Haɗin gwiwar Cochrane yana buga bita na tsararren tsarin kula da harkokin kiwon lafiya. Ita wannan kungiya da a da a baya ta kai matsayin da ba za a sake dawowa ba, inda za ta bace daga gare ta, saboda wuce gona da iri da tsarin mulki, da kare muradun kungiya da kudi, rashin iya aiki, rashin iya aiki, tantancewa, da kuma amfani da siyasa.1 Wannan babban abin kunya ne saboda ana buƙatar Cochrane sosai.
A kan yunƙurin Sir Iain Chalmers, mu mutane 77 ne waɗanda suka taru a Oxford a Burtaniya a cikin Oktoba 1993 kuma muka yarda mu fara Haɗin gwiwar Cochrane. Na bude Cibiyar Nordic Cochrane a Copenhagen a wannan watan.2
Mun kasance masu kishi da nasara. Mun tsara mahimman ka'idodin Cochrane, waɗanda suka haɗa da haɗin kai, aiki tare, sadarwa mai buɗe ido da yanke shawara, haɓaka tattalin arziƙin ƙoƙari, tsauraran kimiyya, guje wa rikice-rikice na sha'awa, da kasancewa a buɗe da amsa zargi.3
Duk da haka, kamar yadda zan kwatanta, bisa la'akari da abubuwan da na samu da na abokan aiki na kud da kud, bai daɗe ba kafin Cochrane ya yi watsi da manufofinsa, kuma tabarbarewar ɗabi'a ta tsananta a kan lokaci.
Somatostatin don Jini na Oesophageal Varices
A cikin 1995, na buga rahoton gwaji na asibiti tare da nazarin meta-bincike na gwaje-gwajen sarrafa placebo guda uku kawai da suka wanzu.4 Na yi nazarin bayanan a makance5 kuma bai sami wani tasiri ba. Amma yawancin masu ilimin hanta sun yi imanin somatostatin yayi aiki, kuma lokacin da na ƙaddamar da bita ga Cochrane Hepato-Biliary Group,6 kuma na sabunta shi daga baya lokacin da aka buga ƙarin gwaji, na fuskanci matsala. Masu bitar takwarorinsu sun tambaye ni in yi nazarin rukunin rukuni guda 15. Ba daidai ba ne a yi wannan lokacin da sakamakon gaba ɗaya ya kasance mara kyau; muna kiransa yana azabtar da bayananku har sai sun furta.7
Bugu da ƙari, bitar mu ta yi kuskure. Ya dogara ne akan wallafe-wallafe, gwaje-gwajen masana'antu, kuma mafi girma gwaji, wanda bai sami wani tasiri ba, ba a taɓa buga shi ba. Na tambayi mai binciken, Andrew K. Burroughs, don raba bayanansa tare da mu amma bai yi nasara ba.
A cikin sabuntawarmu na baya-bayan nan, mun sami gwaji 21 (majiyyata 2,588) kuma mun kammala da cewa akwai shakka ko ceton rabin jini na kowane majiyyaci yana da amfani.8
Har yanzu ana amfani da Somatostatin, amma bana jin yana da wani tasiri. Zai zama m idan hormone yana da tasiri mai mahimmanci akan zubar jini wanda sau da yawa yakan mutu.
Na Mites da Maza
Wasu masu fama da asma suna rashin lafiyar kurar gida. Mun nuna cewa babu ɗayan hanyoyin jiki da na sinadarai da yawa da aka gwada da ke da wani tasiri kuma cikin sauri an karɓi bitar mu don bugawa a cikin BMJ.9 Amma editan Rukunin Jirgin Sama na Cochrane, Paul Jones, ya ce yana bukatar cikakken tabbacin cewa fitar da bayanan mu daidai ne. Muna bukatar mu sake duba duk gwajin da aka yi kuma mu je ofishin ƙungiyar a London don yin aiki a wurin yayin da muke “shawartar” ma’aikatan edita, kamar yadda ake kira.
Ba mu buƙatar taimako daga mutanen da ba su cancanta fiye da mu ba,2 kuma karin aikin ya kasance ɓata lokaci. Ya jinkirta buga bitar mu sosai, wanda wataƙila an yi niyya saboda a halin yanzu, babban gwaji ya sami tallafin jama'a wanda ya kai £728,678.
Bayan mun yarda a kan sigar da za a buga, Jones ya canza mana littafin a asirce. Ƙarshen mu, cewa shisshigin "da alama ba su da tasiri kuma ba za a iya ba da shawarar ba," an canza su zuwa, "Babu isassun shaidun da za su nuna…," wanda ke nuna cewa da za mu iya haɗawa da babban gwajin Burtaniya, da mun iya nuna tasiri.
Koyaya, mun nuna, tare da ƙunƙun tazarar amincewa, cewa ba za mu iya rasa wani tasiri mai mahimmanci ba. A cikin sabuntawarmu na baya-bayan nan, har yanzu ba a sami wani tasiri ba, kuma babban gwajin Burtaniya bai yi wani bambanci ba.10 Tare da bayanan kididdiga na, I san hakan zai kasance.
Mun koka game da rashin da’a na edita, amma wasu shekaru bayan haka, Jones ya sake canza maƙalar mu a asirce.
Har ma a yau, “ƙwararrun masana” da hukumomi sun ba da shawarar jiyya da dole ne su sani iya ba aiki.2 Rage abubuwan allergens yayi ƙanƙanta sosai don yin tasiri, kuma akwai ɗimbin mites a cikin yanayin da ke ci gaba da shigowa cikin gidan. A cikin 2010, ƙwararren masani mai gaskiya ya lura cewa za a iya kwatanta katifa a cikin murfin katifa mai hana alerji da zubar da Tekun Atlantika da teaspoon.2
Kungiyar ta Cochrane Airways kuma ta ki canza bita game da huhun masu shan taba kuma korafina ga Babban Editan Cochrane bai yi wani tasiri ba, duk da cewa bita na Cochrane na yaudara ne.2 Marubutan sun nuna cewa haɗin gwiwar maganin yana rage yawan mace-mace, kodayake ɓangaren steroid na miyagun ƙwayoyi ba shi da wani tasiri a cikin wannan.11
Nunin Mammography, Babban abin kunya na Kimiyya na Cochrane
Kwanan nan na kwatanta batutuwan a cikin labarin, "Cochrane akan aikin kashe kansa."1 Kungiyar Cochrane Breast Cancer Group tana da rikice-rikice na sha'awa, kamar yadda cibiyar ke ba da tallafin nono a cikin ƙasa, kuma masu gyara sun ƙi haɗa bayanai game da cutar kanjamau da cutar da mata masu lafiya, duk da cewa an jera waɗannan sakamakon a cikin tsarin mu da ƙungiyar ta buga.
