Archie Cochrane

Archie Cochrane

Archibald Leman Cochrane, the son of Walter Francis and Emma Mabel (née Purdom) Cochrane, was born in Galashiels, Scotland, on 12th January 1909. His father was a prosperous businessman but during the First World War he was killed at the Battle of Gaza.

In 1922 Archie Cochrane became a student at Uppingham School. This was followed by King's College, Cambridge (1927-30). After obtaining a 1st class honours degree he became a research student with Dr N. Wilmerat, at the Strangeways Laboratory, where he worked on tissue culture studies. Cochrane studied psychoanalysis under Theodor Reik, in Berlin, Vienna and The Hague before starting his training as a doctor at University College Hospital in 1934.

On 8th August 1936, a group of doctors, medical students and nurses met in London to consider ways of sending medical help to Republicans fighting in the Spanish Civil War. The meeting was organised by the Socialist Medical Association and addressed by Isabel Brown. As a result it was decided to form a Spanish Medical Aid Committee. Other important members of this group included Leah Manning, George Jeger, Lord Faringdon, Arthur Greenwood, Tom Mann, Ben Tillett, Harry Pollitt and Mary Redfern Davies. Cochrane volunteered to be a member of the medical team sent to Spain.

Cochrane was one of those young doctors who volunteered his services to the Spanish Medical Aid Committee: "It was the time of the Hunger March, Mosley's Blackshirts, and a round of anti-fascist meetings. Then came the Popular Fronts in France and Spain, and a stream of refugees. Finally, in the summer of 1936, Franco and his Moors invaded Spain' and the pot boiled over. My friends and I feared that if Spain went fascist and joined with Hitler and Mussolini, France and the UK were doomed; but we were admittedly ignorant of the complexities of Spanish politics. We were incensed by the UK's commitment to a non-intervention pact, especially when it became clear that Germany, Italy, and Portugal were openly flouting such a policy."

Cochrane joined the First British Hospital established by Kenneth Sinclair Loutit at Grañén near Huesca on the Aragon front. Other doctors, nurses and ambulance drivers at the hospital included Penny Phelps, Peter Spencer, Annie Murray, Julian Bell, Richard Rees, Nan Green, Lillian Urmston, Thora Silverthorne and Agnes Hodgson. Saxton later recalled, "there was only dirt and filth and rats and a stinking courtyard".

Archie Cochrane was fairly critical of the original team of doctors and nurses. He claimed things improved after the arrival of Alex Tudor-Hart and Reginald Saxton: "When the mobile team finally arrived in Albacete only four of its original members remained - Kenneth (Sinclair-Loutit), Thora (Silverthorne), Aileen (Palmer), and myself - a situation which I feel reflected the inadequacy of the original selection process. There were, of course, others from subsequent waves of volunteers. I was glad that Reggie Saxton and Keith Anderson were there. Recent arrivals included Dr Tudor Hart, who had some surgical experience, Joan Purser, a nurse, and Max Colin, a mechanic."

Cochrane, Reginald Saxton and Alex Tudor-Hart eventually joined the 35th Medical Division Unit, attached to the French Battalion the XIV International Brigade. This involved supporting Republican troops at the Battle of Jarama in February 1937. This included setting up a field hospital in a country club, at Villarejo de Salvanés using the bar as a theatre, and operating on three table-tops.

Archie Cochrane was one of those who treated Julian Bell, who had been working as an ambulance driver with the British Medical Unit. He was driving his ambulance along the road outside Villanueva de la Cañada when it was hit by a bomb dropped by a Nationalist pilot. Kenneth Sinclair-Loutit recalled in his autobiography, Very Little Luggage: "It was on the 18th of July 1937 that the Luftwaffe bombed the spot where Julian was repairing the road for his Ambulance to move forward. He had a massive lung wound; his case was beyond hope but he came back in time for us to be able to make his end comfortable." Bell was taken to the military hospital at El Escorial near Madrid. Archie Cochrane was the doctor who treated him in the receiving-room. As soon as he examined him, he realized that he had been mortally wounded; a shell fragment had penetrated deep in his chest. Bell was still conscious and murmured to Cochrane: "Well, I always wanted a mistress and a chance to go to war, and now I've had both." He then fell into a coma from which he never awakened. Richard Rees saw him in the mortuary. He later recalled: "He looked very pale and clean, almost marble-like. Very calm and peaceful, almost as if he had fallen asleep when very cold."

After a year in Spain he returned to his studies at University College Hospital. He recalled his thoughts in his autobiography, One Man's Medicine: "On my flight back to the UK I tried to sum things up. I was glad I had gone to Spain; glad that I had not given up in despair at Grañén. Given my limited abilities, I had made a reasonable contribution to the anti-fascist cause, rather than merely talking about it. I had also learned a lot. Although I had come to hate war, I now knew that fascism would have to be fought and that pacifism was impossible. I had, too, become increasingly suspicious of the communists. There had been valuable opportunities to discuss political theories with knowledgeable people of different persuasions - anarchists and Trotskyites; Russian, German, French, and American communists; British socialists and communists; and a few British liberals. I realised that no one knew how to run a country or a revolution... Overall I had a general feeling of satisfaction that I had risked my life for a cause I believed in."

Archie Cochrane qualified as a doctor in 1938. He later said, "I have given up any attempt to change the world as I once wanted to do and this is where I disagree with my Marxist friends. I feel that I should just concentrate on changing a small bit of it. It's a bit more effective if one does that."

During the Second World War he was a Captain in the Royal Army Medical Corps. He was captured in June 1941 in Crete. Cochrane was a Prisoner of War medical officer at a number of prisoner of war camps, including Salonika, Hildburghausen, Elsterhorst and Wittenberg. Conditions improved after he arrived in Nazi Germany. "German rations at about 2,500 calories a day and regular Red Cross parcels, which took us over the 3,000 calorie mark, were heaven on earth. This transformed me. I lost my oedema and jaundice, put on weight, and became, I hope, a more useful doctor and more reasonable human being."

