The International Cochrane Collaboration

Abstract

Introduction If we are asked how effective mefloquine is in preventing malaria, our response might tell our questioner a lot about how we learn about the world around us, how we assimilate that knowledge and experience, and how it influences our subsequent decision making and action. Thirty years ago, Archie Cochrane drew attention to the haphazard way in which the research evidence about the effects of health care were generated and used. He particularly noted how the evidence from randomized controlled trials was poorly assimilated and used, paying special attention to how better organization of research findings could help us to use resources more rationally. Furthermore, he realized that people who actually want to take more informed decisions about health care rarely have good access to reliable reviews of what is known. He wrote: ‘It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials’ (COCHRANE, 1972). A belated response to this challenge was the establishment of the International Cochrane Collaboration, an international group of people that aims to help others make well-informed decisions about the effects of interventions on health, by preparing, maintaining, and ensuring the accessibility of rigorous, explicit, systematic, and up-to-date reviews of the benefits and risks of health care interventions (CHALMERS et al., 1992; CHALMERS, 1993; GODLEE, 1994). As far as possible these reviews contain statistical pooling of the known effects of interventions (from different trials) in the form of meta-analyses (MULROW, 1994). It is the policy of the International Cochrane Collaboration that the preparation and maintenance of this information follows rigorous and explicit methods. Annual meetings around the world (Cochrane colloquia) are held to debate, iterate and make explicit the methods, criteria and standards that are used in the work of those who contribute to the efforts of the Collaboration. Not only are the methods of preparing and maintaining the information unique; so are the methods used for disseminating it. Archie Cochrane recognized that the best available evidence was neither accessible nor updated appropriately. Consequently, much of the workof the International Cochrane Collaboration is done electronically. This is essential to the international and timely nature of the endeavour. Although teams work across disciplines, continents and time zones, they are bound by an explicit set of quality criteria as well as by a common ideal of making the best possible evidence available to the greatest number in the most accessible form. Most important, perhaps, is the electronic nature of the dissemination. This is done on floppy and compact disks (and soon on the Internet). The importance of publishing using electronic media is that while, like most other libraries, the Cochrane library is constantly receiving new material (much of which makes current material out of date), unlike most other libraries, out-ofdate material in the Cochrane library can be corrected. The Collaboration is, as the name suggests, a collaboration and therefore is not hierarchical. There are Cochrane centres in Australia, Canada, Germany, Norway, Japan, South Africa, the UK and (numerously) in the USA. Many are accessible via the Internet.