A cikin Oktoba 2001, mun buga cikakken bita, gami da illolin, a cikin The Lancet,12 da stymied review a cikin Cochrane Library.13 Editan Cochrane John Simes ya yi ƙarya LancetEditan Richard Horton, lokacin da ya ce mun amince da sauye-sauyen da suka dage a kai, kuma Horton ya rubuta wani babban editan da ke da illa ga sunan Cochrane.14 Ya ɗauki shekaru biyar, tare da maimaita koke ga hukumomin Cochrane,15 kafin a ƙyale mu mu ƙara lahanin dubawa zuwa nazarin mu na Cochrane.16
Na sake sabunta bita a cikin 2009 da 2013. A cikin 2023, na kara yawan mace-mace, kuma yayin da nake tsammanin manyan matsaloli tare da tantancewar Cochrane ta yanzu, na buga waɗannan bayanan akan gidan yanar gizona bayan marubucina ya duba su.17 Kamar yadda a cikin duk sake dubawa na Cochrane, mun lura cewa mace-macen ciwon nono wani sakamako ne wanda ba a iya dogara da shi ba wanda ke nuna son kai don nunawa. Ba mu sami wani tasiri na nunawa akan yawan mace-macen cutar kansa ba, gami da mace-mace ta nono, ko kuma akan mace-mace duka (rabin haɗari 1.00 da 1.01, bi da bi).
Kamar yadda na yi tsammani, Cochrane ya kashe ƙaramin sabuntawar mu tare da maras kyau da bita-da-kullin tsarawa na mutanen da ba su fahimci tushen binciken cutar kansa ko hanyar bita ba. Mutane 91 ne suka ba da gudunmawa a zagayen farko na martani, tare da maki 21 daban-daban masu shafuka XNUMX.1
Mun loda bita, gyara kamar yadda ta sharhin bita, zuwa uwar garken da aka riga aka buga,18 wanda editan Cochrane ya sabawa duk da cewa an riga an buga wasu sabuntawar Cochrane da yawa. A ranar 7 ga Yuni 2024, na yi tweeted (@PGtzsche1):
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.
An yaba da wannan sosai. Sama da rabin miliyan sun ga tweet dina. Amma Cochrane yana da manufar siyasa don kare gwajin mammography, kuma a cikin Fabrairu 2025, sun ƙi sabunta mu, kodayake mun yi iya ƙoƙarinmu don biyan buƙatun da ba su da tushe. Editan ya ƙunshi “wasu sharhi,” waɗanda suka ɗauki shafuka 62. Editan “Sign-Off Editan” ya lura cewa bita namu na iya haifar da wata mummunar gobara ta rashin fahimta, wacce karya ce. Wani rashin hankali shi ne cewa ba a ba mu damar yin kira ga yawan bincike-binciken fiye da kima ba, kodayake sanarwar hukuma da sauran sake dubawa na Cochrane na gwajin cutar kansa sun yi wannan.
An zarge mu da rashin yin la'akari da cewa tantancewar na iya samun "fa'idar da ba a gano ba." Wannan shine yadda masu fafutukar neman magani ke jayayya. Muna kiransa tunanin buri.
Wani editan "mai zaman kansa", Jordi Pardo Pardo daga Kanada, wanda ra'ayinsa game da bincike-bincike ya ɓace.1 Pardo ya yanke shawarar cewa bita na 2024 na David Moher da abokan aiki19 ya ba da misali mai amfani na yadda za mu iya magance matsalolin edita. Moher kuma dan kasar Canada ne. Ya samar da ingantaccen inganci, ingantaccen bita na siyasa wanda bai faɗakar da masu karatunsa ba cewa mace-macen ciwon nono sakamako ne na son zuciya, kuma bai bayar da rahoto kan yawan mace-macen cutar kansa ba. Marubutan sun ba da kiyasin adadin mutuwar da aka ceto (dukkan mace-macen mace-mace) a cikin 1,000 a cikin ƙungiyoyin shekaru daban-daban, wanda na yi imanin yaudara ce saboda tantancewar ba ta rage mace-mace duka.
Moher et al. ba su yarda da overdignosis a matsayin wani makawa sakamakon dubawa ba, kamar yadda suka rubuta cewa overdiagnosis. ana iya danganta shi da duban ciwon nono. A'a, haka ne sa ta nunawa. Sun yi iƙirarin cewa gwaje-gwajen Kanada guda biyu, CNBSS, wasu daga cikin mafi kyawun da aka taɓa yi, suna da babban haɗarin son zuciya kuma sun dogara da wannan bayanan mara kyau akan labaran da aka rubuta ta masu ba da shawara waɗanda suka buga ɓarna sosai, kuma a wasu lokuta na yaudara, takardu game da fa'idodin da ake zargi na gwajin mammography.1
Dalilin da ya sa waɗannan masu ba da shawara na tantancewa suka yi ƙoƙarin ɓata CNBSS na tsawon shekaru 33 shine cewa ba su sami tasirin nunawa akan mutuwar ciwon nono ba. A cikin 2021, masanin rediyo Martin Yaffe, marubucin marubucin bita na Moher, ya zargi masu binciken Kanada da rashin da'a na kimiyya, bayan yin amfani da bazuwar, kuma ya yi kira da a janye wallafe-wallafen.20 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.
Mette ta gabatar da rahotonta ga jami'ar shekaru 1.5 da suka wuce amma duk da bukatar da na yi na ganin rahoton - kasancewa daya daga cikin wadanda Mette ta yi hira da su - jami'ar ta ki. An fitar da rahoton ne a ranakun 16 ko 17 ga watan Yulin 2025, kuma jami’ar ta yi rufa-rufa kan jinkirin ta ta hanyar kaucewa bayar da kwanan wata, ba don fitar da rahoto ba, ko kuma ga rahoton.21 Ba shi yiwuwa a kwafa da liƙa daga rahoton; akwai sakewa na ban dariya; kuma duk wanda aka yi hira da shi an sanya masa suna na karya. An yi min hira a ranar 14 ga Nuwamba 2022 kuma an kira ni Allen. Wannan ba budi ba ne da gaskiya.
Mette ya kammala cewa "Sabbin bayanin ba shi da tasiri mai tasiri na kimiyya akan amincin CNBSS. Sauran masu bincike guda biyu sun kammala daidai da haka, "cewa shaidun da muka samo sun dace da abin da aka sani a baya: cewa tsarin bazuwar a cikin CNBSS ya kasance mai rauni ga rushewa, amma 'ko da idan akwai ayyuka na rushewa, za su iya samun sakamako kaɗan kawai (a cikin adadin) kawai. binciken.”
Babban abin kunya ne cewa jami'ar ba ta wanke masu binciken ba tuntuni. Masu binciken sun yi zargin cewa yana tsoron karar da masu rajin radiyo da ke da zurfin aljihu, barazanar ta taso sau da yawa a baya.15
A cikin Cochrane, babban abin kunya a 2001 yakamata ya sanya shugabannin Cochrane su kula da sabuntawar mu da matuƙar kulawa amma sun kasance kamar bijimai a shagon China, suna lalata sunan Cochrane. Taken Cochrane, “Amintaccen shaida,” ya zama abin dariya. Na yi kira da a yi watsi da tantancewar saboda yana da illa.22
Cochrane Cystic Fibrosis da Ciwon Halitta
Ma'amala da wannan rukuni ya kasance mai wahala da takaici. A shekara ta 2005, matata, Helle Krogh Johansen, ta so ta sabunta bitarta game da alluran rigakafin kamuwa da cuta. Pseudomonas aeruginosa a cikin marasa lafiya da cystic fibrosis. A matsayin marubucin farko a kan bita, Mary Keogan, ba ta amsa wa imel ɗinta ba, kuma kamar yadda ake buƙatar zama aƙalla mawallafa biyu akan bita na Cochrane, Helle yana so ya haɗa ni.