In 1947 he studied the epidemiology of tuberculosis at Henry Phipps Institute, Philadelphia. The following year he joined the Medical Research Council's Pneumoconiosis Unit at Llandough Hospital. Here he began a series of studies on the health of the population of Rhondda Valley. These studies pioneered the use of randomised controlled trials (RCTs).

In 1960 he was appointed Professor of Tuberculosis and Chest Diseases at the Welsh National School of Medicine in Cardiff. In 1971 he published his ground-breaking monograph, Effectiveness and Efficiency: Random Reflections of Health Services. His advocacy of randomized controlled trials 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.

Archie Cochrane asked that his obituary read, "He lived and died, a man who smoked too much, without the 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.

London in the thirties was very political, and though I was working hard, realising that I would be a late qualifier, I became involved. I had come back from Europe strongly anti-fascist but critical of the communists, who had not done enough to support the socialists in Germany and Austria against the fascists. The communist idea that fascism was the last stage of capitalism and would soon disappear seemed too facile. I saw fascism as a true menace to western civilisation.

It was the time of the Hunger March, Mosley's Blackshirts, and a round of anti-fascist meetings. We were incensed by the UK's commitment to a non-intervention pact, especially when it became clear that Germany, Italy, and Portugal were openly flouting such a policy.

Behind the scenes in the UK an important Spanish Medical Aid Committee was set up. The president was Dr Christopher Addison MP, and the main committee contained a galaxy of important names, with peers, MPs, professors, and leading communists appearing united. There was also a working committee, which I gather was left wing. Ostensibly, the intention was to organise and fund a field ambulance unit to serve the Spanish Republican cause. When an advertisement appeared asking for "offers" from doctors and medical students who were prepared to serve in Spain I began to think of joining them.

I thought I knew more about fascism and its probable effect on Western European civilisation than most other British medical students. I was unmarried and had no one dependent on me. My friends and family would miss me if I were killed, but they would believe that I had died in a worthwhile cause. Those were my conscious thoughts, but I suspect there were other factors. I do not remember how conscious they were underneath my political excitement, but there were the elements of a real depression. I still sincerely wanted to do some worthwhile medical research, but the prospects seemed to get worse and worse. I had developed grave doubts about psychoanalysis and also knew that I was no good at laboratory research.

Everyone liked and admired Aileen Palmer, an Australian, for her friendliness, devotion, and hard work. Everyone trusted her, although she was a self-confessed party member. Another self-confessed party member was Thora Silverthorne, a highly skilled surgical theatre sister. Despite a hard streak, she was friendly and amusing. I also liked Ruth Prothero, a charming, migrant doctor from Vienna. I talked fluent German and she introduced me to some of her Swiss and German friends. Margot Miller, another Australian, was a journalist and party member. She was a robust, efficient hard worker and later became a well known writer of detective stories. I enjoyed her company. A fifth female member of the original party I never did get to know. She was a complete loner and soon separated from us.

The males were worse than the females. Lord Peter Churchill was a good public relations figure, a fair administrator, and a friendly person; but I was worried that his fairly obvious homosexuality or bisexuality might run the unit into legal trouble, although I knew little of the laws in Spain. Kenneth Sinclair-Loutit, the official leader of the unit, was a likeable medical student and an obvious secret party member, but I did not think that he would be a good leader. He had a weak streak. O'Donnell, the chief administrator, who had made the bad speech in Paris, was even worse when I met him. I thought him stupid, conceited, and erratic. I certainly did not like the idea of his being in charge. The quartermaster, Emmanuel Julius, also seemed second rate and rather schizoid. The only surgeon, Dr. A. Khan, who was studying in the UK for the FRCS, was reserved, non-political, and rather worried. Of the other two male doctors, one was an American, Sollenberger, and the other, Martin, a former member of the Royal Army Medical Corps. I took a poor view of them both. In addition there were two other medical students.

I did not have very close contact with the drivers. Harry Forster, a cheerful London taxi driver, proved a great success as an electrician on one occasion, but he moved on all too quickly. Alec Wainman, a Quaker photographer, was a charming, if neurotic, character, whom I liked but never got to know. Leslie Preger, an open communist, was rather a shocker. He admitted that he had only got into the unit because he had claimed that he spoke Spanish and knew about first aid. Both claims were false, but no one seems to have checked. The remaining drivers were the two Charlies, Hunt and Hurling. They were two young, extrovert, working class volunteers who wanted adventure and women. I enjoyed their presence at first, but they quite definitely disliked me, particularly my Cambridge accent. Fortunately they were not permanent. They motored backwards and forwards between London and Spain, so that I saw them only infrequently.

We felt cut off. We even lost our radio. I cannot remember whether it was broken, stolen, or confiscated, but its loss increased our sense of isolation. The most political subject discussed was the problem of secret communist meetings and separate reports to the committee and the British Communist party. I was by this time on friendly terms with Sinclair-Loutit, Thora Silverthorne, and Aileen Palmer, and I think I raised the subject with them, pointing out that although we accepted that the communists and secret communists made up most of the unit, we did not think it reasonable for them to hold secret meetings. These were undoubtedly disruptive. I pointed out that three people had already left the unit, possibly because of this. For a time a compromise was reached, in which I was allowed a seat on their committees. I was able to speak but not to vote. Later O'Donnell came up and denounced this, but I think finally the secret meetings were given up. There was also a lot of criticism of Dr Sollenberger as a disruptive element, but he did not leave until much later.

