Cochrane, 'Effectiveness and Efficiency'

In 1972, most medical treatments had never been evaluated in a randomized controlled trial. The NHS had been spending public money for almost a quarter century on surgery, drugs and obstetric care whose effects had rarely been measured. Archie Cochrane, a Scottish-born epidemiologist who had tested a treatment for famine edema on fellow prisoners of war and had directed the MRC Epidemiology Unit in Cardiff since 1960, decided to say so in print.

His monograph, Effectiveness and Efficiency: Random Reflections on Health Services, was written for the 1971 Rock Carling Fellowship, which asked for 20,000 words, and the Nuffield Provincial Hospitals Trust published it in 1972. The argument was blunt: the health service lacked the information to allocate its resources rationally, and the randomized controlled trial was the way to get it. His worked examples ran from pulmonary tuberculosis and diabetes to psychiatry, ENT and midwifery. On midwifery he called the case for moving all births into hospital very thin evidence, noting that Holland, with only 20 percent of confinements in hospital, had one of the lowest perinatal mortality rates in the world.

The book was short and personal. In the introduction Cochrane admitted that his own experience of patient care was slight and unusual, gained almost entirely during four years as a prisoner-of-war doctor in German hands. Its slogan, all effective treatment must be free, came from a banner he had carried alone to a rally about a possible national health service when he was a London medical student in the 1930s. The book became a best seller, and Iain Chalmers later described it as written in a very readable style on issues of general interest.

The proposal most tied to his name came seven years later. In a 1979 essay for the Office of Health Economics he wrote that it was "surely a great criticism of our profession" that no one had organized a critical summary, by specialty and updated periodically, of all relevant randomized controlled trials. Iain Chalmers and colleagues took up the challenge for pregnancy and childbirth, building the Oxford Database of Perinatal Trials and publishing Effective Care in Pregnancy and Childbirth in 1989. The UK Cochrane Centre opened in 1992, and in 1993, 77 people from nine countries met in Oxford and founded the Cochrane Collaboration.

The collaboration wrote a handbook of methods for systematic reviews and published its reviews in the Cochrane Library. By 2023 it had 11,000 members and 100,000 supporters in more than 130 countries. Cochrane died on 18 June 1988, five years before the organization bearing his name was established.