar Cochrane na farko2,3 kuma tattaunawarmu ta daidaita.
Mun lura a cikin roko cewa, a cewar Kwamitin Bincike na Ƙasa ta Burtaniya, ma'auni don gabatar da gwajin shine cewa "Ya kamata a sami shaida daga manyan gwaje-gwajen da aka sarrafa bazuwar cewa shirin tantancewar yana da tasiri wajen rage mace-mace ko cututtuka."28 Tun da gwajin nono baya rage mace-mace kuma yana ƙaruwa, shawararmu game da ko ya kamata a samar da shirin tantancewa ya kasance mai daɗi da gaske. Na yi jayayya a wani wuri cewa a yi watsi da tantancewar saboda yana da illa.29
A ranar 5 ga Yuni 2025, Sabis na Babban Edita na Cochrane ya ƙi roƙonmu a cikin imel.30 An gaya mana cewa wani edita mai zaman kansa ya yanke shawarar cewa an yi amfani da shawarar editan daidai. Na tambayi sau biyu ko wanene wannan editan, lura da cewa muna da damar sanin wannan, bisa ga farkon mahimman ka'idoji goma na Cochrane: “ha] in gwiwar ta hanyar haɓaka haɗin kai a duniya, aiki tare, da sadarwa da yanke shawara a bayyane kuma bayyananne."
Jordi Pardo Pardo ne. Duk abubuwan da muke da su lokacin da muka kirkiro Cochrane sun tafi. Na ba da gudummawa don tsara mahimman ka'idoji, amma Cochrane ya zama tushen iko mafi munin nau'in, wanda na yi dalla-dalla a cikin littattafai guda uku.7,31,32 da labarai masu yawa.33
Ra'ayin Pardo game da binciken fiye da kima ya zama banza. Mun yi jayayya a cikin roko cewa "Buƙatun editan da muke buƙatar samun damar gano daidaikun matan da aka yi wa cutarwa ba daidai ba ne kuma ba su dace da ka'idodin Cochrane ba. Ba zai yiwu a gano waɗanda ke amfana ko ɗaya ba, amma masu gyara ba su da irin wannan buƙatu don wannan sakamakon. Rashin iyawarmu don gano mutanen da ke amfana ko cutar da su ta hanyar tsoma baki shine babban dalilin da ya sa muke yin nazari na tsarin bazuwar.
Tare da kin amincewa, Mai bitar hanyoyin ya kawo sabuwar hujja, wanda ba mu sami damar amsawa a baya ba; wato ya kamata mawallafa na asali na gwaji su yi amfani da kalmar 'overdiagnosis' don bayyana bambancin abin da ya faru da gwajin su. Wannan ba buƙatun Cochrane ba ne da muke sane da su. Bugu da ƙari, marubutan gwaji na asali sun yi amfani da kalmar. "34,35
Pardo yayi ƙoƙari ya soke ingantaccen bayaninmu ta hanyar cewa "ba ya ƙaryata gaskiyar cewa ba mu san adadin nawa ba [sic] na ainihin cutar kanjamau." Wannan hujja ce mara inganci. Ƙwararren bincike al'amari ne na ƙididdiga; wato gano ciwon daji da ba za a iya gano su ba a sauran rayuwar matan. Danmark ita ce kasa daya tilo a duniya da ta ba da damar tantance kima da kima a aikace saboda mun yi gwajin a cikin kashi 20% na yawan jama'a tsawon shekaru 17. Mun sami 33% overdiagnosis,36 wanda ke kusa da 31% ƙarin lumpectomies da mastectomies da muka ba da rahoto a cikin bitar mu na Cochrane na gwajin bazuwar.13 Amma a wannan karon, ba a ba mu damar ambaton bincikenmu na yawan jama'ar Danish da ya dace ba.