I was glad to leave Grañén. I had never been happy there and looked forward to the trip, although I was rather worried when I got my travel document from O'Donnell. With his usual inefficiency it was undated, did not say where I was going, and merely stated that I could negotiate on behalf of the Spanish Medical Aid Committee. This was the one thing I was sure I was not entitled to do. In the event the trip to Albacete went off smoothly. I had one interesting meeting in a bar in Barcelona with a tall Englishman with big feet, who had been fighting with the POUM militia. In the course of the conversation I criticised the anarchist and POUM militia for not capturing Huesca and Zaragoza and linking up with the Basques. He argued fiercely that the anarchists and the POUM had been perfectly correct to consolidate their revolution before thinking of assistance for the communists in Madrid. I later asked him why he had joined the POUM. As far as I remember he admitted it was by chance. They were the first people he met and he liked them. He said his name was Blair (George Orwell). I often wonder what would have happened to his literary output if he had joined the International Brigade. I later enjoyed his books more than I had that conversation.

When the mobile team finally arrived in Albacete only four of its original members remained - Kenneth (Sinclair-Loutit), Thora (Silverthorne), Aileen (Palmer), and myself - a situation which I feel reflected the inadequacy of the original selection process. Recent arrivals included Dr Tudor Hart, who had some surgical experience, Joan Purser, a nurse, and Max Colin, a mechanic. Reorganisation and membership changes led to a new leadership contest. To non-communists this proved an amusing open battle for power between two communists. Usually they settled things in secret. Tudor Hart won and Kenneth became his chief administrator.

The train journey to Valencia was uneventful, but it was interesting how the atmosphere changed from one of happy victory to that of a depressing war zone. I think I briefly met Peter Churchill and Lady Hastings (a real charmer) in Valencia before moving on in some haste to Albacete, where I was apparently expected. After being allocated board and lodging I received the news that I could see Marty that evening. I was nervous. He was already well known as an intolerant leader who was prepared to shoot those he did not like. My only hope seemed my flourishing red beard, although I did take care to prepare a short, cautiously worded speech in French. The meeting went off well. Someone introduced me, while I had a look at Marty. He was an impressive figure - tall, with a bushy beard and small dark hard eyes. I then made my speech offering the services of the Spanish Medical Aid Committee field hospital unit. He replied briefly in French, thanked me, and embraced me. We then sat down and had a drink and I was introduced to the chief medical officer of the International Brigade, a Dr Neumann, who was Austrian, and to Dr Dubois of the XIV Brigade, to which it was thought our mobile unit would be attached. We talked in French and German for a time and then, with a broad grin, Marty turned and asked, "Do tell me, what are you, an English gentleman, doing in Spain?" I replied that I was a Scots anti-fascist who had experienced fascism in Germany and Austria and feared its spread. I also made it clear that I was not a member of the Communist party, but that I was a strong supporter of the Popular Front. He laughed, embraced me for a second time, and handed me over to Dr Neumann and Dr Dubois. The latter, a dashing Pole educated in France, although a communist was much more interested in practical than doctrinal matters. The former, a charming, intelligent Viennese doctor, seemed pleased to have the opportunity to tell me, in German, about the difficulties of building up a medical service for the brigades.

The battle of Brunete was quite different from that of Jarama. Jarama had been essentially a defensive measure. Brunete started with the great hope that it was going to end the encirclement of Madrid. The plan was to advance on the small village of Brunete and break through enemy lines to cut off troops besieging Madrid from their supplies and reinforcements from the west. At first all went well. There was a rapid advance and casualties were slight, with the hospital functioning well and within its capacity. But soon the atmosphere changed. The casualties mounted rapidly and we were all put under real strain. What I particularly remember of this exhausting period are the valiant efforts of the ambulance drivers, who were always under pressure and often under fire. I also think that we in triage coped rather well and that jolly ran a remarkably efficient ward for abdominal cases. There was so much activity that inevitably much of it is hazy in retrospect. Towards the end of the battle there was a small incident which upset me, possibly unreasonably, but I was tired and emotionally overexcited after two or more weeks of triage. An ambulance arrived. The stretchers were brought in and I hurried to classify the wounded. The first case was lying on his right side with his face partially hidden. His left thorax was completely shattered. I could see a heart faintly beating. I signalled to the nurse, by dropping my thumb, that the case was hopeless (language was dangerous). I moved left to see the next case and, by chance, glanced back. To my horror I recognised the face of Julian Bell. (I suppose one must accept the probability of putting a good friend amongst the hopeless category. I have never met anyone who had run a triage in any war, but I am sure the effect is always devastating. A still small voice from your unconscious mutters, "You have condemned your friend to death!") I rushed off, telling my nurse to carry on, to find a surgeon or physician to confirm or refute my diagnosis. Fortunately I found Philip D'Arcy Hart, who was visiting the unit. I showed him the wound. He agreed with my opinion. I did not know whether to be pleased or sorry. We moved Julian to a ward, where he died some time afterwards, and I went back to triage, a changed man.

The battle ended towards the end of July. There had been little to lighten my depression. Julian had died. Another colleague was missing and others, including Dubois, were wounded. I was further depressed by the poor results of the Spanish Republic's efforts to build an army. The pathetic young Spaniards whom I tried to comfort in triage were not trained soldiers. I began to doubt that the Republic could win. But I kept this doubt to myself.

Back at Alcala de Henares, to where many of us were returned, there were dramatic changes. Nearly all the old gang of British volunteers had been given leave in the UK. Rather more surprisingly, all medical students were ordered to return home to qualify. This was just what my unconscious wanted, but my conscious, as a volunteer, had been too proud to suggest it. I was delighted.

On my flight back to the UK I tried to sum things up. There had been valuable opportunities to discuss political theories with knowledgeable people of different persuasions - anarchists and Trotskyites; Russian, German, French, and American communists; British socialists and communists; and a few

British liberals. Overall I had a general feeling of satisfaction that I had risked my life for a cause I believed in.

The train journey to Valencia was uneventful, but it was interesting how the atmosphere changed from one of happy victory to that of a depressing war zone. The former, a charming, intelligent Viennese doctor, seemed pleased to have the opportunity to tell me, in German, about the difficulties of building up a medical service for the brigades.

