archie cochrane - nhs wales cochrane man of geni… · archie cochrane man of genius with ......
TRANSCRIPT
Archie Cochrane Man of genius with feet of clay!
Peter Elwood
PanCeltic Meeting; Holland House Hotel
Friday 21st June 2013
Archie came to Cardiff in 1948….
He joined the MRC Pneumoconiosis Unit and worked with Charles Fletcher, John Gilson, Peter Oldham,
Philip Hugh-Jones, Martin Wright et al….
In 1959 Archie was appointed David Davies Professor of Chest Diseases within the Welsh National School of Medicine.
Sully Hospital
In 1960 MRC recognised Archie as a ‘lateral thinker’, with pioneering work in studies of whole
populations.
The MRC Epidemiology Research Unit was set
up under Archie.
I joined Archie in September 1963
Archie Cochrane Man of genius with feet of
clay!
‘….he helped to make epidemiology a quantitative
science’.
…he had... ‘an almost obsessional interest in
reproducibility and low rates of refusal…’
‘…he developed ‘shoe-leather’ epidemiology’
‘…he promoted the randomised controlled trial’
‘Archie reshaped epidemiology’!
1948- Pneumoconiosis, tuberculosis, chronic bronchitis
Heart disease, blood pressure with Bill Mial
-----------------------------------------
1960 – 1974 Surveys of glaucoma with Graham and Hollows
Surveys of workers in flax, cotton, asbestos, slate
Studies of iron deficiency anaemia
Headache and migraine with Waters
Treatment of varicose veins with Jean Weddell
Renal disease etc. with Waters and Assher
Aspirin and vascular disease
Child growth and milk supplements
Asthma with Burr
Environmental lead
Dietary studies incl. the benefits of fatty fish with Burr
The Caerphilly study: Heart disease, stroke and dementia
Studies conducted by Archie and his Unit:
1948- Pneumoconiosis, tuberculosis, chronic bronchitis
Heart disease, blood pressure with Bill Mial
-----------------------------------------
1960 - Surveys of glaucoma with Graham and Hollows
Surveys of workers in flax, cotton, asbestos, slate
Studies of iron deficiency anaemia
Headache and migraine with Waters
Treatment of varicose veins with Jean Weddell
Renal disease etc. with Waters and Assher
Aspirin and vascular disease
Child growth and milk supplements
Asthma with Burr
Environmental lead
Dietary studies incl. the benefits of fatty fish with Burr
The Caerphilly study: Heart disease, stroke and dementia
Studies conducted by Archie and his Unit:
1948- Pneumoconiosis, tuberculosis, chronic bronchitis
Heart disease, blood pressure with Bill Mial
-----------------------------------------
1960 - Surveys of glaucoma with Graham and Hollows
Surveys of workers in flax, cotton, asbestos, slate
Studies of iron deficiency anaemia
Headache and migraine with Waters
Treatment of varicose veins with Jean Weddell
Renal disease etc. with Waters and Assher
Aspirin and vascular disease
Child growth and milk supplements
Asthma with Burr
Environmental lead
Dietary studies incl. the benefits of fatty fish with Burr
The Caerphilly study: Heart disease, stroke and dementia
Studies conducted by Archie and his Unit:
1948- Pneumoconiosis, tuberculosis, chronic bronchitis
Heart disease, blood pressure with Bill Mial
-----------------------------------------
1960 - Surveys of glaucoma with Graham and Hollows
Surveys of workers in flax, cotton, asbestos, slate
Studies of iron deficiency anaemia
Headache and migraine with Waters
Treatment of varicose veins with Jean Weddell
Renal disease etc. with Waters and Assher
Aspirin and vascular disease
Child growth and milk supplements
Asthma with Burr
Environmental lead
Dietary studies incl. the benefits of fatty fish with Burr
The Caerphilly study: Heart disease, stroke and dementia
Studies conducted by Archie and his Unit:
1948- Pneumoconiosis, tuberculosis, chronic bronchitis
Heart disease, blood pressure with Bill Mial
-----------------------------------------
1960 - Surveys of glaucoma with Graham and Hollows
Surveys of workers in flax, cotton, asbestos, slate
Studies of iron deficiency anaemia
Headache and migraine with Waters
Treatment of varicose veins with Jean Weddell
Renal disease etc. with Waters and Assher
Aspirin and vascular disease
Child growth and milk supplements
Asthma with Burr
Environmental lead
Dietary studies incl. the benefits of fatty fish with Burr
The Caerphilly study: Heart disease, stroke and dementia
Studies conducted by Archie and his Unit:
A study that delighted him A study that impressed him A study that amused him A study that upset him A study that disappointed him
A few special studies with Archie:
A study which delighted him
A study which delighted him
‘Factors associated with
cardiac mortality ….
with particular reference
to the consumption of
wine.’
