Here is the second part of our short biography of Archie Cochrane. Personally, I think he would have been a swell guy to share an icecream with.
Archie Cochrane is best known for his influential book, Effectiveness and Efficiency: Random Reflections on Health Services published in 1972. The principles he set out in it were clear and straightforward: he suggested that because resources would always be limited, they should be used to provide only those forms of health care which had been shown in properly designed evaluations to be effective. In particular, he stressed the importance of using evidence from randomised controlled trials (RCTs) because these were likely to provide much more reliable information than other sources of evidence. Cochrane’s simple propositions were soon widely recognised as seminally important – by lay people as well as by health professionals.
In a manner appropriate for someone writing on the topic of the biases and inconsistencies in medicine, Cochrane began the book by first revealing his own biases. He used the terms effectiveness, efficiency and equality as his yardstick for evaluating the NHS. Effectiveness was used as a measure of how much a medical activity changes the natural course of a disease in a RCT. Efficiency was used to refer to how well the health care system utilized resources such as doctors, nurses, medical equipment, etc. to implement an effective medical intervention. Equality was used to assess care and the variation of care amongst different hospitals.
Cochrane believed that the ultimate duty of medical doctors was to make decisions between alternative therapies based on cost/benefit comparisons. According to him, “these can really only be obtained by an adequately costed RCT.” However, even he realized that RCTs did not always provide an unequivocal answer. One can easily imagine a scenario in which different RCTs provide contradictory results. This was the case with RCTs performed to evaluate the benefit of tonsillectomies. Cochrane found that while one RCT found tonsillectomy to be a beneficial procedure with regards to otitis media, another RCT found no associated benefit. Cochrane realized that clinicians would not find a litany of RCTs helpful and would not necessarily know which trial was the best. This led Cochrane to reach the conclusion in 1979 that “It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized control trials.” His challenge led to the establishment during the 1980s of an international collaboration to develop the Oxford Database of Perinatal Trials. This call for an organized database of RCTs served as an impetus for the formation of the first Cochrane centre (in Oxford, UK) in 1992, the founding of The Cochrane Collaboration in 1993, and ultimately the creation of Evidence Based Medicine.
Archie Cochrane fought ardently for his ideals, regardless of whether they were about politics or healthcare. His self-written obituary ended as follows: “He was a man with severe porphyria who smoked too much and was without consolation of a wife, a religious belief, or a merit award—but he didn’t do so badly.” He died on 18th June 1988. One Man’s Medicine: Autobiography of Professor Archie Cochrane was published in 1989.
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