As the lull in the battle still continued, he proposed driving out to fill in the shell-holes in the road, which would make the evacuation of the wounded quicker and less painful. It was a practical, concerned, and enterprising thing to have done; it showed that Julian Bell was thinking about the situation, and working to improve the efficiency of his unit. But he would not have the time to complete the job. Suddenly on that day, July 18, 1937, the first anniversary of the outbreak of the Civil War, the battle of Brunete was renewed, with a violent counter-attack by the Nationalists. Their planes roared overhead, dropping bombs indiscriminately. Julian was driving his ambulance along the road outside Villanueva de la Canada. This time his luck was at an end.

Later in the day, a wounded ambulance driver, so covered with dirt as to be unrecognizable, was brought into the Escorial hospital on a stretcher. Cochrane was in charge of the receiving room; he ordered the man to be cleaned. It was only after this was done that he recognized him as Julian. As soon as he examined him, he realized that he had been mortally wounded: a shell fragment had penetrated deep in his chest. All that could be done now was to make him as comfortable as possible.

Julian was still conscious, still cheerful. He murmured to Cochrane, "Well, I always wanted a mistress and a chance to go to the war, and now I've had both." Then he lapsed into French, reciting indistinctly lines of what Cochrane thought might be Baudelaire. Soon after he fell into a coma from which he never awakened.

Archie Cochrane, a Spanish veteran and pioneering epidemiologist, became impatient with the grand political pseudo sciences that mesmerized his generation of intellectuals in the thirties. He said, "I have given up any attempt to change the world as I once wanted to do and this is where I disagree with my Marxist friends. It's a bit more effective if one does that." Born of a privileged background, Cochrane attended Cambridge, where he took a first in both parts of the natural science tripos. He worked at the "English" hospital in Granen. After a year in Spain, he returned to University College Hospital in London to complete his medical studies, no longer the callow young student but one who had played a part in five major battles, and, moreover, with his Spanish tan and red beard looked the man of experience he had become. The most politically conservative of the physicians on the staff said to him, "Ah, Cochrane, back again. Had an interesting weekend?"

After finishing his medical course, Cochrane went to the Rhondda, which had sent large numbers of its young men to Spain. It was here in the valleys of South Wales, where the suffering was so acute in the interwar years, and the Communist party and Spain seemed so woven into the very fabric of politics and culture, that Cochrane chose to practice medicine. Ultimately he revolutionized the science of epistemology, for which he was much honored. He became a Fellow of the Royal College of Surgeons and received the MBE and CBE. He returned to his hospital in Spain forty years later, and found it turned into a bar and apartments. "I moved towards a window and suddenly found myself in our old so-called 'operating suite.' It was now a sitting room and two bedrooms, but it was unmistakable, and from this stable point I was able to recognize much else."

Above all was the feeling of having done something against fascism, even as comparatively insignificant as he believed his efforts were, instead of simply talking about it. And unlike some other veterans, he had not transformed Spain into a land of constant nostalgia. Rather he knew it to be an essential stage of a larger journey on which he had embarked, and, nearing the end, acknowledged that it had gone well. Archie Cochrane asked that his obituary read, "He lived and died, a man who smoked too much, without the consolation of a wife, a religious belief or a merit award. But he didn't do so badly." What he said of himself could have been said of many others who had volunteered for Spain. In spite of it all, they hadn't done too badly, and, for many, their lives and political education did not stop when the British Battalion was welcomed home at Victoria Station, or when Franco marched triumphantly into Madrid on May 19, 1939.

Thora, who was able to combine a very Welsh intuitive mind with an amazing sense of discipline, told me that something odd was going on. She, along with everyone else, had expected that, before any commitment could be made to move to the Madrid front and to direct the Unit into the International Brigade, the word would have to come back with me from London. Why else had I gone there? But, while I was away, Archie Cochrane had seen André Marty, the Chief Commissar of the Brigades, on the basis of an introduction arranged by Hugh O'Donnell. Marty gave Cochrane an unusually warm welcome, kissing him on both cheeks and expressing his surprise and joy that an English intellectual of middle-class background should be in Spain as a volunteer...

The general meeting came in a day or two. It was not André Marty but Colonel Domanski-Dubois, PMO of the 35th Division, who presided. Later I got to know him well and can see him to this day with his little smile and firm but somehow comforting manner. He was to give his life in the Aragon offensive of August 1937. For him the meeting was called to induct a group of newly recruited personnel into his Division and to give them their assignments. We were going as a Unit into the 14th (French speaking) International Brigade. He had brought with him all that he needed, namely the badges of rank for the new officers. This he would not have been able to do without prior briefing about the persons concerned. In a genial, informal way he put into Tudor Hart's hands the insignia of a Major, into Archie Cochrane's that of a Captain and into mine the single stripe of a sub-lieutenant, saying, "C'est tous qui me reste" Externally Tudor Hart did not register surprise; Cochrane, who was, like me, a. medical student and who had worked happily with me in Grañen was visibly disconcerted. We had worked together very easily in Grañen, and he had accepted without second thoughts the fact of my being in charge - a seniority that had well ante-dated his own arrival. As the Spanish Medical Aid Administrator, I had been responsible for the Unit in all but the strictly medical sense.

Saxton's most famous patient was Julian Bell, son of the artist Vanessa Bell. This was at Villanueva de la Canada near the Escorial when the ambulance Bell drove came under attack by Nationalist bomber aircraft. Saxton had already noted how they were repeatedly attacked - bombed or strafed by fighter planes, often German or Italian. Bell sought shelter beneath the ambulance but a vast piece of shrapnel hit him in the chest, causing a terrible wound. He was brought into the clearing station and seen by Archibald Cochrane (then a medical student, but later the Professor at Cardiff after whom the Cochrane Library of medicine databases is named), who triaged him to hopelessly wounded.

