Scottish doctor
Archibald Cochrane
|
---|
Born
| Archibald Leman Cochrane
(
1909-01-12
)
12 January 1909
|
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Died
| 18 June 1988
(1988-06-18)
(aged 79)
|
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Nationality
| Scottish
|
---|
Citizenship
| British
|
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Occupation
| Physician
|
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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 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
[1]
in
Oxford
and
Cochrane
(previously known as the Cochrane Collaboration), 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
[2]
at
University Hospital Llandough
,
Penarth
.
Early life and education
[
edit
]
Cochrane was born in Kirklands,
Galashiels
,
Scotland
, into the wealthiest mill owning family in Galashiels. He was acquainted with death from an early age. His father was killed whilst serving with the
King's Own Scottish Borderers
during
World War I
.
[3]
His family nurse and his young brother Walter died from tuberculosis.
Cochrane was academically gifted from an early age. He initially won a scholarship to
Uppingham School
. Then he acquired a scholarship to
King's College, Cambridge
, where he achieved a Double First in
Natural Sciences Tripos
. Later, in 1930, he completed two
MB
studies in physiology and anatomy.
He qualified in 1938 at
University College Hospital
, London.
Like his sister, Cochrane inherited
porphyria
, which caused health problems throughout his life. Medical help in the UK was unavailable. Consequently he emigrated to Germany where, starting in 1931, he received
psychoanalysis
which was undertaken by
Theodor Reik
, initially in Berlin, then in Vienna and eventually in the Hague with the increasing threat to Reik from the
Nazis
. While receiving psychoanalysis, Cochrane undertook medical research in Vienna and at the
University of Leiden
.
He eventually became dissatisfied with psychoanalysis. However he became fluent in German, which became extremely useful to him when he later served as a doctor in a prison of war camp.
[5]
During this period, Cochrane acquired a hatred of fascism and became convinced of the importance of
anti-fascism
.
But crucially, in a precursor of his landmark contribution to medicine:
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.
[7]
In 1936 the Spanish Medical Aid Society was formed in London in response to a request for help from republicans who were fighting fascism in the
Spanish Civil War
. Cochrane volunteered his services to the committee and subsequently worked in the First British Hospital and in the 35th Medical Division Unit.
[8]
World War II
[
edit
]
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.
[9]
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."
As a result, he spent his career urging the medical community to adopt the
scientific method
.
Early career
[
edit
]
After the war, Cochrane studied for a Diploma in Public Health at the
London School of Hygiene & Tropical Medicine
, after which he spent a year at the
Henry Phipps Institute
in
Philadelphia
on a
Rockefeller Fellowship
.
In 1948 he joined the scientific staff of the recently formed
Medical Research Council
's
Pneumoconiosis
Unit in the
Welsh National School of Medicine
(now
Cardiff University School of Medicine
) at
Llandough Hospital
, Penarth.
[12]
While there he began his famous series of studies on the health of the population of
Rhondda Fach
? which pioneered the use of RCTs.
[13]
The website of the
British Film Institute
has a video of the Rhondda Fach studies in which Cochrane talks about his research.
[14]
In 1956, Cochrane underwent a
radical mastectomy
to remove what was thought to be cancerous tissue in his right
pectoralis minor
and
axilla
.
[15]
Later career
[
edit
]
Cochrane was appointed David Davies Professor of Tuberculosis and Chest Diseases at the Welsh National School of Medicine, now
Cardiff University School of Medicine
in 1960. Nine years later he became Director of the new
Medical Research Council
's Epidemiology Research Unit in 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.
[9]
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
,
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".
[9]
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."
[9]
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 retired from the Epidemiology Research Unit in 1974, when he was succeeded in the role by
Peter Elwood
. After his retirement he was a key adviser in a highly detailed cohort study, the
Caerphilly Heart Disease Study
.
[18]
Cochrane retired in 1974,
[19]
after which
Peter Elwood
was appointed as Unit Director.
[20]
Honours
[
edit
]
Cochrane was awarded an
MBE
by the British Government for his "gallant and distinguished services in prisoner of war camps.
[21]
He was later appointed a
CBE
for his contributions to
epidemiology
as a science.
