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Primary care
Editors’ response to concerns over the publication of the Cochrane HPV vaccine review was incomplete and ignored important evidence of bias
  1. Carl Heneghan1,
  2. Igho Onakpoya2
  1. 1 Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Primary Care, University of Oxford, Oxford, UK
  1. Correspondence to Professor Carl Heneghan; carl.heneghan{at}

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A response by Cochrane’s Editor in Chief1 to an article by Jorgensen at al published in BMJ Evidence Based Medicine (BMJ EBM) asks questions about the journal’s peer review and editorial processes.

The article, ‘The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias,’2 was submitted to BMJ EBM on 24th May 2018 for the ‘Debate, analysis and opinion’ section of the journal. The handling editor, Dr Igho Onakpoya (Research Editor, BMJ EBM) sent it for external peer review to an expert in HPV vaccines and for internal peer review to Professor Carl Heneghan, Editor in Chief of BMJ EBM, who is an expert in evidence synthesis and systematic review methods. Peer reviewers reports were returned by 19th June and were sent to the authors, who were invited to make revisions. The revised version was submitted on 3 July, accepted by the handling editor on 7 July and published online on the 27July 2018.2 With permission from the peer reviewers and authors, the peer review reports and the authors’ responses are appended to this article (see Table 1).

BMJ EBM has invited the authors of the analysis article2 to respond to the Cochrane response, and they have said they will do so. We have also invited the authors of the original Cochrane systematic review3 to respond. We have also asked the Editor in Chief of Cochrane to clarify what specific editorial and peer review processes he believes were lacking rigour.

The Cochrane response raised several concerns. It said that the BMJ EBM article did not provide a list of 20 eligible but missed trials of HPV vaccine.2 The authors of the article have confirmed that their index of 206 trials was published in January 20184 and submitted to the review group. Preliminary analysis suggests at least five now meet the inclusion criteria. Given the availability of this trial index prior to publication of the Cochrane review,3 it is unclear why these trials weren’t included in the review. The authors of the article have said they will provide an updated list of missed trials with reasons for their eligibility.

The Cochrane response said that two authors of the BMJ EBM article were unaware of the publication schedule. All co-authors are informed when an article is accepted, but only the corresponding author is informed at the time of online publication.

The Cochrane response also questioned the tone of the BMJ EBM article. We acknowledge that articles in our journal will seek to hold organisations to account and will and should not shrink from offering criticisms that may be considered inconvenient. Academic freedom means communicating ideas, facts and criticism without being censored, targeted or reprimanded. We believe that the article by Jørgensen et al provokes healthy debate and poses important questions about the need to ensure that all available evidence is included in systematic reviews to properly inform healthcare decisions.

Table 1

Peer review comments and responses: The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias - 3 July 2018: accessed from scholar one.


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  • Contributors CH wrote the first draft and IO revised the editorial.

  • Competing interests CH has co-authored 16 peer-reviewed articles with Tom Jefferson (two of which are Cochrane reviews) and holds grant funding jointly with Tom Jefferson from Cochrane on methods for deciding when to prioritise the use of clinical study reports in systematic reviews. CH is a member of Cochrane and a contact editor for the Cochrane Acute Respiratory Infection group and has been an author 21 Cochrane reviews including updates. He is a founder of AllTrials and an advisor ot the WHO International Clinical Trial Registry Platform. and He has received expenses and fees for his media work (including payments from BBC Radio 4 Inside Health). He has received expenses from the WHO, and holds grant funding from the NIHR, the NIHR School of Primary Care Research, NIHR BRC Oxford and Cochrane. He has received financial remuneration from an asbestos case and given free legal advice on mesh cases. He has also received income from the publication of a series of toolkit books published by Blackwells. On occasion, he receives expenses for teaching EBM and is also paid for his NHS GP work in urgent care (contract with Oxford Health NHS Foundation Trust). He is Director of CEBM at the University of Oxford, which jointly runs the EvidenceLive Conference with the BMJ and the Overdiagnosis Conference with international partners, based on a non-profit making model. He is Editor in Chief of BMJ Evidence-Based Medicine. IO is Research Fellow in Evidence Synthesis at the CEBM, University of Oxford, a clinician who works across several NHS Trusts and is funded by the NIHR School of Primary Care Research. IO has co-authored eight peer-reviewed articles jointly with Tom Jefferson (one of these is a Cochrane review).

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.