Cochrane indicated to the orderlies to put him to one side. But he suddenly recognised the human face beyond the wound. Saxton was called, and the brilliant Spanish surgeon Moisés Broggi i Vallés, who examined him and retrieved from the gaping chest wound his wallet and passport which had been blown into the cavity. "His heart was visible through the wound," Saxton remembered: "I gave him a blood transfusion and dressed him again. But we realised we had to let him die and he died that night. When he saw me all he said was, 'Thank goodness it's you.' And I gave him morphine."

I remember at that time reading one of those propaganda pamphlets, considered suitable for POW [prisoner of war] medical officers about "clinical freedom and democracy". I found it impossible to understand. I had considerable freedom of choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge. I had never heard of "randomized controlled trials", but 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.

I was assigned to the medical section where there were two other British doctors, who had been captured at Dunkirk. My first reaction was to the food situation. German rations at about 2,500 calories a day and regular Red Cross parcels, which took us over the 3,000 calorie mark, were heaven on earth. I lost my oedema and jaundice, put on weight, and became, I hope, a more useful doctor and more reasonable human being.

I slowly assessed the situation and decided on the jobs I could most usefully do. I knew a certain amount about tuberculosis and offered to take over that section of the work, which was not popular with others. With my knowledge of German I tried to arrange facilities with the local clinic for screening and x raying patients. In this I was successful, and the local doctor, who was a lady, was cooperative. (This early specialisation in patients with tuberculosis had one unfortunate consequence. When the International Red Cross visited us they asked to see the cemetery, and one of them inquired who had looked after the patients who had been buried there. I had to admit that all of them were mine. The fact that tuberculosis was the sole cause of death amongst prisoners did not salvage my reputation. There was a tendency afterwards to refer to the cemetery as Cochrane's Corner. This tuberculosis work took up only a small part of my time. I realised that the rest of my efforts must be devoted to "care," as the chance of a cure among the other cases was minimal. I also realised that "care" in a prisoner of war hospital was far more than the

"tender, loving care" in a London teaching hospital. It involved looking after the total morale of a lot of very worried human beings. In particular, there were the Yugoslavs in the hospitals. They needed total care more than the British as they knew no English and none of the doctors knew Yugoslav; they also got no food parcels.

Another event at Elsterhorst had a marked effect on me. The Germans dumped a young Soviet prisoner in my ward late one night. The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I examined him. He had obvious gross bilateral cavitation and a severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect.

I felt desperate. I knew very little Russian then and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. I was ashamed of my misdiagnosis and kept the story secret."


History

Why 'Cochrane'?
Cochrane is named in honour of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

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 so clearly were straightforward: he suggested that, because resources would always be limited, they should be used to provide equitably 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 randomized 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 1979 he wrote, "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 controlled trials." His challenge led to the establishment during the 1980s of an international collaboration to develop the Oxford Database of Perinatal Trials.

In 1987, the year before Cochrane died, he referred to a systematic review of RCTs of care during pregnancy and childbirth as "a real milestone in the history of randomized trials and in the evaluation of care", and suggested that other specialties should copy the methods used. His encouragement, and the endorsement of his views by others, led to the opening of the first Cochrane Centre (in Oxford, UK) in 1992 and the founding of The Cochrane Collaboration in 1993.


James Lind Library Illustrating the development of fair tests of treatments in health care

Archibald Leman Cochrane was born in Galashiels, Scotland, on 12 January 1909, into a well-off Scottish tweed-making family, the first son of Walter Francis and Emma Mabel (née Purdom) Cochrane. His father was killed at the Battle of Gaza when Archie was only eight years old one of Archie’s brothers (Walter) died aged two from pneumonia the other (Robert) died aged twenty-one, after a motorcycle accident. Unsurprisingly, Archie’s lifelong relationship with his older sister, Helen, was very close, and it was her son and daughter-in-law – Joe and Maggie Stalker – who cared for Archie at their home in Somerset, England, in the years before his death on 18 June 1988.

That Archie’s sister Helen outlived him was in part because he challenged a diagnosis of dementia made after she had been admitted to a psychiatric hospital. Further investigation led to the discovery that she – and Archie – both had porphyria. Because he was concerned that other members of the family scattered around the world might unknowingly have the condition and put themselves at risk, he solicited urinary and faecal samples from 153 relatives and succeeded in obtaining satisfactory specimens from 152 of them.

In some ways this anecdote encapsulates the essence of Archie Cochrane. He was always ready to challenge medical (and non-medical) authorities to provide better evidence about the basis for their diagnoses and treatments. Although he had an epidemiologist’s interest in the wellbeing of communities, he was also deeply concerned for the welfare of individuals. And, as reflected in the survey of his relatives, he was known particularly for achieving very high rates of participation and follow-up in his epidemiological and clinical studies.

Early Life

After attending a preparatory school at Rhos-on-Sea in Wales, Archie Cochrane won a scholarship to Uppingham School (in Rutland, England) in 1922, where he became a school prefect and a member of the rugby football 1st XV. In 1927, he won a scholarship to King’s College Cambridge, where he graduated in 1930 with 1st class honours in Parts I and II of the Natural Sciences Tripos, and also completed 2nd MB studies. An inheritance enabled him to continue studying, and during 1931 he worked on tissue culture at the Strangeways Laboratory in Cambridge.

Richard Doll (1912-2005) has suggested that it was fortunate for medicine that Archie soon tired of what he concluded was trivial research. Furthermore, he became anxious about his sexual development, and this led him to abandon his research and seek medical help. He received little sympathy from the British doctors he consulted, but found that doctors at the Kaiser Wilhelm Institute in Berlin were willing to take his problem seriously. Between 1931 and 1934 he underwent psychoanalysis with Freud’s leading lay analyst, Theodor Reik (1888-1969), initially in Berlin, but then in Vienna and The Hague as Reik fled from Hitler. Archie did some medical studies in Vienna and Leiden during this time, and published his first paper (Elie Metchinikoff and his theory of an ‘instinct de la mort’). More significantly, these three years in Europe resulted in Archie becoming fluent in several languages, which were to serve him well later when he was a prisoner of war medical officer. His sojourn in Europe in the early 1930s also instilled in him a hatred of fascism and a sceptical attitude to all theories (including psychoanalysis) which had not been validated in experiments.