Kungiyar ta amsa cewa rikici ne na sha'awar yin aure kuma ta ƙarfafa Helle ta sami mawallafi daga wata ƙasa "don nuna yanayin haɗin kai na duniya."
Ni da Helle mun buga sharhi guda 8 na Cochrane tare, a cikin wasu ƙungiyoyin Cochrane, kuma bayan na yi zanga-zangar, an ba ni izinin shiga ta. Wannan ya haifar da muhimman canje-canje da ake buƙata ga bita, amma Keogan ya ji haushi sosai lokacin da muka aika mata bita kuma muka janye marubucinta.
Don haka Helle ta yi mamakin lokacin da ta, a cikin Yuni 2006, ta gano cewa an jera Keogan a cikin layin a matsayin mawallafin marubucin sabuntawar da aka buga. Bugu da ƙari, wannan bai dace da ciki ba. Mun rubuta a cikin yarda cewa Keogan marubuci ne akan sigar da ta gabata, kuma takaddar ta ce "Kamar yadda daga fitowar ta 1, 2006, MK bai sake shiga cikin bita ba."
Edita ne da rashin da'a na kimiyya don ƙara sunan Keogan a bayanmu, saboda ba ta amince da ainihin rubutun da aka canza ba. Uzurin kungiyar, cewa manufarsu ce ta ajiye marubutan farko a kan layi har sai an buga wani bayani mai mahimmanci, ya ɓace.
Bayan watanni shida, rukunin ya aiko mana da wasu littattafan da ba mu nema ba. Mun amsa ba kyakkyawan ra'ayi ba ne don buƙatar sabuntawa na shekara-shekara; cewa dukkanmu muna buƙatar yin la'akari sosai yadda muke kashe ƙarancin albarkatunmu (ka'idar Cochrane ita ce haɓaka tattalin arziƙin ƙoƙarin); kuma ba mu yi mamakin cewa babu wani sabon gwaji ba, kamar yadda muka san yankin da masu bincike da kyau.
Bayan wata shekara, mun sabunta bita.23 Akwai manyan gwaje-gwaje guda biyu kawai, kuma yayin da ɗaya daga cikinsu ba a buga ba, mun tambayi kamfanin, Crucell NV, don aiko mana da rahoton binciken asibiti, ko aƙalla taƙaitaccen bayani. Da yake ba mu sami amsa ga imel ɗinmu ba, mun aika da wasiƙar rajista ta hanyar aikawa. Crucell ya buƙaci mu shigar da yarjejeniya ta doka wacce ta ba su 'yancin yin sharhi game da rubutun da kuma hana yin amfani da bayanansu.
Ba mu shiga yarjejeniyar ba da amsa kuma mun amsa cewa Crucell ya bayyana a cikin sanarwar manema labarai shekaru 1.5 da suka gabata cewa kamfanin ya dakatar da ci gaban asibiti na rigakafinsa. Mun kuma lura cewa rashin buga sakamakon gwaji kuskure ne na kimiyya,24 wanda ke nuna rashin jin daɗi ga marasa lafiya waɗanda suka ba da kansu don shiga cikin gwaji don taimakawa ci gaban kimiyya da kuma taimaka wa sauran marasa lafiya.
Ba mu sami bayanai ba. Lokacin da muka ƙaddamar da sabuntawa, an gaya mana cewa mun amince da ɗaukar sabon mawallafi na uku. Mun amsa cewa muna so mu hada da wanda ke da alhakin babban gwajin da ba a buga ba, amma da yake ba mu da bayanai, ba za mu iya yin hakan ba.
Mun sake sabunta bita a cikin 2013. An yi aiki da yawa don kammala cewa "Ayyukan rigakafi Pseudomonas aeruginosa ba za a iya ba da shawarar ba," bisa ga gwaje-gwaje uku kawai (marasa lafiya 996).
Alpha-1 Antitrypsin na ciki
Ana amfani da wannan magani ga marasa lafiya da cututtukan huhu wanda ke haifar da rashi na alpha-1 antitrypsin gada. A cikin 2008, farashinsa ya kai € 116,000 kowace shekara ga kowane majiyyaci kuma kamar yadda fa'idarsa ba ta da tabbas, Kwamitin Lafiya a Majalisar Danish ya nemi in sake duba gwajin.
Babu wata kwakkwarar hujja da ke nuna cewa maganin ya yi aiki. Amma a cikin kafofin watsa labarai, Hukumar Lafiya ta karɓi lada saboda ta tanadi makudan kuɗi ga masu biyan haraji na Danish. Ba a ambaci sunana ba duk da cewa na tanadi akalla Yuro miliyan 30 a shekara.2
Lokacin da na yanke shawarar yin bita na Cochrane tare da Helle, masu gyara na Cochrane sun buƙaci mu ɗauki ƙwararren mawallafi a matsayin mawallafi saboda yana da mahimmanci cewa memba na ƙungiyar bita ƙwararren likita ne da ke aiki a wannan filin.
Wannan mummunan hukunci ne. Yawancin likitocin sun kasance mafi yawan mutanen da za su yi aiki da su, wanda abubuwan da na samu game da binciken mammography da kurar kurar gida suka kwatanta.2
John Ioannidis daga Jami'ar Stanford, mai binciken likitancin da aka fi ambata a duniya, shi ma yana da mummunan gogewa tare da samun ƙwararrun yanki a cikin ƙungiyar bita. Mun buga wata takarda inda muka yi gargaɗi game da son zuciya da kuma ƙwaƙƙwaran masana, kuma mun lura cewa ƙarfin ƙwarewa, ƙarfin ra'ayi na farko, ƙananan ingancin bita, da ƙarancin lokaci da aka kashe akan su.25 Masana sukan yi watsi da tsananin bincike na farko kuma suna yaba takardu masu ƙarancin inganci tare da sakamakon da ke goyan bayan imaninsu. Wannan shine dabarar UFO. Kai mai yaudara ne idan ka yi amfani da hoto mai ban tsoro don "tabbatar" ka ga UFO lokacin da hoton da aka ɗauka tare da ruwan tabarau mai ƙarfi ya nuna cewa abin jirgin sama ne.26
Littafin Jagorancin Cochrane ya bayyana cewa "Ƙungiyoyin bita dole ne su haɗa da gwaninta a cikin yankin da ake nazari da kuma haɗa, ko samun damar yin amfani da, ƙwarewa a cikin tsarin bita na tsari."27 Ni da John mun ba da shawarar akasin haka kuma mun lura cewa muna ɗaukar ka'idar juyin halitta a matsayin mafi mahimmancin ganowa a kowane lokaci amma Charles Darwin ba shi da cancantar ilimin halitta. Ya karanta likitanci, shari'a, da tiyoloji.
