Who cares? The lost legacy of Archie Cochrane

Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this devel...

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Bibliographic Details
Published in:Medical humanities 2017-03, Vol.43 (1), p.41-46
Main Authors: Askheim, Clemet, Sandset, Tony, Engebretsen, Eivind
Format: Article
Language:English
Subjects:
Clinical medicine
Cochrane
Collaboration
Delivery of Health Care - standards
Efficiency
Epidemiology
Equality
Evidence-based medicine
Evidence-Based Medicine - history
Health services
History, 20th Century
Humans
Literature, Modern - history
Medicine
Randomized Controlled Trials as Topic
Reading
United Kingdom
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Summary:Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's book Effectiveness and Efficiency from 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, is not part of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences in Effectiveness and Efficiency. From these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner.
ISSN:1468-215X
1473-4265
DOI:10.1136/medhum-2016-011037