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Archie Cochrane

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For other people named Archibald Cochrane, see Archibald Cochrane.

Archibald Cochrane
Born
Archibald Leman Cochrane

(1909-01-12)12 January 1909
Galashiels, Scotland
Died18 June 1988(1988-06-18) (aged 79)
NationalityScottish
CitizenshipBritish
OccupationPhysician

Archibald Leman Cochrane CBE (12 January 1909 – 18 June 1988) was a Scottish physician noted for his book, Effectiveness and Efficiency: Random Reflections on Health Services, which advocated the use of randomized controlled trials (RCTs) to make medicine more effective and efficient. His advocacy of RCTs eventually led to the development of the Cochrane Library database of systematic reviews, the establishment of the UK Cochrane Centre in Oxford, and the international Cochrane Collaboration.[1] He is known as one of the fathers of modern clinical epidemiology and evidence-based medicine and is considered to be the originator of the idea of evidence-based medicine in the current era. The Archie Cochrane Archive is held at the Archie Cochrane Library in Cardiff University.

Early life and education

Cochrane was born in Kirklands, Galashiels, Scotland, into a family he described as "industrial upper middle class".[2] His father was killed whilst serving with the King's Own Scottish Borderers during World War I.[3] He won a scholarship to Uppingham School, and obtained another scholarship to King's College, Cambridge, achieving first class honours in Parts I and II of the Natural Sciences Tripos and completing 2nd MB studies in physiology and anatomy in 1930.[4] He qualified in 1938 at University College Hospital, London, at University College London.[1]

Cochrane was born with porphyria, which caused health problems throughout his life. He underwent treatment using psychoanalysis under Theodor Reik. Following Reik to Berlin, Vienna, and the Hague as the influence of the Nazis increased, Cochrane combined his treatment with further medical evaluation in Vienna and Leiden.[4] He became dissatisfied with psychoanalysis but gained fluency in German (which was useful later on in life).[5] His travels also convinced him of the importance of the anti-fascist cause.[6]

During the Spanish Civil War, Cochrane served as a member of a British Ambulance Unit within the Spanish Medical Aid Committee.[1]

World War II

Cochrane joined the British Army in World War II. He was captured during the Battle of Crete. Subsequently he worked as a Medical Officer at Salonika (Greece) and Hildburghausen, Elsterhorst, and Wittenberg an der Elbe (Germany) prisoner of war camps. His experience in the camp led him to believe that much of medicine did not have sufficient evidence to justify its use.[7]

He said, "I knew that there was no real evidence that anything we had to offer had any effect on tuberculosis, and I was afraid that I shortened the lives of some of my friends by unnecessary intervention."[8] As a result, he spent his career urging the medical community to adopt the scientific method.

Post World War II

After the war Cochrane studied for a Diploma in Public Health at the London School of Hygiene & Tropical Medicine and spent a year at the Henry Phipps Institute in Philadelphia on a Rockefeller Fellowship.[9] Cochrane joined the Medical Research Council's Pneumoconiosis Unit at Llandough Hospital, a part of Welsh National School of Medicine (now Cardiff University School of Medicine), in 1948. Here he began a series of studies on the health of the population of Rhondda Fach—studies which pioneered the use of RCTs.[10]

Cardiff University has released an online video of the Rhondda Fach studies. The video shows some archival footage of the community study. Cochrane describes what he was looking for in the surveys.[11]

In 1956, Cochrane underwent a radical mastectomy to remove what was thought to be cancerous tissue in his right pectoralis minor and axilla.[12]

Academia

In 1960 he was appointed David Davies Professor of Tuberculosis and Chest Diseases at the Welsh National School of Medicine, now Cardiff University School of Medicine, and nine years later became Director of the new Medical Research Council's Epidemiology Research Unit at 4 Richmond Road, Cardiff. His groundbreaking paper on validation of medical screening procedures, published jointly with fellow epidemiologist Walter W. Holland in 1971, became a classic in the field.[13].

His 1971 Rock Carling Fellowship monograph Effectiveness and Efficiency: Random Reflections on Health Services, first published in 1972 by the Nuffield Provincial Hospitals Trust – now known as the Nuffield Trust,[8] was very influential. To quote from the book's summary :

"An investigation into the workings of the clinical sector of the NHS strongly suggests that the simplest explanation of the findings is that this sector is subject to severe inflation with the output rising much less than would be expected from the input". According to a review in the British Medical Journal, "the hero of the book is the randomized control trial, and the villains are the clinicians in the "care" part of the National Health Service (NHS) who either fail to carry out such trials or succeed in ignoring the results if they do not fit in with their own preconceived ideas".[14]