Ni da Helle mun cika bukatu na wauta ta Cochrane ta hada da Farfesa Asger Dirksen, babban mai bincike na gwaji guda biyu kacal da aka yi. Yana da rikice-rikice na kudi na sha'awa amma muna jin za mu iya magance shi da hujjojin kimiyya.
Ba haka ba. Ni da Helle mun yi dukan aikin, kuma lokacin da Dirksen ya ga mummunan sakamakonmu, ya janye mawallafinsa. Editocin sun ƙi aika binciken mu don bitar takwarorinsu kafin mu sami marubuci na uku wanda ya buƙaci ya zama ƙwararren yanki na abun ciki. Wannan zai zama rashin da'a na kimiyya, kamar yadda muka riga muka yi dukan aikin.
Mun yi bayanin cewa muna da damammaki ga masana kuma ba sa bukatar su zama mawallafa. Sa'an nan editocin sun ba mu sharhi daga ƙwararren da ke da rikice-rikice masu yawa game da maganin kuma ya ce zai kasance a shirye ya zama mawallafi. Wannan abin ban tsoro ne. Ɗaya daga cikin ƙa'idodin Cochrane shine kauce wa rikice-rikice na sha'awa.
Da yake na kasa shawo kan editan, Alan Smyth, don ci gaba, na bayyana lamarin ba tare da sunansa ba a cikin jerin tattaunawa na Ƙungiyar Editocin Likitoci ta Duniya. Babu wani tausayi ko kadan game da halin Cochrane. Na yi kuka ga masu sasantawa na littafin Cochrane da Babban Editan, David Tovey, kuma ajali ya ƙare ne kawai lokacin da Tovey ya gaya wa ƙungiyar su aika da aikinmu don bitar takwarorinsu ba tare da neman marubuci na uku ba.
Editocin ba su fahimci al'amuran ƙididdiga na farko ba. Ba zan iya gamsar da su cewa P = 0.06 yayi magana game da yawa a kan ra'ayi mara kyau na babu bambanci kamar P = 0.03. Muna da ƙimar P-biyu a cikin bita, kuma sun nuna cutarwa da fa'ida, bi da bi. Na nemi a mayar da sharhinmu zuwa wani rukunin Cochrane, wanda ya buga shi.28
A cikin 2020, Majalisar Likitoci ta Danish ta ba da shawarar maganin saboda "dangantaka mai ma'ana tsakanin ƙimar maganin da farashin magani."29 Ta yaya hakan zai yiwu ga maganin da ba ya aiki kuma yana da tsadar batsa? Sabbin gwaji guda daya ne kawai ya bayyana; yana daga maganin da ake shaka; kuma an sami ƙarin ɓarna, ƙarin abubuwan da ba su da kyau, da ƙarin raguwar miyagun ƙwayoyi fiye da kan placebo.30
Sharhinmu game da Tasirin Placebo da Gabaɗayan Kiwon Lafiyar Jama'a ba su da matsala
Mun ƙaddamar da sake dubawar mu game da tasirin placebo da binciken lafiyar gabaɗaya ga Cochrane Consumers & Communication Review Group da Cochrane Ingancin Ayyuka da Ƙungiyar Kulawa (EPOC), bi da bi. A cikin waɗannan ƙungiyoyin, babu ƙwararrun ƙwararrun yanki da za su murƙushe tsarin gaba ɗaya, daidai abin da ni da John muke so ga duk Cochrane, kuma ba mu gamu da wata matsala ba.
Ana iya tantance amfanin takarda da adadin takardun da ta gabata ta zama abin ban mamaki. A kan wannan ƙididdiga, nazarin placebo ɗinmu ya yi fice, yayin da ya jefa sama da shekaru 46 na binciken placebo.31 Mun raba imani gama gari cewa akwai mahimman tasirin placebo, amma wannan ba shine abin da muka samo ba. Mun haɗa da gwaji 130, kuma placebo ba shi da wani tasiri mai mahimmanci akan sakamakon binary. Don ci gaba da sakamako, tasirin ya ragu tare da ƙara girman samfurin, yana nuna ƙananan gwaje-gwajen sun kasance masu ban sha'awa (duk gwaje-gwajen sun kasance masu ban sha'awa saboda ba za ku iya makantar da kwatanta tsakanin placebo ba kuma babu magani). Duk da haka, kawai babban tasiri da muka samu, akan zafi, ya yi ƙanƙanta da yawa don ya kasance da wani mahimmanci.2
Binciken namu yana barazana ga mutanen da suka gina ayyukansu akan tasirin placebo, kuma mun shafe lokaci mai tsawo a cikin shekaru shida masu zuwa muna karyata kurakuran bincike ko kuskure da jayayya mara inganci.2 Ko da a yau, ana buga takardu marasa kuskure waɗanda ke da'awar babban tasirin placebo. Kamar yadda a cikin 1955 Jama Labari, "Mafi kyawun wuribo," mafi munin labaran sun kiyasta tasirin placebo kamar yadda kafin-bayan bambanci a cikin marasa lafiya a cikin rukunin placebo na gwaji na bazuwar, wanda ya yi watsi da haɓakawa ba tare da bata lokaci ba.
Labarin game da placebo mai ƙarfi ba zai tafi ba, kuma yana da ƙarfi musamman a ilimin tabin hankali. Likitan tabin hankali kan yi kuskuren bambance-bambancen baya-bayan don tasirin placebo.32 Suna kuma kiran tasirin kyakkyawar dangantakar likita da haƙuri da tasirin placebo, amma wannan nau'i ne na ilimin halin mutum.32
Duban lafiya na yau da kullun
Binciken mu na duba lafiya na yau da kullun, wanda ake kira fisiki na shekara-shekara a Amurka, shima ya zo ga sakamakon da ba a zata ba. Mun buga sharhinmu a cikin 2012 kuma mun sabunta shi a cikin 2019.33 Ba a sami raguwa a cikin yawan mace-mace (rabo mai haɗari 1.00), mace-mace na zuciya da jijiyoyin jini (rabo mai haɗari 1.05), mace-mace ciwon daji (rashin haɗari 1.01), ko fa'idodi ga wasu al'amuran asibiti. Tare da mutuwar 21,535, sakamakonmu yana da gamsarwa sosai. Duban lafiyar gabaɗaya yana da illa, saboda yana haifar da tantancewa da wuce gona da iri da kuma matsalolin tunani idan aka gaya wa mutane cewa ba su da lafiya fiye da yadda suke zato.
Binciken mu ya ceci biliyoyin rawanin ga masu biyan haraji na Danish yayin da a Burtaniya, inda binciken kiwon lafiya ya kasance wani ɓangare na sabis na kiwon lafiya na ƙasa, gwamnati ba ta damu da bayanan ba.2 Shirin na Burtaniya ya dogara ne akan shaida har sai da bincikenmu ya nuna bai yi aiki ba. Sa'an nan, shirin ya dogara ne akan "jagorancin masana" maimakon.
