Posted on October 23, 2013
If, like me, you were busy at medical school during the recent Cochrane Colloquium in Quebec, you may be interested in watching the plenary videos available here. I’ve just highlighted a few of the key points from the talks that gave me pause for thought. In this blog I’ve looked at Plenary I – in future blogs I’ll look at the other plenaries.
He spoke from the perspective of the NIHR as a funding body, which provides a lot of support to Cochrane. The idea that struck me from his talk was one of a virtuous circle. The NIHR funds clinical trials (in fact, it spends roughly 90% of its budget doing so) – and it wants those to be based on an evidence gap, as identified by a systematic review. These funded trials then feed back into new systematic reviews, and so the virtuous circle is complete. In theory this sounds like a fantastic idea, and how publicly funded research can run to lead to benefit for the patients who (in the UK) are funding it. Using a couple of examples of NICE guidelines citing Cochrane evidence – it seems that this works in some areas.
Another point mentioned was that with an ageing population and more patients with multiple co-morbidities, the way we use and synthesise evidence may need to change. He spoke of a need to balance pragmatism with academic purity, so that reviews were useful in terms of improving patient care.
Before listening to her talk, I had no idea that The Cochrane Collaboration was an NGO affiliated with The WHO. This is EBM on a very big scale, and one of the key areas is systematic reviews for prospective essential medicines – this is one way where a systematic review can make a considerable difference to the care of a large number of patients if the decisions on which medicines to class as essential are evidence-based.
His talk focused on the history of The Cochrane Collaboration and how it’s moved on and expanded, including implications for the future. The rate of change is staggering, with The Cochrane Library now available free for more than half the world! The implications for the future are important, as these determine the kind of systematic review likely to be available. As in the first talk, the possibility of changing methods was raised – now there is more literature to keep on top of than ever before, and current methods may be unsustainable. Globalism was also a feature, as evidence-based medicine should also be applicable to low- and middle-income countries, so going about that is the challenge.
Overall, I thought these talks were an interesting overview of the development of EBM as we know it, and raise important issues for the future of EBM, and thus clinical practice. I think there are relevant to any student who is either interested in The Cochrane Collaboration, or in how the practice of EBM is likely to change. If you’ve watched the videos, what do you think are the key issues raised? How will they affect your practice?