In 2018, a so-called crisis developed in the Cochrane network of systematic reviewers. It was widely depicted in terms of two competing narratives – [a] “bad behaviour” by one individual and [b] scientific and moral decline within Cochrane. This presentation will report the attempt of an interdisciplinary group of scholars (from medicine, sociology, critical management studies and science and technology studies) to distil insights on the structural, ethical and linguistic issues underpinning the crisis, without taking a definitive position on the accuracy of either narrative. It is based on a recently published paper (Greenhalgh et al, J Eval Clin Pract 2019, DOI: 10.1111/jep.13124). Prof Greenhalgh will draw on (among other theories) Becker’s notion of moral entrepreneurship and Foucault’s conceptualisation of power to analyse the claims and counter-claims made by different parties. Both narratives include strong moral claims about the science of systematic review and the governance of scientific organisations. The expelled individual and his supporters defined good systematic reviews in terms of a particular kind of methodological rigour and elimination of bias, and good governance largely in terms of measures to achieve independence from industry influence. Most of Cochrane’s Governing Board and their sympathisers evaluated systematic reviews according to a broader range of criteria, incorporating attention to relationships among reviewers and reflexivity and dialogue around scientific and other judgements. They viewed governance partly in terms of accountability to an external advisory group. Power-knowledge alignments in Cochrane have emerged from, and contributed to, a particular system of meaning which is now undergoing evolution and challenge. The author will propose that polarising Cochrane’s “crisis” into two narratives, only one of which is true, is less fruitful than viewing it in terms of a duality consisting of tensions between the two positions, each with some validity. Having framed the conflict as primarily philosophical and political rather than methodological, the author will use the seminar series’ theme of ‘translation’ to illustrate how the scholars on both poles of this divide might harness their tensions productively.
Trish Greenhalgh is Professor of Primary Care Health Sciences and Fellow of Green Templeton College, University of Oxford. She is Co-Director of the Interdisciplinary Research in Health Sciences (IRIHS) Unit, a programme of research at the interface between social sciences and medicine. She was awarded the OBE for Services to Medicine in 2001 and made a Fellow of the UK Academy of Medical Sciences in 2014.