Pardo ya lura cewa yana buƙatar "tsari da aka riga aka ƙayyade" da ka'ida idan marubuta suna son ambaton binciken lura a cikin sashin Tattaunawa. Mun yi tambaya kan ingancin wannan bukata, wanda muka yi imanin ba wata ka'ida ba ce ta Cochrane. A zahiri, ya zama ruwan dare gama gari a cikin sake dubawa na Cochrane, gami da wasu namu, misali bitar mu na duban melanoma,27 don ambaci karatun lura ba tare da samun ka'ida ta yau da kullun don wannan ba. Duk da haka mun goge duk wani binciken da aka yi na lura daga Tattaunawarmu baya ga wasu kaɗan waɗanda ke da amfani musamman ga masu karatu su sani.23
Pardo ya soki cewa mun rubuta a cikin Ƙarshewarmu cewa mafi amintattun gwaje-gwajen ba su goyi bayan cewa tantancewar nono yana rage mace-macen cutar kansar nono ga kowane rukuni ba, kuma mun yi imanin cewa lokaci ya yi da za a sake tantance ko har yanzu ya kamata a ba da shawarar gwajin mammography na duniya. Har ila yau, an zarge mu da samun ra'ayoyin da aka riga aka yi game da rashin fa'ida na tantancewa "maimakon la'akari da cewa watakila ba a gano fa'idar ba."
Me ya sa za mu yanke shawarar cewa za a iya yin watsi da fa'ida bayan mata 600,000 sun shiga gwaji waɗanda ba su da tasiri a kan mace-macen cutar kansa ko yawan mace-mace (matsakaicin haɗarin 1.00 da 1.01, bi da bi)? Kuma, kamar yadda masu gyara suka buƙata, mun rubuta a cikin taƙaitaccen binciken binciken cewa "mammography na iya yin tasiri kaɗan ko baya tasiri akan mace-macen ciwon nono."
Cochrane Ya Fi son Bincike mara inganci wanda Marubuta Masu Rikici suka Gudanar
Mun sanar da masu gyara cewa kimantawar da muka yi na haɗarin son zuciya a cikin gwaji guda ɗaya daidai yake da a cikin nau'ikan bita na mu da aka buga a baya kuma kin amincewa da kimar mu da masu gyara suka yi ya kasance kin amincewa da bita-da-kullin takwarorinsu na baya da kuma yanke shawara na edita.
Mahimmin batu shine gwajin Kanada guda biyu (CNBSS). Pardo ya lura cewa sake dubawa na 202437 David Moher et al. don Ƙungiyar Task Force ta Kanada ta canza amincin waɗannan gwaje-gwajen daga matsakaici zuwa babban haɗari na nuna bambanci idan aka kwatanta da bita na 2017 ta hanyar aiki guda ɗaya don sassan tsararrun tsararru da ɓoyewa saboda sabon shaida ya fito.
To, menene sabon shaida game da waɗannan gwaji na shekaru 32? Babu ko ɗaya! Moher et al. ya rubuta cewa "An taso da damuwa game da CNBSS game da haɗakar da marasa lafiya marasa lafiya, yiwuwar bazuwar bazuwar, da kuma ingancin mammography [18-22].37
Nassoshi guda biyar sun kasance ga labaran da ƙwararrun masu fafutuka suka rubuta, waɗanda suka haɗa da Martin Yaffe, Daniel Kopans, Stephen Duffy, da Norman Boyd. Na rubuta cewa wasu daga cikin waɗannan marubutan sun buga ɓarna sosai, kuma a wasu lokuta na damfara, takardu game da fa'idodin binciken mammography.2,3
Abin da Moher et al. kuma Pardo ya rubuta karya ne. Na farko, babu wata sabuwar shaida da ta fito. Na biyu, mun rubuta a cikin duk nau'ikan bita na mu na Cochrane cewa "Bita mai zaman kanta na hanyoyin da za a iya juyar da bazuwar ba a gano wata shaida ba."38 Na uku, masu dubawa da ƙungiyoyin sarrafawa sun kasance masu kama da juna don mahimman abubuwan da ke iya ganewa. Wannan ya bambanta da duk sauran gwaje-gwajen, babu ɗaya daga cikinsu wanda ya ba da cikakken rahoto game da kowane nau'i na ƙididdiga a cikin ƙungiyoyin da aka bazu ba tare da shekaru ba, kuma yawancinsu suna da bambance-bambancen shekaru.3,13 Na hudu, ingancin mammogram na Kanada yana da kyau sosai cewa ciwace-ciwacen da aka gano sun kasance ƙanana, a matsakaici, fiye da waɗanda aka gano a wasu gwaje-gwaje na zamani.39