After returning to Britain in 1934, Archie enrolled as a clinical medical student at University College Hospital (UCH), London, but he abandoned his studies two years later in order to serve as a volunteer during the Spanish Civil War in a Field Ambulance Unit on the Aragon front and at the siege of Madrid. He resumed his clinical studies at UCH in 1937, and qualified MB, BCh (Cantab) in 1938. Until the outbreak of the Second World War he worked first as a house physician at the West London Hospital and then as a research assistant at the Medical Unit at UCH. As a captain in the Royal Army Medical Corps, he served first in Egypt as a hospital medical officer, then as a medical officer in D Battalion Layforce, a commando unit. The one military action in which he was then involved ended disastrously in Crete. Following the surrender of Allied troops there in 1941, he served as a prisoner of war medical officer in Salonica, Hildburghausen, Elsterhorst, and Wittenberg-am-Elbe (he was subsequently awarded MBE (military) in recognition of this service). During these prisoner of war days he wrote poetry (subsequently published privately in 1954 as Poems from Prison) as a defense against distress.

Archie’s experience as a prisoner of war medical officer made clear to him the importance of care when there is no hope of cure, and reinforced his interest in testing unsubstantiated claims about the effects of medical treatments.

I remember at that time reading one of those propaganda pamphlets, considered suitable for POW [prisoner of war] medical officers about ‘clinical freedom and democracy’. I found it impossible to understand. I had considerable freedom of choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge. I had never heard of ‘randomized controlled trials’, but 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. (Cochrane 1972, p 6).

Indeed, it was during his time as a prisoner of war that Archie organised what he later referred to as his “first, worst and most successful clinical trial” (Cochrane 1941 Cochrane 1984).

Epidemiology

After leaving the army at the end of the war, Archie Cochrane obtained a Rockefeller fellowship in preventive medicine. The first element of this involved attending the Diploma in Public Health course at the London School of Hygiene and Tropical Medicine, where he was greatly influenced by Austin Bradford Hill’s (1897-1991) teaching on epidemiology and randomized clinical trials. In 1947, for the second element of the fellowship, Archie went to the Henry Phipps Clinic in Philadelphia, where he became interested in X-ray studies of pulmonary tuberculosis and developed what became a lifelong interest in inter-observer and intra-observer error (Cochrane 1950).

Back in Britain in 1948, Archie joined the scientific staff of the recently formed Medical Research Council’s Pneumoconiosis Research Unit in Penarth, near Cardiff (South Wales), and initially conducted groundbreaking comparative studies of dust levels in the coal mines of South Wales. Two years later, he launched the Rhondda Fach – Aberdare Valley (“two valleys”) scheme to investigate the etiology of progressive massive fibrosis. Archie worked at the Pneumoconiosis Research Unit for over a decade, during which time his main interests were the X-ray classification of coal workers’ pneumoconiosis and the relationship he demonstrated between X-ray categories, dust exposure, and disability. His interest in this field continued for the rest of his life, as reflected in the completion during 1974 to 1986 of twenty-year and thirty-year follow-up studies of the population of the Rhondda Fach.

Archie’s research set very high standards for epidemiological studies because of his insistence on achieving very high response rates in surveys and follow-up studies, and for his checks on the reproducibility of the measurements made. The meticulous quality of his work owed a great deal to the team of disabled miners he formed to help maximize survey follow-up rates. It was an exceptional departure from the use of professional researchers, but Archie’s miner assistants drew in their colleagues, and helped to reduce resistance to taking part in the research.

The quality of Archie’s research was reflected in the decision by the MRC to invite him to establish and direct a new epidemiology unit based in Cardiff. Archie took up this invitation in 1960, and was appointed in the same year to the David Davies Chair of Tuberculosis and Diseases of the Chest at the Welsh National School of Medicine. He held the chair until 1969 (when he was appointed CBE).

Under Archie’s direction, the MRC Epidemiology Unit quickly established an international reputation for the quality of its surveys and studies of the natural history and etiology of a wide range of common diseases, including anemia, glaucoma, asthma, and gallbladder disease. Indeed, the Vale of Glamorgan became the epidemiologically most well-defined area of the UK. These studies led naturally to Archie’s interest in the validation of screening strategies within the National Health Service. Indeed, he became a leading critic of the introduction of screening for cancer of the cervix on what he regarded as seriously inadequate evidence of its effects.

Clinical Trials

Although Archie Cochrane himself was particularly proud that the quality of his epidemiological studies had set new standards for the specialty, he is probably most widely remembered for his advocacy of randomized controlled trials. He always acknowledged the important influence of Bradford Hill in introducing him to the principles of using these studies to obtain unbiased estimates of the effects of healthcare interventions, and the establishment of the MRC Epidemiology Unit under his direction provided him with the opportunity to put these principles into practice. The Unit coordinated a wide variety of randomized trials to evaluate pharmaceutical, surgical and health service interventions. The trials with the most enduring and important implications for human health were those led by Archie’s colleague Peter Elwood (1930- ), who succeeded him as director in 1974. These pioneering studies were the first to establish that aspirin could reduce the incidence of cardiovascular diseases.

Randomized trials are of obvious relevance in guiding decisions about the use of resources in health services. An invitation from the Nuffield Provincial Hospitals Trusts to prepare the 1971 Rock Carling Lecture provided Archie with an opportunity to develop this theme, and he did so in a way that no-one had done previously. His delivery of the lecture itself (on 20 March 1972, in Edinburgh) was apparently less than fluent but the book that resulted from it – Effectiveness and efficiency: random reflections on health services – promptly became an influential best seller (Cochrane 1972).