Dangane da kiraye-kirayen da aka yi na a soke shirin, Kiwon Lafiyar Jama'a Ingila ta sanar da cewa za a kafa wani kwamitin kwararru da zai yi nazari kan ingancinsa da kimar kudinsa, kuma za a yi amfani da samfurin. Bahasin sun kasance masu ban mamaki har na rubuta cewa ƙwararrun kwamitin shine sigar zamani na Oracle a Delphi kuma ƙirar ƙididdiga ta kasance kamar raɗaɗi a cikin kunnen mayen wanda sakamakon kuna son ji.2,34
Duk da yunƙurin "Ee, Minista", mutane sun mai da hankali ga bitar mu kuma sha'awar kafofin watsa labarai ta kasance abin mamaki.2 Shafukan yanar gizo da yawa sun fara tambayar duba lafiyar lafiya.
Magungunan hauka
Zai iya zama da wahala daidai da fitar da kwayoyin bacin rai kamar yadda ake fitowa daga benzodiazepines32 kuma lokacin da na ba da shawara a cikin 2016 don yin nazarin hanyoyin da za a taimaka wa marasa lafiya suyi nasara, likitan ilimin likitancin Rachel Churchill, editan kungiyar Cochrane depression, ya nuna sha'awa sosai.2
Koyaya, mun ɗauki watanni tara kafin mu sami wani ra'ayi game da ƙa'idarmu, kuma ƙungiyar ta gabatar da buƙatun su a kan hanyar zuwa matakan da ba za mu iya cimma ba.2 Bayan shekaru biyu, lokacin da muka gabatar da bita guda uku na ƙa'idar, mun sami kalmomi 13,874 na sharhi daga editoci huɗu da masu bitar takwarorinsu huɗu, sau takwas fiye da kalmomin da ke cikin ƙa'idarmu, kuma Churchill ya ƙi ƙa'idar.
Na biyuth kuma bita ta ƙarshe ta zama uzuri don kawar da mu. Yana ɗaya daga cikin mafi munin da na taɓa gani, kuma, ya bambanta da duk sauran sake dubawa, ba a san su ba. Mun nemi ainihin mai bita, amma ɗan rataye namu ya kasance marar ganuwa, sabanin ƙa'idodin Cochrane.
Dan rataye ya kare muradun kungiyar masu tabin hankali da masana'antar muggan kwayoyi ta hanyar musun dogayen hujjojin kimiyya da kuma yin amfani da gardama na kai hari kan maganganun da ba mu taba yi ba.2 Bukatu da yawa ba su da mahimmanci, misali ya kamata mu bayyana yadda magungunan ke aiki, lura cewa wasu magungunan antidepressants na iya zama mafi inganci fiye da sauran, kuma ƙara saƙonnin tallace-tallace game da abubuwan al'ajabi - bisa ga ka'idar Cochrane - ƙwayoyin ɓacin rai na iya cika, wanda ba shi da amfani a cikin bita game da taimaka wa marasa lafiya su fito da magungunan da ba sa so.
Mun daukaka kara game da kin amincewa yayin da muke amsa duk maganganun kuma mun ƙaddamar da sigar mu ta huɗu. Mun tunatar da Churchill cewa Cochrane ya kasance game da haɗin kai da kuma taimaka wa juna, amma tsarin roƙon Cochrane shima kuskure ne. Rebecca Fortescue, editan kungiyar Cochrane Airways, ta goyi bayan matakin kin amincewa ba tare da ganin maganganunmu ko kuma sake fasalin yarjejeniya ba inda muka riga mun bi yawancin batutuwan da ta gabatar. An gaya mana cewa matsayinmu bai yi daidai da haɗin kai na duniya ba kuma yana iya haifar da ƙararrawa tsakanin masu amfani da bita waɗanda suka dogara ga rashin son kai na Cochrane. Ba mu bayar da wani "tsayi" ba kuma Cochrane ba batun yarjejeniya bane amma game da samun ilimin kimiyya daidai da taimakawa marasa lafiya.
A cikin Maris 2023, na yi kuka ga Babban Editan Cochrane, likitan hauka Karla Soares-Weiser, game da rashin da'a na edita kuma na yi wasu tambayoyi masu sauƙi ta ƙi amsa.35 Mu'amalar da na yi da shugabancin Cochrane ta kasance mai ban mamaki.36 Ba su gabatar da koke na ga tsarin da ya dace ba, kuma ya zama cewa Cochrane ba shi da wata hanyar da za ta iya magance zarge-zargen da ake yi na edita ba tare da nuna son kai ba, wanda duk manyan mujallu ke da shi.
Yayin da ake lalata tsarin mu, wata ƙungiya ta ƙaddamar da irin wannan yarjejeniya kuma Cochrane ya buga sharhin su a cikin 2021.37 Bai haɗa da gwaje-gwajen da ke kwatanta dabarun janyewa daban-daban ba, wanda muka yi, kuma ya haɗa da yawancin binciken da ba daidai ba da aka kwatanta da katsewa ba zato ba tsammani (turkey mai sanyi) tare da ci gaba, waɗanda ba su da mahimmanci kuma suna ba da ra'ayi na ƙarya cewa marasa lafiya sun sake komawa kuma suna buƙatar ci gaba da kwayoyi.
Ko da yake rashin amfani fiye da bitar mu, wanda muka buga a cikin mujallar likita,38 Binciken Cochrane shine sau 23 tsawon lokaci. Marubutan Cochrane ba su iya yin wani tabbataccen sakamako ba, wanda muka yi. Matsakaici na 50% na marasa lafiya sun yi nasarar fitar da kwayar su, kuma tsayin taper yana da tsinkaya sosai don ƙimar nasara (P = 0.00001). Mun kuma lura cewa duk binciken ya rikitar da alamun cirewa tare da sake dawowa; ba a yi amfani da tapering hyperbolic ba; janye maganin da sauri cikin layin layi; kuma ya dakatar da shi gaba ɗaya lokacin da yawan masu karɓa ya kasance har yanzu. Mun kammala cewa ainihin adadin marasa lafiya waɗanda za su iya tsayawa lafiya dole ne su kasance sama da 50%.
Binciken na Cochrane ya bayyana cewa ci gaba da maganin rashin jin daɗi yana rage haɗarin sake dawowa da sake dawowa da 50-70%, wanda ba daidai ba ne. Mutanen da aka bazu zuwa turkey mai sanyi suna haɓaka alamun ƙauracewa waɗanda aka yi kuskuren fassara su azaman koma baya.32
Lokacin da muka kafa Haɗin gwiwar Cochrane a 1993, muna so mu taimaka marasa lafiya a cikin yanke shawara. Duk da haka, sashen Background ya kasance game da menene likitoci tunani kuma bita ya kasance na uba sosai. Ba a ambaci cewa yawancin marasa lafiya suna so su fita daga magungunan ba, wanda ya kamata ya zama mabuɗin mahimmanci ga marubutan suyi nazari!
