Archie Cochrane Photo
Archie Cochrane was born in the Scottish cloth-manufacturing town of Galashiels in 1909. He studied natural sciences at Cambridge, and completed his medical studies in London after serving with a field ambulance unit during the Spanish Civil War. He spent most of his career as a medical researcher in Wales, conducting several long-term epidemiological studies into tuberculosis and other chest diseases among the coal mining communities of South Wales. The success of these studies earned Cochrane the respect and admiration of his peers, but his international renown is founded on the publication in 1972 of his book ‘Effectiveness and Efficiency: random reflections on health services’.

Cochrane’s wartime experiences as a Captain in the Royal Army Medical Corps profoundly shaped the ideas he articulated in his book about the nature of evidence and effectiveness in health care. He was taken prisoner of war (POW) in Crete in 1941 and spent the rest of World War II in POW camps in Greece and then Germany. As medical director of these camps, Cochrane was forced to practise in difficult circumstances and without access to the medical treatments he had been taught were necessary. In this extract from his autobiography One Man’s Medicine he describes caring for prisoners with tuberculosis:

What I decided I could not continue doing was making decisions about intervening (for example pneumothorax and thoracoplasty) when I had no idea whether I was doing more harm than good. I remember reading a pamphlet (I think from the BMA) extolling the advantages of the freedom of British doctors to do whatever they thought best for their patients. I found it ridiculous. I would willingly have sacrificed all my medical freedom for some hard evidence telling me when to do a pneumothorax ... This was certainly the birth of an idea which culminated in Effectiveness and Efficiency.

Cochrane continued to be critical of the medical profession for failing to seek evidence to support treatment recommendations. In a paper published in 1979 he famously 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 randomised controlled trials’.

In response to this challenge, a group of researchers spent most of the 1980s gathering together and reviewing randomised trials of care during pregnancy and childbirth. In 1989 (the year after Cochrane died) they published systematic reviews of the effects of nearly 300 interventions in the landmark two-volume book Effective Care in Pregnancy and Childbirth and a paperback summary entitled A Guide to Effective Care in Pregnancy and Childbirth, which was written for women using the maternity services. To keep the reviews up to date, they began electronic publication of 6-monthly updates in the Oxford Database of Perinatal Trials.

This work was well received and, in 1992, the recently established NHS Research and Development Programme in England funded a Centre to facilitate the extension of the methods used in pregnancy and childbirth to other areas of health care. A year later the Centre convened a meeting in Oxford at which the international Cochrane Collaboration was formed.

Further reading
Cochrane AL. Effectiveness and efficiency. Random reflections of health services (new edition). London: RSM Publishing, 1999.
Cochrane AL. One man’s medicine. London: BMJ, 1989.

See also Archie Cochrane - biographical summary and excerpts

Close Window