[22]
Publications
[
edit
]
Articles
[
edit
]
Books
[
edit
]
- 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
[
edit
]
References
[
edit
]
- ^
"Cochrane UK: Trusted evidence, Informed decisions, Better health"
. Retrieved
4 January
2024
.
Cochrane is a truly global, independent network with members and supporters worldwide.
- ^
"Archie Cochrane Library"
.
Cardiff University
. Retrieved
4 January
2024
.
- ^
"Captain Walter Cochrane"
.
The Coldstream & District Local History Society
. 10 November 2023
. Retrieved
4 January
2024
.
- ^
Hill, Gerry B. (2000). "Archie Cochrane and his legacy: An internal challenge to physicians' autonomy?".
Journal of Clinical Epidemiology
.
53
(12): 1189?1192.
doi
:
10.1016/S0895-4356(00)00253-5
.
PMID
11146263
.
- ^
Chalmers, Iain
(January 2008).
"Archie Cochrane (1909-1988)"
.
Journal of the Royal Society of Medicine
.
101
(1): 41?44.
doi
:
10.1258/jrsm.2007.071004
.
PMC
2235918
.
- ^
Simkin, John (January 2020).
"The Spanish Civil War: Spanish Medical Aid Committee"
.
Spartacus Educational
. Retrieved
4 January
2024
.
- ^
a
b
c
d
See 'Articles' under 'Publications'.
- ^
Chalmers, Iain (2008).
"Archie Cochrane (1909-1988)"
.
Journal of the Royal Society of Medicine
.
101
(1): 41-44
. Retrieved
27 April
2024
.
- ^
"University lauds medical pioneer"
.
BBC News
.
Archived
from the original on 15 December 2019
. Retrieved
2 February
2014
.
- ^
"Watch Archie Cochrane talk about his research"
. Retrieved
27 April
2024
.
- ^
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
.
- ^
Buck, C.; Llopis, A.; Najera, Terris M., eds. (1988),
The Challenge of Epidemiology: Issues and Selected Readings
, Washington, DC: Pan American Health Organization.
- ^
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
.
- ^
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
.
- ^
Ness, Reynolds and Tansey (2002: 131)
- ^
Ness, Reynolds and Tansey (2002: 110)
- ^
"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
.
- ^
"Biographical Outline of Archibald Leman Cochrane (1909-1988)"
.
Cardiff University
. Archived from
the original
on 22 February 2014
. Retrieved
2 February
2014
.
Works cited
[
edit
]
Further reading
[
edit
]
- Sanazaro, P.J.; Hart, J.T.; Williamson, J.W. (1973).
"Review of Effectiveness and Efficiency: Random Reflections on Health Services, by A. L. Cochrane"
.
International Journal of Health Services
.
3
(1): 93-100.
JSTOR
45129912
.
- Elwood, P.C.
"Obituary to Professor Archie Leman Cochrane"
(PDF)
.
MRC
News. pp. 36?7.
Archived
(PDF)
from the original on 22 February 2014
. Retrieved
8 February
2014
– via
Cardiff University
.
- Maynard, Alan; Chalmers, Iain, eds. (1997).
Non-random reflections on health services research: On the 25th anniversary of Archie Cochrane's Effectiveness and Efficiency
. London: BMJ Publishing Group.
ISBN
0-7279-1151-1
.
- Ness, Andy R.; Reynolds, Lois A.; Tansey, E.M., eds. (2002).
Population-based Research in South Wales: The MRC Pneumoconiosis Research Unit and the MRC Epidemiology Unit
(PDF)
. London: Wellcome Trust Centre for the History of Medicine at UCL.
ISBN
0-85484-081-8
.
- Goldacre, Ben
(19 August 2006).
"Objectionable 'objectives'
"
.
The Guardian
.
Archived
from the original on 12 April 2010.
- Chalmers, Iain (2008).
"Archie Cochrane (1909-1988)"
.
Journal of the Royal Society of Medicine
.
101
(1): 41?44.
doi
:
10.1258/jrsm.2007.071004
.
PMC
2235918
.
- Harford, Tim
(July 2011),
Trial, error and the God complex
,
TED
- Thomas, Hugh F. (1999).
"Medical research in the Rhondda valleys"
.
Postgraduate Medical Journal
.
75
(883): 257?259.
doi
:
10.1136/pgmj.75.883.257
.
PMC
1741226
.
PMID
10533625
.
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