Sashin bangon baya yana cike da tallan tallan da ba su da mahimmanci da kuma maganganun yaudara. Don "tabbatar da" cewa magungunan suna da tasiri, marubutan sun ambaci wani cikakken nazari na Cipriani et al., Wanda bai sami sakamako mai mahimmanci na asibiti ba amma ya ba wa kamfanonin da suka fi yaudara.2,39 Binciken Cochrane na escitalopram, tare da Cipriani a matsayin marubucin farko, kuma ya nuna cewa Cochrane yana kallon masana'antar. Yana da'awar cewa escitalopram yana da tasiri sosai fiye da citalopram,40 wanda binciken da masana'anta, Lundbeck, ya bayar, ya nuna, amma wannan ba zai yiwu ba saboda escitalopram shine stereoisomer mai aiki na citalopram.32
Bita na 2021 Cochrane game da kwayoyin bakin ciki a cikin yara41 ya kasance kuma mai dacewa da masana'antu "Sharar gida, datti."42 Marubucin farko, Sarah Hetrick, edita ce a cikin rukunin Cochrane wanda ya buga bita. Kodayake ta sami tasirin "kananan da marasa mahimmanci", ta yi iƙirarin cewa ana iya ba da shawarar magungunan "ga wasu mutane a wasu yanayi." Ana iya amfani da irin wannan tunanin na buri game da duk jiyya mara inganci. Bugu da ƙari, abstract ya lura cewa "escitalopram na iya 'aƙalla kaɗan' rage rashin daidaituwa na sakamakon kashe kansa." Gaskiyar ita ce, waɗannan kwayoyi sun ninka haɗarin kashe kansa a cikin yara.32
Kusan duk sake dubawa na Cochrane na gwaje-gwaje masu sarrafa placebo na magungunan tabin hankali suna da lahani saboda tasirin cirewa; saboda ba su da isasshen makanta; kuma saboda akwai ƙarancin bayanai akan illolin.32 Bita biyu na Cochrane da ma'aikata na suka yi sun gano cewa kowane gwaji guda ɗaya da aka taɓa yi na methylphenidate don ADHD yana cikin haɗarin son zuciya.43
A watan Mayu 2015, na ba da wani magana a sanannen muhawarar Maudsley a London kuma ya bayyana a cikin BMJ cewa amfani da magungunan tabin hankali na dogon lokaci yana haifar da lahani fiye da mai kyau kuma yakamata a yi amfani da magungunan sosai.44 Na sanar da abokan aikina na Cochrane a gaba a matsayin ladabi, amma alherina bai dawo ba. A wannan rana labarina ya bayyana, Babban Editan Cochrane, David Tovey, da editoci uku da ke kula da kungiyoyin kula da lafiyar kwakwalwar Cochrane guda uku, sun kai hari kan amincin kimiyya na akan. BMJ website.45
BMJ ya buga wani labari na wauta, "Cochrane ya nisanta kansa daga ra'ayoyi masu rikitarwa game da magungunan tabin hankali."46 Ba abin jayayya ba ne cewa masana kimiyya sun gaya wa jama'a abin da suka sani, kuma tashar labarai ta sami daidai: "Ba za a iya magance gardamar Gøtzsche ta kowace hanya ta hankali ko kimiyya ba, tsarin ilimin hauka, kuma, alas, mambobin Cochrane Collaboration kanta, sun kunyata kansu tare da zarge-zarge da sauri da kuma cin zarafi na aikinsa."47
Carl Heneghan, Daraktan Cibiyar Nazarin Shaida ta Magunguna a Oxford, ya ce ayyukan Cochrane a gare ni suna da illa sosai.2 Idan Cochrane ba ya son abin da kuke faɗa, za ku sami rashin amincewa da jama'a. Babu wanda yake so ya kasadar hakan.
Carl da abokin aikinsa Tom Jefferson, kwanan nan sun lura cewa Haɗin gwiwar Cochrane ya ƙare.48 Wadanda, kamar ni, an zabe su a Hukumar Mulki ta Cochrane kuma suka yi ƙoƙari su riƙe Cochrane da lissafi, an yi musu izgili kuma an yi watsi da su, kuma a cikin 2018, an kore ni daga hukumar kuma daga Cochrane a matsayin mutum daya tilo.49 Me yasa? Domin na yi nuni da “juyawar kungiya zuwa tsarin tsarin kasuwanci na kasuwanci, nesa da tushenta na gaskiya na mai zaman kanta, nazarin kimiyya da kuma muhawarar jama’a a bayyane.”48
Gwajin Nunin Cochrane, Watakila Mafi Muni A Ilimi
An kore ni daga Cochrane bayan gwajin gwaji na mafi munin yanayi, inda shugabannin Cochrane suka karya duk wata doka mai mahimmanci ga masu ba da agaji da kuma Cochrane, sun yi amfani da bayanan karya da shugaban kwamitin, Martin Burton ya dasa, kuma sun yi ƙarya game da ni yayin taron kwamitin sirri da kuma bayan haka.2,49
John Ioannidis ya buga wani zazzafar sukar shugabancin Cochrane,50 da kuma BMJEditan Fiona Godlee ta bugi ƙusa a kai lokacin da ta rubuta cewa ya kamata Cochrane ya jajirce wajen riƙe masana'antu da ilimi a cikin lissafi, kuma korar da na yi daga Cochrane ya nuna "bambancin ra'ayi mai zurfi game da kusancin masana'antu ya yi kusa sosai."51 Ko da a yau, za ku iya zama marubucin Cochrane duk da samun kuɗi kai tsaye daga kamfanin wanda kuke kimantawa.2
A lokacin gwajin nuna,49 Mamban hukumar David Hammerstein ya ce duk wani rikici da ke tsakanina da hukumar gudanarwa ta tsakiya ya shafi batun da hukumar ta dauki bangaren masana'antar harhada magunguna. Ya yi gargadin cewa Cochrane yana kafa misali mai haɗari wanda wakilan masana'antu kawai dole ne su rubuta koke ga Cochrane sannan kuma Cochrane kogo a cikin matsin lamba. Ya kuma ce shugabannin Cochrane sun gaya masa game da kudin ne, ba batun samun ilimin kimiyya ba: "Abin da Cibiyar Nordic Cochrane ke damun mutane da yawa."
Lokacin da na buga littafina da ya shahara game da shirya laifuka a masana'antar miyagun ƙwayoyi a cikin 2013,52 Sabon shugaban Cochrane da aka nada, dan jarida Mark Wilson, ya yi tir da hakan, misali ta rubutawa masu ilimin hauka na Danish cewa “ra’ayoyin” a littafina ba ra’ayin Cochrane bane. To, "ra'ayoyi na" ba ra'ayi ba ne amma an rubuta su sosai.
