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1. Opening of the Austrian Cochrane Branch - Iain Chalmers

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Introduction and welcome to the opening by Dr. Kylie Thaler, Associate Director of the Austrian Cochrane Branch. Followed by a presentation by Sir Iain Chalmers on the James Lind Library initiative. December 14th, 2010, In Krems, Austria.

Veröffentlicht in: Gesundheit & Medizin
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1. Opening of the Austrian Cochrane Branch - Iain Chalmers

  1. 1. “The James Lind Library:explaining the rationale for and evolution of systematic reviews” Iain Chalmers ichalmers@jameslindlibrary.org Opening of the Austrian Branch of the Cochrane Collaboration 14 December 2010
  2. 2. Fund raisingadvertisement for theUnited NationsAssociation, just before Ileft the UK to work inthe Gaza Strip in 1969
  3. 3. Gaza Learning the hard lesson that- acting with the best of intentions - „do gooders‟ sometimes do more harm than good.
  4. 4. One of severalpersonal examples
  5. 5. Should I have given antibiotics prophylactically to children with measles?
  6. 6. Severe malnutrition following measles
  7. 7. Some children developing measles in the Gaza Strip in 1969 and 1970 suffered and probably diedunnecessarily because I withheld prophylactic antibiotics, as my teachers at medical school had told me to do.
  8. 8. Six controlled trials, all reported before I went to Gaza, showed that:antibiotics prescribed for children with measles can reduce their risk of developing pneumonia
  9. 9. Am I the only health professional who has been misled bymedical authorities and experts?
  10. 10. JAMA 1992;268:240-248.
  11. 11. Conclusions“Advice on some life-saving therapieshas been delayed for more than adecade, while other treatments havebeen recommended long after controlledresearch has shown them to be harmful.”Antman et al. JAMA 1992;268:240-248.
  12. 12. In brief… science is cumulative, and scientists shouldcumulate scientifically. The process of cumulation(information synthesis) should use methods to reduce biases and the play of chance.
  13. 13. Lord Rayleigh, 1842-1919“One of the very few members of the higher nobility who won fame as an outstanding scientist.”
  14. 14. “If, as is sometimes supposed, scienceconsisted in nothing but the laboriousaccumulation of facts, it would soon come toa standstill, crushed, as it were, under itsown weight…The work which deserves,but I am afraid does not alwaysreceive, the most credit is that in whichdiscovery and explanation go hand inhand, in which not only are new factspresented, but their relation to old onesis pointed out.” Lord Rayleigh, 1884
  15. 15. Because information about the effects of healthcare interventions has not been synthesizedsystematically and kept up to date, people have suffered and died unnecessarily
  16. 16. Who was James Lind andwhat has he got to do with this?
  17. 17. James Lind, 1716-1794
  18. 18. www.jameslindlibrary.org
  19. 19. Some illustrations of the evolution of informationsynthesis in health research
  20. 20. Two definitions relevant in discussionsof information synthesis(Last, Dictionary of Epidemiology, 2001)Systematic review: The application ofstrategies that limit bias in the assembly,critical appraisal, and synthesis of allrelevant studies on a specific topic.Meta-analysis: The statistical synthesis ofthe data from separate but similar, i.e.comparable studies, leading to aquantitative summary of the pooledresults (so reducing the play of chance).
  21. 21. Karl Pearson (1857-1936)
  22. 22. Park WH, Bullowa JGM, Rosenbluth NM (1928). The treatment of lobar pneumonia with refined specific antibacterial serum. JAMA 91:1503-8.
  23. 23. Jan Stjernswärd
  24. 24. In 1979, Archie Cochrane awardsobstetrics and gynaecology „thewooden spoon‟ for being the medicalspeciality least informed by scientificevidence, and observes:"It is surely a great criticism of ourprofession that we have not organised acritical summary, by speciality orsubspeciality, adapted periodically, ofall relevant randomized controlled trials.“
  25. 25. Early 1980s An international collaboration is established to prepare and maintain systematic reviews ofcontrolled trials in pregnancy and childbirth.
  26. 26. 1989: publication of:Effective Care in Pregnancy andChildbirth (ECPC)A Guide to Effective Care inPregnancy and Childbirth (GECPC)Oxford Database of PerinatalTrials (ODPT)
  27. 27. 1992 This ‘pilot experience’ leads the NHS R&D Programme to fund ‘a Cochrane Centre’ to facilitate the preparation ofsystematic reviews of randomized controlled trials of health care
  28. 28. The Cochrane Collaboration:an international, independent, not-for-profit organisation of over 27,000 contributors from more than 100 countries, dedicated to making up-to-date, accurate information about the effects of health care readily available worldwide.
  29. 29. A reminder “The work which deserves, but I am afraid does not always receive, the most credit is that in which discovery and explanation go hand in hand, in which not only are newfacts presented, but their relation to old ones is pointed out.” Lord Rayleigh, 1884
  30. 30. Austin Bradford Hill, 1965Four questions to whichreaders want answerswhen reading reports ofresearch.1. Why did you start?2. What did you do?3. What answer did you get?4. And what does it mean anyway?
  31. 31. * *actually, the non-useOnly 11 of 24 responding authors of trial reportsthat had been added to existing systematicreviews were even aware of the relevant reviewswhen they designed their new studies.
  32. 32. Austin Bradford Hill, 1965Four questions to whichreaders want answerswhen reading reports ofresearch.1. Why did you start?2. What did you do?3. What answer did you get?4. And what does it mean anyway?