Dalilin da ya sa masu bayar da shawarwarin tantancewa suka yi ƙoƙarin ɓata gwajin da Kanada ke yi na tsawon shekaru 33 shi ne cewa ba su sami tasirin tantancewa kan mace-macen cutar kansar nono ba. Masanin rediyo Daniel Kopans da Martin Yaffe, kuma masanin rediyo kuma marubucin bita na Moher, sun kasance masu tsauri musamman. A cikin 2021, Yaffe ya sake zargin masu binciken Kanada da rashin da'a na kimiyya, da yin amfani da bazuwar, kuma ya yi kira da a janye wallafe-wallafen.40 Wannan ya sa Jami'ar Toronto ta gudanar da bincike na yau da kullun a karkashin jagorancin Mette Kalager, shugabar da ta gabata na shirin tantance nono na Norway. Na kasance ɗaya daga cikin mutanen da Mette ta yi hira da su saboda ina da cikakken ilimin gwaji.
Mette ta gabatar da rahotonta ga Jami'ar shekaru 1.5 da suka wuce amma duk da bukatar da na yi na ganin rahoton, Jami'ar ta ki yarda, ko da bayan na aika da bukatar 'Yancin Bayanai a hukumance, wanda aka yi watsi da shi saboda duk wani abu da ya shafi bincike an keɓe. An gaya mini cewa za a fitar da rahoton "a nan gaba kadan," amma na fuskanci cewa wannan na iya nufin shekaru biyar lokacin da batun bai dace da masu gudanarwa ba. A cewar Mette, kwamitin bai gano wani kuskuren kimiyya ba ko kuma wasu batutuwa masu mahimmanci game da gwajin, kuma babban abin kunya ne cewa Jami'ar ba ta wanke masu binciken ba tuntuni. Masu binciken sun yi zargin cewa jami'ar na fargabar kararrakin da wasu kwararrun likitocin rediyo da ke da zurfin aljihu, lamarin da ya kasance batun sau da yawa a baya.2,3 kuma yayin da ba a yi komai ba, Yaffe ya ci gaba da tursasa masu binciken marasa laifi.40
Alama ce ta koma bayan ɗabi'a na Cochrane, wanda na yi dalla-dalla a cikin littattafai guda uku.7, 31, 32 cewa sun ƙyale marubuta masu rikici su yanke shawarar cewa ya kamata a yi la'akari da gwajin Kanada a cikin babban haɗari na son zuciya. Pardo ya yanke shawarar cewa bita na Moher ya ba da misali mai amfani kan yadda za mu iya magance matsalolin edita game da bitar mu. Wannan abin ban mamaki ne saboda bitar Moher ba ta da inganci, bita ta siyasa.
Ko da yake mun yi rubuce-rubuce da yawa a cikin nazarin mu na Cochrane cewa mace-macen ciwon nono sakamako ne mai ban sha'awa wanda ya fi dacewa da nunawa, kuma saboda haka muna buƙatar duba yawan mutuwar ciwon daji, ciki har da mutuwar ciwon nono, nazarin Moher bai faɗakar da masu karatun su ga wannan ra'ayi ba kuma ba su bayar da rahoto game da yawan mace-macen ciwon daji ba, wanda ba shi da uzuri. Mun bayar da rahoto a cikin bita na 2013 na Cochrane cewa "Babban wahala wajen tantance dalilin mutuwar zai iya faruwa lokacin da aka gano marasa lafiya tare da cututtuka fiye da ɗaya" kuma ba a rage yawan mutuwar ciwon daji ba (rashin haɗari 1.00, 95% CI 0.96 zuwa 1.05).13
Tun da chemotherapy da radiotherapy na ciwon daji da aka gano suna kara yawan mace-mace,13 jimlar mace-mace shine kawai sakamakon mace-mace mara son zuciya. Kamar yadda muka gani a sama, a cikin sabunta bincikenmu cewa Cochrane ya ƙi bugawa, mun gano cewa ba a rage yawan mace-mace ba ko dai (rabin haɗari 1.01, 95% CI 0.99 zuwa 1.04).14,19
Binciken na Moher ya gano adadin bincike na sama da kashi 9-11%, wanda ya yi nisa ƙasa da ƙimar gaskiya, kamar yadda aka samo daga gwaje-gwajen bazuwar da kuma ingantaccen binciken lura inda suka kasance 31%13 kuma 52%,41 bi da bi. Moher et al. kar ma a yarda da fiye da kima a matsayin gaskiya, kamar yadda suka rubuta cewa overdiagnosis ana iya danganta shi da duban ciwon nono. A'a, sakamakon bincike ne da babu makawa, kuma haka ne sa ta nunawa.