Don bikin Cochrane's 20th ranar tunawa a 2013, an tambayi ɗan jaridar kimiyya Alan Cassels ya rubuta littafi game da Cochrane. Ya yi hira da mutane da yawa, amma a cikin Fabrairu 2013, ya rubuta wa Tom da ni cewa ya ɗauke mu mutane da suka fi aminci a Cochrane kuma yana so ya fara gaya mana mugun labari. Wilson ya kashe littafinsa yana mai cewa ya kamata ya fi sukar aikina kuma "akwai Peter Gøtzsche da yawa" a ciki. Amma Alan ya rubuta littafi game da muhimman abubuwan da suka faru a tarihin Cochrane, ba game da waɗanda ke da ratsin kafada ba. Na ba da tallafin tattalin arziki don in fitar da littafin, amma Alan ya sami wani mawallafi.53
Duk da cewa Manufofin Kakakin Cochrane na ƙarfafa zargi game da sake dubawa na Cochrane, na sha fuskantar sau da yawa cewa editoci ko marubuta sun ƙi buga suka na a cikin bita, tare da amsa daga marubutan, kuma sun ƙi canza bita ko da lokacin da suka yi kuskure ko ma yaudara.2,11
A cikin 2001, mun buga bita na ingancin 53 sabbin sake dubawa na Cochrane a cikin BMJ.54 Mun gano cewa shaidun ba su da cikakken goyon bayan ƙarshe a cikin sake dubawa tara (17%), kuma duk ƙaddamarwar matsala sun kasance masu dacewa ga gwajin gwaji. Mun sanar da abokan aikinmu na Cochrane a gaba da littafin domin su iya shirya tambayoyi daga 'yan jarida.36 Amma an zagi alherin mu. Kungiyar Cochrane Steering Group ta matsa mani lamba akan kada in buga sakamakonmu. Na yi jayayya cewa wannan zai zama aikin tantancewa kuma na bayyana cewa yana da mahimmanci ga marasa lafiya, likitoci, da sauran su a yi musu gargaɗi cewa suna bukatar karantawa fiye da ƙarshe kawai ko kuma zance.
Na yi abin da manufar Mai magana da yawun ta karfafa kuma an yi godiya ga kokarin da aka yi na kore. Maimakon kiyaye amincin kimiyya, Wilson an cinye shi tare da haɓaka alamar Cochrane da samfuran kuma ya buƙaci tantance ra'ayoyin ƙin yarda. Ya bar Cochrane, amma halin bai canza ba. Wilson yana da cikakken iko da Hukumar Mulki ta Cochrane kuma ya ba su wa'adin cewa ko dai su kore shi ko ni.2,49
Lokacin da Tom, ɗalibi na PhD Lars Jørgensen, da na nuna cewa nazarin Cochrane na maganin rigakafin HPV ya rasa aƙalla mata 25,000 da bazuwar da kuma mummunan cutar da alluran kuma muka buga abubuwan lura,55 Babban Editan Cochrane da mataimakinsa sun kai mana hari sosai. Sun ki amincewa da tayin da aka yi musu na yin tir da sukar da muke yi a cikin mujallar guda kuma a maimakon haka sun kai mana hari a gidan yanar gizon Cochrane, wanda bai dace da kimiya ba, har ma sun yi amfani da hujjar da suka san karya ce.2
Ya taka muhimmiyar rawa don korar da na yi cewa na soki wannan babban bita na Cochrane.2,49 Littafina na 2025 game da takaddun rigakafin HPV cewa mun yi daidai kuma Cochrane ba daidai ba ne.56 Mutane da yawa sun gaya mani cewa sun rasa babban darajar su game da sake dubawa na Cochrane saboda nazarin rigakafin HPV da kuma yadda Cochrane ya tallata shi, kamar kamfanin magunguna.2,49
Karin Amfanin Siyasa
Na yi la'akari da sagas game da sake dubawa game da binciken mammography da kuma janye magungunan baƙin ciki ƙusoshi na ƙarshe a cikin akwatin gawa wanda ke nuna buƙatar Cochrane.
Amma akwai kusoshi da yawa a cikin akwatin gawar. Likitocin da suka rubuta nazarin Cochrane game da tsofaffi masu tawayar sun rubuta cewa "babu wata shaida da ta nuna cewa ECT yana haifar da kowace irin lalacewar kwakwalwa."57 ECT yana haifar da asarar ƙwaƙwalwar ajiya a yawancin marasa lafiya, asarar ƙwaƙwalwar ajiya na dindindin a wasu, kuma yana kashe kusan ɗaya cikin dubu, wanda ke nufin cewa ana kashe ƙwaƙwalwa, ma.58
A farkon cutar ta Covid-19, Tom ya sabunta nazarinsa na 2006 Cochrane game da tsoma bakin jiki don rage yaduwar ƙwayoyin cuta na numfashi. Koyaya, Cochrane ya riƙe ta tsawon watanni 7 kuma a cikin wannan lokacin, ƙasashe da yawa sun ba da umarnin yin amfani da abin rufe fuska yayin da sauran masu binciken Cochrane suka samar da ayyukan da ba za a yarda da su ba, ta amfani da ingantaccen karatu, wanda ya ba da "amsar da ta dace."59
Wannan shine tauhidi na mafi muni. Dalilin da yasa aka dage wallafawa shine amfanin siyasa. Shugabannin Cochrane sun san da kyau yadda mahimmancin bita ke da shi, kuma ya zama bita mafi girma a tarihin Cochrane.60
Lokacin da Tom ya sabunta bita a cikin 2023,61 Cochrane ya sake yin kuskuren edita. Mai tasiri wanda bai san komai game da abin rufe fuska ko kimiyya ba62 da'awar a cikin New York Times abin rufe fuska ya yi aiki, kuma binciken abin rufe fuska na Cochrane ya yaudari jama'a.63 Labarin nata yana cike da kurakurai, amma babban editan Cochrane, Karla Soares-Weiser, ta nemi afuwa.64 wannan rana akan gidan yanar gizon Cochrane don kalmomin a cikin taƙaitaccen bita,65 duk da cewa babu wani abu da za a yi uzuri.2,66 Ta kuma keta dokokin Cochrane na sukar bayan bugawa, wanda yakamata a buga tare da bitar Tom, tare da amsarsa, kuma ba ta ma sanar da Tom game da abin da za ta rubuta ba kafin ta yi gaggawar shiga aiki.62 Ƙara zagi ga rauni, an fassara bayanin Cochrane a matsayin uzuri da ke fitowa daga marubuta, kuma wasu mutane sun yi imanin cewa an janye bitar.
Bayan Tom a cikin bita na Cochrane bai sami wani tasiri na rigakafin mura ba akan mace-mace a cikin tsofaffi, ƙungiyar masu binciken "sun sake tsara" bayanan "bayan gayyata daga Cochrane"67 kuma ya ruwaito cewa rigakafin ya rage mace-mace68 - ƙididdigar ƙididdiga mai ban mamaki idan aka yi la'akari da cewa haɗarin haɗarin ya kasance 1.02 kuma mutane huɗu ne kawai suka mutu.
Cochrane kuma ya gaza sosai a cikin nazarinta na rigakafin Covid-19.69 Marubutan sun ce babu wani bambanci ko kadan a cikin munanan abubuwan da suka faru idan aka kwatanta da placebo, amma lokacin da Peter Doshi da abokan aikinsa suka yi amfani da bayanan ka'idoji don sake nazarin gwajin mRNA mai mahimmanci, sun gano cewa wani mummunan lamari ya faru ga kowane mutum 800 da aka yi wa allurar.70 Sun kuma gano cewa cutarwar ta fi fa'idar girma - guje wa asibiti. Sukar Doshi game da sake dubawa na Cochrane, wanda aka buga a cikin bita, yana da matukar mahimmanci cewa yana da kyau a kira Cochrane review.71 datti mai amfani a siyasance, motsa jiki.
