After attending the recent Cochrane Colloquium in Madrid, we take a closer look at the man behind the ideas behind the Collaboration. Stay tuned for part 2 next week!
Archibald Leman Cochrane was born in Galashiels, Scotland, on 12th January 1909. He became a student at Uppingham School followed by King’s College, Cambridge (1927-30). After obtaining a 1st class honours degree he became a research student working on tissue culture studies. He left for Germany and studied psychoanalysis under the guidance of Theodor Reik (while at the same time receiving psychoanalytic treatment from him) who was one of the first students of Sigmund Freud. After starting his medical studies, Cochrane decided to return to London after becoming convinced that his psychoanalytic treatment lacked a scientific basis. Later in his life, Cochrane condemned the entire field of psychiatry for “using a large number of therapies whose effectiveness has not been proven” and for being “basically inefficient.”
Archie Cochrane qualified as a doctor in 1938 and during the Spanish civil war volunteered his services to the Spanish Medical Aid Committee. The next twenty years were the formative ones in his life. During the Second World War he was a Captain in the Royal Army Medical Corps. He was captured in June 1941 in Crete. Cochrane had picked up some German during his time with Theodor Reik and as a result of his linguistic abilities; he was assigned the dual role of a medical officer for the POWs and a negotiator. To his credit, Cochrane remained vigilant about helping the other prisoners in spite of being served only a 600 calories-per-day diet for extended periods of time. It was during this time that Cochrane performed his first trial. He conducted a non-random trial involving 20 subjects to convince the Germans that a yeast supplement to the prisoner diet would cure the widespread oedema amongst them. In spite of the lack of scientific rigor, Cochrane succeeded in convincing the Germans. He later described the venture as his “first, worst, and most successful trial.” It was also during this time that Cochrane realized the extent to which unsubstantiated claims plagued medicine. As Cochrane reveals, “I had considerable clinical choice of therapy: my trouble was that I did not know which to use and when.” This frustration planted the seeds for a lifelong journey of trying to distinguish between scientifically valid medical therapies and the invalid ones.
After returning from the war, Cochrane trained as an epidemiologist. His training involved spending a year in the Henry Phipps Institute, Philadelphia and receiving tutelage from Sir Bradford Hill, who pioneered the RCT and was the first to demonstrate a connection between cigarette smoke and lung cancer. He started his career by studying whether pneumoconiosis progresses to Progressive Massive Fibrosis (PMF) as a result of tuberculosis in coal miners. Although the experiment did not produce conclusive results because the prevalence of tuberculosis fell spontaneously in the control population, Cochrane did manage to achieve response rates close to 100%, and his study was the first to use a whole population in a controlled experiment. It was the high response rates that earned Cochrane the reputation of being an excellent epidemiologist. In the sixties, he left the pneumoconiosis research unit to work as a David Davies professor of tuberculosis and chest diseases at the Welsh National School of Medicine. He also served as the honorary director of the Medical Research Council Epidemiology Unit during this time. As well as maintaining his expectations of a high response rate in epidemiology studies, he was offered a Rock Carling Fellowship to write a book about evaluating the British National Health Service (NHS). In 1971 he published his ground-breaking monograph, Effectiveness and Efficiency: Random Reflections of Health Services.
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