Archie’s little book was written in a very readable style, and covered important issues of general interest – the importance of using randomized trials to identify which health service interventions are more likely to do good than harm the relevance of assessing the costs of the options available when deciding what to make available within the British National Health Service and the importance of equitable access to effective treatments, and to sensitive care when cure was not possible. The seminal importance of the book was recognized by the lay media as well as the medical press, and it was subsequently translated into several languages (Maynard and Chalmers 1997).

International Recognition

In the year the book was published, 1972, Archie Cochrane became the first president of the new Faculty of Community Medicine (subsequently Faculty of Public Health). He received an honorary doctorate from the University of York the following year was Dunham Lecturer at Harvard University, USA, in 1974 became an honorary fellow of the American Epidemiological Association in 1975 and, in 1977, he received an honorary doctorate from Rochester University, USA, and became an honorary fellow of the International Epidemiological Association.

In 1979, in a contribution to a book published by the Office of Health Economics (Cochrane 1979), Archie wrote: ‘It is surely a great criticism of our profession that we have not organised a critical summary, by speciality or subspeciality, adapted periodically, of all relevant randomized controlled trials’. A few years after his death, this proved to be the rallying point that led to the creation of the Cochrane Collaboration (www.cochrane.org). Over 15,000 people in many countries and specialties – most of them volunteers – are now involved in preparing and maintaining systematic reviews of randomized trials and other evidence within this international, non-profit organization. Cochrane Reviews are published electronically in The Cochrane Database of Systematic Reviews, the principal element of The Cochrane Library.

Archie Cochrane was an accomplished gardener (his scree garden won an award from the Royal Horticultural Society) and a discerning collector of modern art and sculpture. He died of cancer in 1988 after a long illness. As he concluded in the obituary he wrote about himself for publication in the British Medical Journal, ‘He was a man with severe porphyria who smoked too much and was without the consolation of a wife, a religious belief, or a merit award – but he didn’t do so badly.’

Archie Cochrane’s life has been described in an autobiography written with the assistance of Max Blythe (Cochrane, with Blythe 1989) a celebratory volume edited by Xavier Bosch (2003) and an entry authored by Richard Doll in the Dictionary of National Biography (Doll 2004) and a version of this text has been published in the Dictionary of Medical Biography (Chalmers 2007), edited by William and Helen Bynum. More information about Cochrane and his work is held in the Archie Cochrane Archive at the Education Centre, University Hospital Llandough, Cardiff.

Acknowledgements

I am grateful to Max Blythe, Peter Elwood, and Joe and Maggie Stalker for comments on earlier drafts of this text. A slightly shorter version of this text has been published in Bynum WF, Bynum H, eds. Dictionary of Medical Biography. Westport, CT: Greenwood and the current text has been republished in the Journal of the Royal Society of Medicine 2008101:41-44. Print PDF

References

Bosch FX, Molas R, eds (2003). Archie Cochrane: Back to the Front. Barcelona, Spain: Thau, SL. Order through [email protected]

Chalmers I (2007). Archibald Leman Cochrane. In: Bynum WF, Bynum H. Dictionary of Medical Biography. Westport, CT: Greenwood Press, 2007, p 353-355.

Cochrane AL (1950). Methods of investigating the connections between dust and disease. In: The application of scientific methods to industrial and service medicine. London: Medical Research Council, p 97-100.

Cochrane AL (1972). Effectiveness and Efficiency: random reflections on health services. London: Nuffield Provincial Hospitals Trust.

Cochrane AL (1979). 1931-1971: a critical review with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics, p 1-11.

Cochrane AL (1984). Reported in: Sickness in Salonica: my first, worst, and most successful clinical trial. BMJ 289:1726-1727.

Cochrane AL, with Blythe M (1989). One Man’s Medicine: an autobiography of Professor Archie Cochrane. London: BMJ Books.

Doll R (2004). Cochrane, Archibald Leman (1909-1988). Oxford: Dictionary of National Biography.

Maynard A, Chalmers I (1997). Non-random reflections on health services research: on the 25th anniversary of Archie Cochrane’s ‘Effectiveness and Efficiency’. London: BMJ Books.


Academic life

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. ⎚]

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, Ώ] 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". ⎛]

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." ⎜] 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. ⎝]

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. ⎞] He also promoted the cohort study and was a key adviser in a highly detailed cohort study: the Caerphilly Heart Disease Study, which was based on a representative population sample of 2,375 middle-aged men, with a response rate of 89%. ⎟]


Developments in the 1980’s

Throughout the 1980’s and early 1990’s, Cochrane’s work was being formulated into a more practical approach by scientists across the Atlantic, namely David Eddy, at Duke University, North Carolina and Gordon Guyett and David Sackett at McMaster University,
Toronto. Their work developed into a methodology capable of being applied to modern healthcare practice and in 1992 the National Health Service Research and Development Programme funded the establishment of the Cochrane Centre in Oxford in order to carry out further research into this concept.


Archibald Cochrane, MD, CBE, FRCP, FFCM

“Archie” Cochrane was a Scotsman educated at Kings College, Cambridge. Due to an interesting personal condition he sought psychoanalysis and followed his analyst to Berlin, Vienna, and the Hague, eventually throwing over analysis for medical school at University College Hospital, London. He served with the International Brigade in the Spanish Civil War.

In World War II he was taken prisoner in Crete by the Germans and served as a medical officer in POW camps for several years in Greece and Germany. He spent 1947-48 at the Phipps Institute in Philadelphia studying tuberculosis and then became member of the Medical Research Council Pneumoconiosis Unit in Wales from 1948-1960, after which he directed the MRC Epidemiology Unit in Cardiff until 1974.

His fame relates mainly to a small book published in 1972 on health services (see below), but he was a pioneer in both cohort studies and randomized trials and contributed largely to the development of the science of epidemiology. He carried out long term studies of risk characteristics in mining cohorts in the Rhondda Fach in Wales, where he trained two notable CVD epidemiologists, Ian Higgins and William Miall.