St Ledger and Cochrane
Lancet 1979;I:1017-
Archie and Fred Moore worked on WHO data from 18 developed countries and they published a number of reports.
‘At last... a vascular risk factor that is both beneficial and enjoyable’
Sir Richard Doll
A study which delighted him and others!
‘Factors associated with
cardiac mortality with
particular reference to the
consumption of wine.’
St Ledger and Cochrane
Lancet 1979;I:1017-
‘The correlation of
cardiovascular
mortality with the
number of doctors is
positive!’
Results which delighted him but not all others!
Results which delighted him but not all others!
‘A malevolent pixie!’ Paul Luke
Paul Luke Secretary , Faculty of
Public Health
‘The correlation of
cardiovascular
mortality with the
number of doctors is
positive!’
Within his unit, many RCTs were done. Undoubtedly the one that impressed him most,
was low-dose aspirin and heart disease
A study that impressed him...
Archie was a great encourager. He encouraged numerous colleagues and above all he promoted the randomised controlled trial….
1,400 post-MI men in hospitals in South Wales were randomly
allocated to aspirin or a matching placebo for two years
Low-dose aspirin was associated with a 24% reduction in heart disease deaths. BMJ 1974:1:436-440
A study that impressed him...
Low-dose aspirin associated with a 24% reduction in heart disease deaths. BMJ 1974:1:436-440
This was the first randomised trial
of the benefit of aspirin, and it later
played a part in…..
A study that impressed him...
-the development of the Cochrane Collaboration by Iain Chalmers
-the development of systematic overviews and meta-analyses by Richard Peto
- the amassing of evidence on aspirin and cancer reduction by Peter Rothwell
A study which amused him…
The mortality of tropical fish!
Experiment
A randomised controlled trial
Hard water Soft water
Hard water Soft water
Result
A massive disparity in population
Interpretation
Is hard water contraceptive?
Hard water Soft water Soft water
Interpretation
Is hard water contraceptive?
Soft water Soft water
Interpretation
Is hard water contraceptive?
Soft water Soft water
A trial in prison
A study that upset him...
Sickness in Salonica: my first, worst and
most successful randomised
clinical trial.
BMJ 1984;289:1726-7
A most moving study...
Prevalence of oedema in the camp in Salonica
A study which disappointed him...
A study of punishment!
A study which disappointed him...
Smoking, caning and delinquency
in a Secondary Modern School. John Palmer
Br J Prev Soc Med 1965;19:18.
John Palmer
Retired computer programmer
Now an amateur archaeologist
A study which disappointed him...
Smoking, caning and delinquency
in a Secondary Modern School. John Palmer
Br J Prev Soc Med 1965;19:18.
Punishment: a field for
experiment.
John Palmer Br J Crim 1967;1:434.
John Palmer
Retired computer programmer
Now an amateur archaeologist
Former Lord Chancellor and Secretary of State for Justice
What would please Archie most…
What would disappoint him most…
What would please him most…
The Cochrane Collaboration
What would please him most…
Evidence based medicine
Iain Chalmers, Chris Silagy, Dave Sackett et al.
The Cochrane Collaboration
What would please him most…
‘Evidence based medicine’
Iain Chalmers, Chris Silagy, Dave Sackett
- The multiplicity of RCTs
- Systematic overviews and meta-analyses of RCTs
What would please him most…
- The multiplicity of RCTs
- Systematic overviews and meta-analyses of RCTs
What would please him most…
BUT….
Archie recognised the value of observational studies…..
RCTs test a single hypothesis
Cohort studies generate many new hypotheses
What would disappoint him most…
The low response rates in many studies, making the results
unrepresentative and incapable of extrapolation with confidence!
(‘Cochrane units’)
The absence of randomised trials in fields other than medicine, such as education and sentencing in the courts.
Ben Goldacre and The Campbell Collaboration
which are promoting the use of systematic reviews in policy-making beyond just healthcare.
The Cochrane building on the UHW site
Archie Cochrane Man of genius with feet of
clay!
…with feet of clay!
‘He was a man… without the consolation of a wife,
a religious belief, or a merit award.’
‘He was a man… without the consolation of a wife,
a religious belief…’
‘He was a man… without the consolation of a wife,
a religious belief…’
‘He was a man… without the consolation of
a religious belief…
Archie Cochrane 1909 - 1988
……. with Fred Moore
In 1974 Archie retired….
...but continued to work in the Unit
The White House "hatchet man” Served seven months in prison in 1976.
On release set up Prison Fellowship, which, involves churches of all denominations, and has become the
world's largest outreach to prisoners, ex-prisoners, and their families.
Chuck Colson