Har ma mafi muni, sun yi da'awar ƙarya cewa tantancewa yana rage yawan mace-mace kuma ya ba da kiyasin adadin mutuwar da aka ceto cikin 1,000 a cikin ƙungiyoyin shekaru daban-daban.
karshe
Mun kafa Haɗin gwiwar Cochrane bisa ga sha'awa, haɗin gwiwa, da neman gaskiya, ƙalubale hukumomi, akida, da buƙatun kamfanoni. Wannan halitta mai ban al’ajabi ta rikiɗe zuwa wata ƙungiya mai fa’ida ta siyasa wacce ba ta damu da amincin kimiyya ko jama’a da ake son yi wa hidima ba.
Dangane da sake dubawa na Cochrane da aka buga, a cikin fagage daban-daban, na ci karo da lokuta da yawa na munanan ɗabi'a na edita, kare muradun guild da kuɗi, da babban rashin iya aiki,7,31,32 amma labarin game da sabuntawar mu na nazarin binciken mammography shine ƙusa na ƙarshe a cikin akwatin gawa kuma yana nuna buƙatun Cochrane.
Babban abin kunya a cikin 2001, inda ba a ba mu izinin buga manyan illolin da ke tattare da tantancewa yakamata ya sanya shugabannin Cochrane su kula da sabunta mu da matuƙar kulawa amma sun kasance kamar bijimai a cikin shagon China, suna lalata sunan Cochrane. Taken Cochrane, “Amintaccen shaida,” ya zama abin dariya.
Cochrane baya bauta wa marasa lafiya - yana hidima da kansa. Rasa a cikin kallon cibiya, yanzu yana ba da fifikon baiwa abokan aiki da hukumomi jin daɗi maimakon isar da ingantaccen kimiyya da ingantaccen lokaci.
Kwanan nan na yi hira da abokina na kirki, Farfesa John Ioannidis daga Stanford, masanin binciken likita a duniya, game da Cochrane don fim ɗinmu da tashar hira, Broken Medical Science.42 Na ce ina fatan Cochrane zai tashi daga toka ya tsira kuma ya gina Cochrane mafi kyau ba tare da matsalolin da suka kai ga fitar da ni shekaru biyar da suka wuce ba.7,31,32
John ya amsa da cewa: "Zan yarda da irin wannan shirin na sabuntawa, sabuntawa, tashin matattu, sake fasalin Cochrane mai ban sha'awa kuma ina fatan wannan zai iya faruwa saboda akwai babban hazaka, babban sadaukarwa daga mutane da yawa waɗanda za su ji gaba ɗaya marayu idan Cochrane Haɗin gwiwa, alal misali, ya zama mai shiga cikin riba ko samun ƙarin ajandar samun riba. aikin hukuma.”
Wannan shine fatanmu ga Cochrane. Amma yanzu ya makara. Cochrane yana kan aikin kashe kansa kuma ba da daɗewa ba zai ɓace cikin mantawa. Abun kunya.
Rikici na sha'awa: Babu.
References
1 Sjönell G, Ståhle L. Hälsokontroller med mammografi minskar inte dödlighet i bröstcancer. Läkartidningen 1999;96:904-13.