Lokacin da Peter Aaby, fitaccen mai binciken maganin alurar riga kafi, ya gano cewa rigakafin trivalent diphtheria, tetanus, da pertussis (DTP) yana kara yawan mace-mace a cikin kasashe masu karamin karfi, WHO ta nemi manyan mutanen Cochrane da su tantance shaidar.2 WHO ta damu da abin da za su iya ganowa kuma ba ta ƙyale masu binciken su samar da meta-binciken binciken ba. Cochrane bai kamata ya yarda da irin wannan tsangwama da ba a yarda da shi ba tare da bincikensa amma sun bi buƙatun kuma sun samar da rahoto mara kyau wanda ya haɗa da ƙidayar kuri'a - nawa nazari ne kuma nawa ne akasin haka? – wacce hanya ce da aka ba da shawarar gaba da ita a cikin Littafin Jagoran Cochrane.27 Daya daga cikin marubutan shine Babban Editan Cochrane, Karla Soares-Weiser, wani kuma masanin kididdiga Julian Higgins, editan Cochrane Handbook. Wani lauya a New York ya tambaye ni don tantance shaidun kuma binciken da na yi ya goyi bayan binciken Aaby tare da rubuta kurakuran da yawa a cikin rahoton Cochrane.72
Cochrane kuma yana ƙoƙari ya zama mai amfani a addini duk da cewa addini ya saba wa kimiyya. Waraka mai nisa ya haɗa da addu'a, da nazarin Cochrane na addu'ar neman gafara,73 Cochrane Schizophrenia Group ne ya buga shi da kyau saboda bitar tana da alaƙa da tunanin ruɗi, ginshiƙi ne na kunya ga Cochrane.74
Marubutan Cochrane sun yi watsi da cewa an taso da zargin zamba a kan babban gwaji, kuma “gwaji mafi girma,” da aka buga a cikin BMJ Batun Kirsimeti, an yi nufin yin nishadi. Wannan gwaji ya kimanta tasirin addu'a shekaru 4-10 bayan marasa lafiyar sun bar asibitin da rai ko kuma sun mutu sakamakon kamuwa da cutar jini. Marubutan Cochrane ba su ambaci cewa an raba marasa lafiya shekaru da yawa bayan sakamakonsu ya faru kuma ba su tattauna yiwuwar cewa lokaci zai iya komawa baya ba, ko kuma addu'a na iya tada matattu.
Kamar yadda aka riga aka san sakamakon ga duk majiyyata, ba daidai ba ne a ba da maki na karatun karya don zama “makafi biyu.” Marubutan Cochrane sun karkatar da ka'idodin tsarin kuma sun sanya kansu abin dariya, wanda editan ƙungiyar, Clive Adams, shi ma ya yi lokacin da ya tabbatar mana da bitar ba abin wasa ba ne.74 Ba mu zo ko'ina tare da sukar mu game da wannan bita ba, wanda yakamata a janye.
karshe
A farkon, Cochrane yana da alaƙa da haɗin gwiwa da neman gaskiya, ƙalubalen hukumomi, koyarwa, da bukatun kamfanoni. Mun taimaka wa mawallafa su sami ko da maras kyau sake dubawa maimakon ƙin yarda da su bayan sun tayar da shingen da ba za a iya magance su ba, wanda yanzu ya zama ruwan dare idan bita ya yi barazanar guild, kuɗi, ko muradun siyasa.
Cochrane ya kafa wasu sharuɗɗa masu banƙyama don marubuta waɗanda ba su wanzu a wasu mujallu na kimiyya kuma an ƙirƙira ƙarin ma'auni na ad hoc. Lokacin da ni da likitan fata suka yi bitar maganin laser mai laushi don haɓakar gashi maras so, ƙungiyar Cochrane Skin ta buƙaci mabukaci a matsayin mawallafi. Na yi mamakin dalilin da yasa za a dauki mace mai gashin lebe na sama a matsayin ƙwararren masanin kimiyya. Mun sami ɗaya, amma da yake ba ta ba da gudummawa mai ma'ana ba, mun ajiye ta a matsayin marubuciya.75
A cikin Afrilu 2021, Farfesa Ken Stein, Darakta na Shirin Ƙirar Shaida a Cibiyar Nazarin Kiwon Lafiya da Kulawa ta Burtaniya (NIHR) ta yi magana a gidan yanar gizon yanar gizo game da aikin a cikin ƙungiyoyin Cochrane na Burtaniya da kuma tallafin su na gaba.2,49 He suka soki Cochrane sosai saboda dalilai guda ɗaya kamar yadda na yi kuma na jaddada cewa ya kamata marubutan Cochrane su kasance masu hazaka. Game da gazawar ilimin kimiyya, Stein ya lura cewa, "Wannan batu ne da mutane suka gabatar a cikin Haɗin gwiwar don tabbatar da cewa datti ba ya shiga cikin bita; in ba haka ba, sake dubawa naku zai zama datti." Shekaru biyu bayan haka, duk ƙungiyoyin Cochrane a Burtaniya sun rasa kuɗi daga NIHR, wanda ya sanya ƙaramin Denmark, ƙasata ta haihuwa, babbar mai ba da gudummawa ga Cochrane.2
Matata ta bayyana shekaru da yawa da suka wuce cewa Cochrane ita ce aljannar masu son. Lallai. Ko da yake umarni mai sauƙi na shirye-shirye zai hana a gani da buga hotuna marasa amfani, ya ɗauki shekaru biyar, tare da imel da yawa da buƙatun a tarurruka da kwamitoci, kafin in yi nasarar samun jadawali marasa amfani daga sake dubawa na Cochrane. Yana da rashin ƙwarewa sosai don buga shafuka da yawa ba tare da wani bayani ba saboda babu ɗayan gwaje-gwajen da ya yi rahoton takamaiman sakamako a cikin ƙa'idar Cochrane. Aikin hukuma na Cochrane yana da ban tsoro da gaske, kuma manyan masana kimiyya da yawa sun bar jirgin da ke nutsewa.
Masu son Cochrane ba su damu da karuwar aikin da suke haifarwa ga masu aikin sa kai da ba a biya su ba wadanda ke samar da arzikin Cochrane.76 Wasu sake dubawa na Cochrane sun fi tsayi duka. Mafi dadewa na gani, shafuka 785, game da magungunan da ake amfani da su don tashin zuciya da amai. Ya haɗa da gwaje-gwaje 737 da kuma kusan marasa lafiya 100,000, amma duk da haka, akwai son zuciya da zamba a cikin gwaje-gwajen da marubutan ba su iya kammala wani abu game da wane magani ya fi kyau ba.77
A shekara ta 2019, an gayyace ni in ba da jawabi a hedkwatar CrossFit da ke Santa Cruz a California, wadda na maimaita a Madison, Wisconsin: “Mutuwar mai ba da labari da rugujewar ɗabi’a na Cochrane.”78 Na tsira kuma ina cikin koshin lafiya, amma Cochrane ba ya. Yana da rauni.
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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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