Cochrane proposed that randomized clinical trials, and later, their systematic review, were the more reliable evidence sources for evaluation of medical care. His recommendations and influence led to the posthumous founding of the Cochrane Collaboration in his honor, a center specializing in systematic reviews or meta-analyses among international data from clinical trials.

Sources

Higgins, IT and Cochrane, AL. Chronic respiratory disease in a random sample of men and women in the Rhondda Fach in 1958. British Journal of Industrial Medicine, 18 (1958): 93-102.

Cochrane, AL. Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972.


History of evidence-based practice

In 1972, Professor Archie Cochrane, a medical doctor and researcher in the UK, highlighted the fact that most treatment related decisions were not based on a systematic review of clinical evidence. He proposed that researchers should collaborate internationally to systematically review all the best clinical trials specialty by specialty. This highlighted gaps that existed between research and clinical practice and started to convince practitioners of the benefits of an evidence-based approach. The Cochrane Library remains one of the most influential sources of systematically reviewed evidence today.

The Cochrane Collaboration logo.
More information

The term ‘evidence-based medicine’ was introduced by Gordon Guyatt and his team in 1991 to shift the emphasis in clinical decision-making from ‘intuition, unsystematic clinical experience, and pathophysiologic rationale’ to scientific, clinically relevant research. In 1996, D. L. Sackett, a Canadian-American doctor and founder of the first department of clinical epidemiology at McMaster University in Ontario, explained that evidence-based clinical decision-making is a combination of not only research evidence but also clinical expertise, as well as the unique values and circumstances of individual patients.

Additional material

If you would like to read about the History of Evidence-Based Medicine, this article published in the AMA Journal of Ethics (2013) provides a summary overview. [4]

In terms of research evidence, it is important to note that the ‘best available’ may be different for each situation. A vast amount of new information is constantly being generated, and conclusive evidence does not exist for every clinical question.

For urgent issues, please call the Statewide Service Desk on 1300 28 55 33 and press 2 for clinical. If the agent is unable to assist, you’ll be transferred directly to the CIAP team.

If you are not a member of NSW Health and would like to get in touch, please submit your enquiries here.


Our history


Professor Archibald Leman Cochrane, CBE FRCP FFCM, (1909-1988)
(as depicted by a composite of hundreds of photos of Cochrane contributors)

Why 'Cochrane'?
Cochrane is named in honour of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

Archie Cochrane is best known for his influential book, Effectiveness and Efficiency: Random Reflections on Health Services, published in 1972 [1]. The principles he set out in it so clearly were straightforward: he suggested that, because resources would always be limited, they should be used to provide equitably 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 randomized controlled trials (RCT s) 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 1979 he wrote, "It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials."[2] His challenge led to the establishment during the 1980s of an international collaboration to develop the Oxford Database of Perinatal Trials.

In 1987, the year before Cochrane died, he referred to a systematic review of RCTs of care during pregnancy and childbirth as "a real milestone in the history of randomized trials and in the evaluation of care", and suggested that other specialties should copy the methods used.[3] His encouragement, and the endorsement of his views by others, led to the opening of the first Cochrane Centre (in Oxford, UK) in 1992 and the founding of The Cochrane Collaboration in 1993.


Works by and about Archie Cochrane

Cochrane AL. Effectiveness and Efficiency. Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972. (Reprinted in 1989 in association with the BMJ, Reprinted in 1999 for Nuffield Trust by the Royal Society of Medicine Press, London (ISBN 1-85315-394-X) .) [1]

Cochrane AL. 1931-1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics, 1979, 1-11. [2]

Cochrane AL. Foreword. In: Chalmers I, Enkin M, Keirse MJNC, eds. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1989. [3]

Dickersin K and Manheimer E. The Cochrane Collaboration: Evaluation of health care and services using systematic reviews of the results of randomised controlled trials. Clinical Obstetrics and Gynecology 41(2):315-331, 1998. Provides an excellent account of how Archie Cochrane's vision inspired others, leading ultimately to the founding of The Cochrane Collaboration.

Archie Cochrane: Back to the front, edited by F. Xavier Bosch, uses Archie Cochrane's experiences in the Spanish civil war as a starting point to discuss his life and work, and his influence on the founding and development of The Cochrane Collaboration. Includes commentary from a diverse group of family, friends and colleagues. Copies of the book are available for €75.00 (GBP £52.00) to order, use this order form.


Our history

Cochrane is named in honour of Archie Cochrane, a British medical researcher who contributed greatly to the development of epidemiology as a science.

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 so clearly were straightforward: he suggested that, because resources would always be limited, they should be used to provide equitably 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 randomized 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 1979 he wrote, "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 controlled trials." His challenge led to the establishment during the 1980s of an international collaboration to develop the Oxford Database of Perinatal Trials.

In 1987, the year before Cochrane died, he referred to a systematic review of RCTs of care during pregnancy and childbirth as "a real milestone in the history of randomized trials and in the evaluation of care", and suggested that other specialties should copy the methods used. His encouragement, and the endorsement of his views by others, led to the opening of the first Cochrane Centre (in Oxford, UK) in 1992 and the founding of The Cochrane Collaboration in 1993.


History of The Cochrane Collaboration

Medicine was the first to introduce an evidence‐based approach to clinical practice in the 18 th century when navigation was important for overseas trading in the United Kingdom. Long journeys to Australia and the Far East were taking place with sailors deprived of fresh fruit and vegetables, which resulted in scurvy and other medical problems. James Lind MD, the surgeon to the British Navy, wrote an article on Treatise of the Scurvy, which g ignored for many years. Still, it is considered the first controlled clinical trial to translate into clinical practice by stocking long‐distance trade ships with lemons and limes to avoid the ship’s crew members from developing scurvy 1 .

In 1971, the British epidemiologist, Archie Cochrane, in his influential monograph titled “Effectiveness and Efficiency,” introduced a new concept which tells that all treatment interventions must be proven to be effective before introducing it into clinical medicine. The above idea supported by an early example in which data were combined from multiple clinical trials investigating premature births and infant mortality.