archie cochrane - nhs wales cochrane man of geni… · archie cochrane man of genius with ......

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