Maintaining this challenge to the medical care system as he saw it, in 1978, with colleagues, he published a study of 18 developed countries in which he made the following observations: "the indices of health care are not negatively associated with mortality, and there is a marked positive association between the prevalence of doctors and mortality in the younger age groups. No explanation of this doctor anomaly has so far been found. Gross national product per head is the principal variable which shows a consistently strong negative association with mortality."[15] This work was selected for inclusion in a compendium of influential papers, from historically important epidemiologists, published by the Pan American Health Organization (PAHO/WHO) in 1988.[16]

Cochrane promoted the randomised trial and is a co-author with Professor Peter Elwood on a report on the first randomised trial of aspirin in the prevention of vascular disease.[17] He also promoted the cohort study and was a key adviser in a highly detailed cohort study, the Caerphilly Heart Disease Study.[18]

Honours

Cochrane was awarded an MBE by the British Government for his "gallant and distinguished services in prisoner of war camps.[19] He was later appointed a CBE for his contributions to epidemiology as a science.[20]

Publications

Articles

  • Cochrane, A.L.; Holland, w.W. (1971). "Validation of screening procedures". British Medical Bulletin. 27 (1): 3–8.
  • Cochrane, A.L.; St Leger, A.S.; Moore, F. (1978). "Health service 'input' and mortality 'output' in developed countries". Journal of Epidemiology and Community Health. 32 (3): 200–205.
  • Cochrane, Archibald L. (1984). "Sickness in Salonica: my first, worst, and most successful clinical trial". British Medical Journal. 289 (6460): 1726.

Books

  • 1972. Effectiveness and efficiency Random reflections on health services. London: Nuffield Provincial Hospitals Trust.
  • 2009. (Originally 1975 with Max Blythe.) One man's medicine An autobiography of Professor Archie Cochrane (1909 - 1988) - The Cardiff University Cochrane Centenary Edition. Cardiff: Cardiff University. ISBN 0954088433.

See also

References

  1. ^ a b c "Archie Cochrane: The name behind Cochrane". www.cochrane.org. Cochrane Collaboration. 5 December 2013. Archived from the original on 19 October 2014. Retrieved 10 September 2014.
  2. ^ Cochrane & Blythe 2009.
  3. ^ Cochrane & Blythe 2009, p. 3.
  4. ^ a b Cochrane & Blythe 2009, p. 269.
  5. ^ Hill, GB (December 2000). "Archie Cochrane and his legacy: An internal challenge to physicians' autonomy?" (PDF). Journal of Clinical Epidemiology. 53 (12): 1189–92. doi:10.1016/s0895-4356(00)00253-5. PMID 11146263. Archived from the original (PDF) on 17 June 2010.
  6. ^ Cochrane & Blythe 2009, pp. 17–18.
  7. ^ See 'Articles' under 'Publications'.
  8. ^ a b Cochrane 1972.
  9. ^ Cochrane & Blythe 2009, pp. 115–118.
  10. ^ "University lauds medical pioneer". BBC News. Archived from the original on 15 December 2019. Retrieved 2 February 2014.
  11. ^ "Watch Archie Cochrane talk about his research". www.cardiff.ac.uk. Cardiff University. Archived from the original on 22 February 2014. Retrieved 3 February 2014.
  12. ^ Tetlock, Philip E.; Gardner, Dan (2015). Superforecasting : the art and science of prediction (First Paperback ed.). New York: Broadway Books. pp. 24–25. ISBN 978-0-8041-3671-6.
  13. ^ See 'Articles' under 'Publications'.
  14. ^ See 'Articles' under 'Publications'.
  15. ^ See 'Articles' under 'Publications'.
  16. ^ Buck, C.; Llopis, A.; Najera, Terris M., eds. (1988), The Challenge of Epidemiology: Issues and Selected Readings, Washington, DC: Pan American Health Organization.
  17. ^ Elwood, PC; Cochrane, AL; Burr, ML; Sweetnam, PM; et al. (9 March 1974). "A randomized controlled trial of acetyl Salicylic Acid in the secondary prevention of mortality from myocardial infarction". British Medical Journal. 1 (5905): 436–40. doi:10.1136/bmj.1.5905.436. PMC 1633246. PMID 4593555.
  18. ^ The Caerphilly and Speedwell Collaborative Group (September 1984). "Caerphilly and Speedwell collaborative heart disease studies". Journal of Epidemiology and Public Health. 38 (3): 259–62. doi:10.1136/jech.38.3.259. PMC 1052363. PMID 6332166.
  19. ^ "Letter to Archie Cochrane, medical pioneer, from King George VI". People's Collection Wales. 1945. Archived from the original on 22 February 2014. Retrieved 2 February 2014.
  20. ^ "Biographical Outline of Archibald Leman Cochrane (1909-1988)". Cardiff University. Archived from the original on 22 February 2014. Retrieved 2 February 2014.

Bibliography

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