Cochrane (organisation)

Last updated

Cochrane
Pronunciation
Formation1993;31 years ago (1993) (as Cochrane Collaboration)
TypeCharity in UK
PurposeIndependent research into data about health care
Headquarters London, England [1]
Region served
Worldwide
Official language
English
Key people
  • Tracey Howe
  • Catherine Marshall
Volunteers
Over 37,000 (2015) [2]
Website www.cochrane.org OOjs UI icon edit-ltr-progressive.svg
Formerly called
Cochrane Collaboration

Cochrane is a British [1] international charitable organisation formed to synthesize medical research findings to facilitate evidence-based choices about health interventions involving health professionals, patients and policy makers. [3] [4] It includes 53 review groups that are based at research institutions worldwide. Cochrane has over 37,000 [2] volunteer experts from around the world. [5]

Contents

The group conducts systematic reviews of healthcare interventions and diagnostic tests and publishes them in the Cochrane Library. [6] [3] According to the Library, articles are available via one-click access, but some require paid subscription or registration before reading. [7] [8] A few reviews, in occupational health for example, incorporate results from non-randomised observational studies [6] as well as controlled before–after (CBA) studies and interrupted time-series studies. [9]

History

Cochrane, previously known as the Cochrane Collaboration, was founded in 1993 under the leadership of Iain Chalmers. [10] It was developed in response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomised controlled trials in the field of healthcare. [11] [12] [13]

In 1998, the Cochrane Economics Methods Group (CEMG) was established to facilitate the basing of decisions on health economics, evidence-based medicine, and systematic reviews. [14]

Cochrane's suggestion that methods used to prepare and maintain reviews of controlled trials in pregnancy and childbirth be applied more widely was taken up by the Research and Development Programme, initiated to support the National Health Service. Through the NHS research and development programme, led by Michael Peckham, [15] [ when? ] funds were provided to establish a "Cochrane Centre", to collaborate with others, in the UK and elsewhere, to facilitate systematic reviews of randomised controlled trials across all areas of healthcare. [16] [ when? ]

In 2004, the Campbell Collaboration joined with the CEMG to form the Campbell & Cochrane Economics Methods Group (CCEMG). [17] [18]

In 2013 the organization published an editorial describing its efforts to train people in developing nations to perform Cochrane reviews. [19] A 2017 editorial briefly discussed the history of Cochrane methodological approaches, such as including studies that use methodologies in lieu of randomised control trials and the challenge of having evidence adopted in practice. [9]

During its 2018 annual meeting, the Cochrane board expelled Peter C. Gøtzsche, board member and director of Cochrane's Nordic center, from the organization, telling Nature that it had received "numerous complaints" about Gøtzsche after he co-authored an article in BMJ Evidence-Based Medicine alleging bias in Cochrane's May 2018 [20] review of HPV vaccines. Gøtzsche's expulsion led four elected board members to resign in protest, which in turn led the board to cut two appointed members in order to comply with the ratio of elected to appointed members required by the organization's charter. [21] Gøtzsche announced that this had happened via an open letter, in which he said there is a "growing top-down authoritarian culture and an increasingly commercial business model" taking root at Cochrane that "threaten the scientific, moral and social objectives of the organization". Gøtzsche remains an outspoken critic of Cochrane's relationship with the pharmaceutical industry. The Cochrane board stated that Gøtzsche was expelled for his behavior, which had been reviewed by an independent counsel hired by Cochrane. [21]

Reception

A 2004 editorial in the Canadian Medical Association Journal noted that Cochrane reviews appear to be more up to date and of better quality than other reviews, describing them as "the best single resource for methodologic research and for developing the science of meta-epidemiology" and crediting them with leading to methodological improvements in the medical literature. [22]

Studies comparing the quality of Cochrane meta-analyses in the fields of infertility, [23] physiotherapy, [23] [24] and orthodontics [25] to those published by other sources have concluded that Cochrane reviews incorporate superior methodological rigor. A broader analysis across multiple therapeutic areas reached similar conclusions but was performed by Cochrane authors. [26] Compared to non-Cochrane reviews, those from Cochrane are less likely to reach a positive conclusion about the utility of medical interventions. [27]

Key criticisms that have been directed at Cochrane's studies include a failure to include a sufficiently large number of unpublished studies, failure to pre-specify or failure to abide by pre-specified rules for endpoint [28] or trial [29] inclusion, insufficiently frequent updating of reviews, an excessively high percentage of inconclusive reviews, [30] and a high incidence of ghostwriting and honorary authorship. [31] [32] In some cases Cochrane's internal structure may make it difficult to publish studies that run against the preconceived opinions of internal subject matter experts. [33]

Partnerships

World Health Organization

Cochrane maintains an official relationship with the World Health Organization [34] that affords Cochrane the right to appoint nonvoting representatives to WHO meetings, including sessions of the World Health Assembly, and make statements on WHO resolutions. [35]

