Research Methods & Ethics · 1993
Founding of the Cochrane Collaboration
Archie Cochrane spent most of his career frustrated that medicine committed resources to treatments that had never been rigorously evaluated and, worse, ignored the trials that had already been done. His 1972 book Effectiveness and Efficiency argued that randomized controlled trials were medicine's best tool for separating what worked from what did not, and that systematic reviews of those trials, collected discipline by discipline, would give clinicians and policymakers a reliable base for decisions. He made a specific challenge: obstetrics, he said, had done more good trials than any other field, yet their results were not assembled anywhere a clinician could use them.
Iain Chalmers, a British epidemiologist with a long background in perinatal research, took that challenge seriously. He and colleagues built a database of perinatal trials in the 1980s that would eventually become the Oxford Database of Perinatal Trials, demonstrating that systematic synthesis was feasible and that it often reversed conventional wisdom. In October 1992, Chalmers established the UK Cochrane Centre in Oxford, funded by the NHS Research and Development Programme. The Cochrane Collaboration formally launched the following year, in 1993, with review groups forming across several countries and an editorial structure that gave each group oversight of a specific clinical area.
The Collaboration's core innovation was methodological standardization. Before Cochrane, systematic reviews were largely narrative, reflecting the judgment and reading habits of their authors. Cochrane reviews required explicit search strategies, pre-specified inclusion and exclusion criteria, structured data extraction, and, where appropriate, formal meta-analysis with pooled effect estimates. The protocol had to be registered in advance, making it possible to audit the process and update the review as new trials appeared.
By the late 1990s and into the 2000s, the Cochrane Library had become a recognized input for clinical guideline development in most high-income countries. Regulatory bodies including the FDA and the European Medicines Agency began referencing Cochrane reviews in their assessments of evidence; the WHO incorporated Cochrane methods into its Essential Medicines evaluation process. Reviews from the Collaboration have been cited in submissions for drug approvals and in court cases involving disputed treatment evidence.
Cochrane had died in 1988, four years before the Centre opened in Oxford. The network named for him has since published tens of thousands of systematic reviews across virtually every clinical specialty, and it has trained a generation of clinicians in methods they did not learn during medical school. The central registry of controlled trials maintained by the Collaboration, which absorbed earlier databases including the Oxford perinatal work, remains one of the largest such repositories in existence.
Key People
- Iain Chalmers — Founding director of the UK Cochrane Centre, principal organizer
- Archie Cochrane — Epidemiologist whose 1972 monograph inspired the collaboration's mission
- Andy Oxman — Early contributor to Cochrane methods and the Oslo group
- Murray Enkin — Canadian obstetrician who co-developed the Oxford perinatal trials database with Chalmers
Bero & Rennie, JAMA 1995
Related landmarks
- 1992 · Evidence-based medicine: a new approach to teaching the practice of medicine (Research Methods & Ethics)
- 1996 · CONSORT Statement (Research Methods & Ethics)
- 2005 · Ioannidis, "Why Most Published Research Findings Are False" (Research Methods & Ethics)
- 1976 · Large simple trials and trial overviews (Peto and colleagues) (Research Methods & Ethics)