2 Gøtzsche PC. Nunin Mammography: Babban yaudara. Copenhagen: Cibiyar 'Yancin Kimiyyar Kimiyya 2024 (akwai kyauta).
3 Gøtzsche PC. Binciken mammography: gaskiya, karya da jayayya. London: Radcliffe Publishing; 2012.
4 Gøtzsche PC, Olsen O. Shin gwajin kansar nono tare da mammography ya dace? Lancet 2000;355:129-34.
5 Horton R. Mammography na nunawa – an sake duba bayyani. Lancet 2001; 358: 1284-5.
6 Wilcken N, Ghersi D, Brunswick C, et al. Ƙari akan mammography. Lancet 2000; 356: 1275-6.
7 Gøtzsche PC. Mai ba da labari a cikin koshin lafiya. Copenhagen: Cibiyar 'Yancin Kimiyya; 2025 (Autobiography; samuwa kyauta).
8 Olsen O, Gøtzsche PC. Binciken Cochrane akan nunawa don ciwon nono tare da mammography. Lancet 2001; 358: 1340-2.
9 Olsen O, Gøtzsche PC. Bita na tsare-tsare na nunawa don ciwon nono tare da mammography. Lancet 2001; Oktoba 20.
10 Olsen O, Gøtzsche PC. Binciken ciwon nono tare da mammography. Cochrane Database Syst Rev 2001;4: CD001877.
11 Gøtzsche PC, Nielsen M. Binciken ciwon nono tare da mammography. Cochrane Database Syst Rev 2006;4: CD001877.
12 Gøtzsche PC, Nielsen M. Binciken ciwon nono tare da mammography. Cochrane Database Syst Rev 2009;4: CD001877.
13 Gøtzsche PC, Jørgensen KJ. Binciken ciwon nono tare da mammography. Cochrane Database Sys Rev 2013;6: CD001877.
14 Gøtzsche PC. Binciken ciwon nono tare da mammography. Copenhagen: Cibiyar 'Yanci na Kimiyya 2023; Mayu 3.
15 Saitin farko na sake dubawa na abokan zaman Cochrane, maki 91, shafuka 21. Cibiyar 'Yanci na Kimiyya 2024; Fabrairu 6.
16 Liberati A, Altman DG, Tetzlaff J, et al. Bayanin PRISMA don bayar da rahoton bita na tsari da meta-bincike na nazarin da ke kimanta ayyukan kula da lafiya: bayani da haɓakawa. Ann Intern Med 2009 18;151:W65-94.
17 Zorzela L, Loke YK, Ioannidis JP, et al. PRISMA yana cutar da jerin abubuwan dubawa: haɓaka rahoton lahani a cikin sake dubawa na tsari. BMJ 2016;352:i157.
18 Amsar mu ga saitin farko na sake dubawar abokan aikin Cochrane. Cibiyar 'Yanci na Kimiyya 2024; 22 ga Maris.
19 Gøtzsche PC, Jørgensen KJ. Binciken ciwon nono tare da mammography. Sabuntawa na Cochrane 2024; Yuni 6: medRxiv preprint.
20 Saiti na biyu na sake dubawa ta abokanan Cochrane, maki 38, shafuka 34. Cibiyar 'Yanci na Kimiyya 2024; 29 ga Agusta.
21 Gøtzsche PC. Binciken Cochrane na magungunan ƙwaƙwalwa ba su da aminci. Mahaukaciya a Amurka 2023; 14 ga Satumba.
22 Amsar mu ga saiti na biyu na sharhin takwarorinsu na Cochrane. Cibiyar 'Yanci na Kimiyya 2024; Nuwamba 22.
23 Gøtzsche PC, Jørgensen KJ. Binciken ciwon nono tare da mammography. Sabuntawar da ba a buga ba na 2013 Cochrane Review, CD001877. An ƙaddamar da shi zuwa Cochrane akan 20 Nov 2024.
24 https://training.cochrane.org/handbook/current/chapter-15#section-15-6-4.