Wikipedia

In 2014, the Cochrane-Wikipedia partnership was formalised. This supports the inclusion of relevant evidence within all Wikipedia medical articles, as well as processes to help ensure that medical information included in Wikipedia is of the highest quality and accuracy. [36] Wikipedia and Cochrane collaborate to increase the incorporation of Cochrane research into Wikipedia articles and provide Wikipedia editors with resources for interpreting medical data. [37] Cochrane and John Wiley and Sons, publisher of Cochrane reviews, make one hundred free Cochrane accounts available to Wikipedia medical editors—the financial value of which has been estimated by Cochrane at between thirty thousand and eighty thousand US dollars per annum—and pay a nominal stipend and travel expenses to support a Wikipedian in Residence at Cochrane. [38]

In 2014, the Cochrane blog hosted a rebuttal, written by four Wikipedia medical editors, of an article published in the Journal of the American Osteopathic Association that was critical of the accuracy of Wikipedia medical content. [39] [40]

Funding partners

Cochrane receives funding from governments, supranational organizations, non-governmental organizations, academic institutions, hospitals, and foundations, while avoiding funding from corporate interests. [41] Primary government donors include the United Kingdom's National Institute for Health and Care Research (NIHR), the Danish Health Authority, the Federal Ministry of Health (Germany), and the National Institutes of Health (NIH).

Academic funders include McMaster University, Amsterdam University Medical Centers, Kazan Federal University, and University of Copenhagen, among others. Funding from foundations includes the National Research Foundation (South Africa) and the Gerber Foundation.

Public involvement

Cochrane involves patients and the public via community curation, to produce systematic reviews and other outputs. Tasks can be organised as 'entry level' or higher. Tasks include:

A recent systematic review of how people were involved in systematic reviews aimed to document the evidence-base relating to stakeholder involvement in systematic reviews and to use this evidence to describe how stakeholders have been involved in systematic reviews. [43] Thirty per cent involved patients and/or carers.

While there has been some criticism of how Cochrane prioritises systematic reviews, [44] a recent project involved people in helping identify research priorities to inform future Cochrane Reviews. [45]

The representation of women as editors in Cochrane was found to be better than that of other organizations. [46]

See also

Related Research Articles

Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.

<span class="mw-page-title-main">Randomized controlled trial</span> Form of scientific experiment

A randomized controlled trial is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical techniques, medical devices, diagnostic procedures, diets or other medical treatments.

Archibald Leman Cochrane 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 improve clinical trials and medical interventions. His advocacy of RCTs eventually led to the creation of the Cochrane Library database of systematic reviews, the UK Cochrane Centre in Oxford and Cochrane, an international organization of review groups that are based at research institutions worldwide. He is known as one of the fathers of modern clinical epidemiology and is considered to be the originator of the idea of evidence-based medicine. The Archie Cochrane Archive is held at the Archie Cochrane Library at University Hospital Llandough, Penarth.

<span class="mw-page-title-main">Medical guideline</span> Document with the aim of guiding decisions and criteria in healthcare

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.

<span class="mw-page-title-main">Systematic review</span> Comprehensive review of research literature using systematic methods

A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on the topic, then analyzes, describes, critically appraises and summarizes interpretations into a refined evidence-based conclusion. For example, a systematic review of randomized controlled trials is a way of summarizing and implementing evidence-based medicine.

A hierarchy of evidence, comprising levels of evidence (LOEs), that is, evidence levels (ELs), is a heuristic used to rank the relative strength of results obtained from experimental research, especially medical research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 80 different hierarchies have been proposed for assessing medical evidence. The design of the study and the endpoints measured affect the strength of the evidence. In clinical research, the best evidence for treatment efficacy is mainly from meta-analyses of randomized controlled trials (RCTs). Systematic reviews of completed, high-quality randomized controlled trials – such as those published by the Cochrane Collaboration – rank the same as systematic review of completed high-quality observational studies in regard to the study of side effects. Evidence hierarchies are often applied in evidence-based practices and are integral to evidence-based medicine (EBM).

<span class="mw-page-title-main">Iain Chalmers</span> British medical researcher

Sir Iain Geoffrey Chalmers is a British health services researcher, one of the founders of the Cochrane Collaboration, and coordinator of the James Lind Initiative, which includes the James Lind Library and James Lind Alliance.

In epidemiology, reporting bias is defined as "selective revealing or suppression of information" by subjects. In artificial intelligence research, the term reporting bias is used to refer to people's tendency to under-report all the information available.

Peter Christian Gøtzsche is a Danish physician, medical researcher, and former leader of the Nordic Cochrane Center at Rigshospitalet in Copenhagen, Denmark. He is a co-founder of the Cochrane Collaboration and has written numerous reviews for the organization. His membership in Cochrane was terminated by its Governing Board of Trustees on 25 September 2018. During the COVID-19 pandemic, Gøtzsche was criticised for spreading disinformation about COVID-19 vaccines.

The Jadad scale, sometimes known as Jadad scoring or the Oxford quality scoring system, is a procedure to assess the methodological quality of a clinical trial by objective criteria. It is named after Canadian-Colombian physician Alex Jadad who in 1996 described a system for allocating such trials a score of between zero and five (rigorous). It is the most widely used such assessment in the world, and as of May 2024, its seminal paper has been cited in over 24,500 scientific works.

Critical appraisal in evidence based medicine, is the use of explicit, transparent methods to assess the data in published research, applying the rules of evidence to factors such as internal validity, adherence to reporting standards, conclusions, generalizability and risk-of-bias. Critical appraisal methods form a central part of the systematic review process. They are used in evidence synthesis to assist clinical decision-making, and are increasingly used in evidence-based social care and education provision.

<span class="mw-page-title-main">Preferred Reporting Items for Systematic Reviews and Meta-Analyses</span> Scientific reporting standard

PRISMA is an evidence-based minimum set of items aimed at helping scientific authors to report a wide array of systematic reviews and meta-analyses, primarily used to assess the benefits and harms of a health care intervention. PRISMA focuses on ways in which authors can ensure a transparent and complete reporting of this type of research. The PRISMA standard superseded the earlier QUOROM standard. It offers the replicability of a systematic literature review. Researchers have to figure out research objectives that answer the research question, states the keywords, a set of exclusion and inclusion criteria. In the review stage, relevant articles were searched, irrelevant ones are removed. Articles are analyzed according to some pre-defined categories.

Alessandro Liberati was an Italian healthcare researcher and clinical epidemiologist, and founder of the Italian Cochrane Centre.

The discipline of evidence-based toxicology (EBT) strives to transparently, consistently, and objectively assess available scientific evidence in order to answer questions in toxicology, the study of the adverse effects of chemical, physical, or biological agents on living organisms and the environment, including the prevention and amelioration of such effects. EBT has the potential to address concerns in the toxicological community about the limitations of current approaches to assessing the state of the science. These include concerns related to transparency in decision making, synthesis of different types of evidence, and the assessment of bias and credibility. Evidence-based toxicology has its roots in the larger movement towards evidence-based practices.

Tom Jefferson is a British epidemiologist, based in Rome, Italy, who works for the Cochrane Collaboration. Jefferson is an author and editor of the Cochrane Collaboration's acute respiratory infections group, as well as part of four other Cochrane groups. He was also an advisor to the Italian National Agency for Regional Health Services.

The Centre for Evidence-Based Medicine (CEBM), based in the Nuffield Department of Primary Care Health Sciences at the University of Oxford, is an academic-led centre dedicated to the practice, teaching, and dissemination of high quality evidence-based medicine to improve healthcare in everyday clinical practice. CEBM was founded by David Sackett in 1995. It was subsequently directed by Brian Haynes and Paul Glasziou. Since 2010 it has been led by Professor Carl Heneghan, a clinical epidemiologist and general practitioner.

Lesley Ann Stewart is a Scottish academic whose research interests are in the development and application of evidence synthesis methods, particularly systematic reviews and individual participant data meta-analysis. She is head of department for the Centre for Reviews and Dissemination at the University of York and director for the NIHR Evidence Synthesis Programme. She was one of the founders of the Cochrane Collaboration in 1993. Stewart served as president of the Society for Research Synthesis Methodology (2013-2016) and was a founding co-editor in chief of the academic journal Systematic Reviews (2010–2021).

Kay Dickersin is an academic who trained first in cell biology and subsequently epidemiology. She went on to a career studying factors that influence research integrity, in particular publication bias and outcome reporting bias. She is retired Professor Emerita in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health where she was Director of the Center for Clinical Trials and Evidence Synthesis there. She was also Director of the US Cochrane Center and the US Satellite of the Cochrane Eyes and Vision Group within the Cochrane Collaboration. Dickersin received multiple awards for her research.

<span class="mw-page-title-main">Robert Brian Haynes</span> Canadian physician, clinical epidemiologist

Robert Brian Haynes OC is a Canadian physician, clinical epidemiologist, researcher and an academic. He is professor emeritus at McMaster University and one of the founders of evidence-based medicine.

<span class="mw-page-title-main">Peter Tugwell</span> Canadian physician working on health equity

Peter Tugwell is a Canadian physician and Professor in the Department of Medicine and School of Epidemiology and Public Health at the University of Ottawa. He is known for promoting clinical epidemiology and championing for health equity worldwide. In 2013 he was named Officer of the Order of Canada for his efforts as "tireless contributor to global health".

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