25 Kin amincewa da Cochrane na sake dubawarmu, shafuka 62. Cibiyar 'Yanci na Kimiyya 2025; Fabrairu 26.
26 Rokonmu na kin amincewa da Cochrane na sabunta bitar mu. Cibiyar 'Yanci na Kimiyya 2025; Maris 24. Abin da aka makala 1, 2, 3, 4, Da kuma 5.
27 Johansson M, Brodersen J, Gøtzsche PC, et al. Nunawa don rage cututtuka da mace-mace a cikin m melanoma. Cochrane Database Syst Rev 2019;6: CD012352.
28 Jagora: Ma'auni don shirin tantance yawan jama'a. Kwamitin Bincike na Ƙasa ta Burtaniya 2022; 29 ga Satumba.
29 Gøtzsche PC. Binciken mammografi yana da illa kuma yakamata a yi watsi da shi. JR Soc Med 2015; 108: 341-5.
30 Kin amincewa da Cochrane na roko. Cibiyar 'Yancin Kimiyyar Kimiyya 2025; Yuni 5.
31 Gøtzsche PC. Mutuwar mai ba da labari da rugujewar ɗabi'a na Cochrane. København: Jaridar Jama'a; 2019.
32 Gøtzsche PC. Rushewa da faduwar daular Cochrane. Copenhagen: Cibiyar 'Yancin Kimiyya; 2022 (akwai kyauta).
33 https://www.scientificfreedom.dk/research/.
34 Zackrisson S, Andersson I, Janzon L, et al. Adadin yawan gano cutar kansar nono shekaru 15 bayan ƙarshen gwajin gwajin mammographic na Malmö: binciken da ya biyo baya. BMJ 2006; 332: 689-92.
35 Baines CJ, To T, Miller AB. Ƙididdigar da aka sake dubawa na fiye da kima daga Nazarin Haɗin Kan Nono na Ƙasar Kanada. Prev Med 2016; 90: 66-71.
36 Jørgensen KJ, Zahl PH, Gøtzsche PC. Ƙwararren bincike a cikin shirye-shiryen mammography a Denmark. Nazarin kwatance. BMC Lafiyar Mata 2009;9:36.
37 Bennett A, Shaver N, Vyas N, et al. Nunawa don ciwon nono: sabuntawar bita na tsari don sanar da Ƙungiyar Task Force ta Kanada akan jagorar Kula da Kiwon Lafiyar Kariya. Syst Rev 2024; 13: 304.
38 Bailar JC 3rd, MacMahon B. Randomization in the Canadian National Breast Screening Studies: bita don shaida na rushewa. CMAJ 1997; 156: 193-9.
39 Narod SA. Kan kasancewar girman da ya dace: Sake kimanta gwajin mammography a Kanada da Sweden. Lancet 1997; 349: 1849.
40 Yafi M. Matsayin baƙo: Jami'ar Toronto yakamata ta ɗauki mataki akan kuskuren binciken binciken nono. karyata Watch 2025; Afrilu 28.
41 Jørgensen KJ, Gøtzsche PC. Ƙwararren bincike a cikin shirye-shiryen gwajin mammogram da aka tsara a bainar jama'a: bita na tsari na abubuwan da suka faru. BMJ 2009;339:b2587.
42 Me yasa Cochrane ya kori Peter Gøtzsche? Hira da John Ioannidis. Karya Kimiyya Kimiyya 2025; Fabrairu 9.
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Dokta Peter Gøtzsche shi ne ya kafa Cochrane Haɗin kai, wanda da zarar an yi la'akari da babbar ƙungiyar bincike ta likita mai zaman kanta ta duniya. A cikin 2010 Gøtzsche an nada shi Farfesa na Tsarin Bincike na Clinical da Bincike a Jami'ar Copenhagen. Gøtzsche ya buga fiye da 100 takardu a cikin "manyan biyar" mujallolin likita (JAMA, Lancet, New England Journal of Medicine, British Medical Journal, da Annals of Internal Medicine). Gøtzsche ya kuma rubuta litattafai kan al'amuran kiwon lafiya da suka hada da Magungunan Mutuwa da Laifukan Tsara.
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