Archie Cochrane Man of Genius with Feet of Clay!

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!

‘Archie reshaped epidemiology’!

‘….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’ Studies conducted by Archie and his Unit:

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:

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 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. 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-

‘At last... a vascular risk factor that is both beneficial and enjoyable’ Sir Richard Doll Results which delighted him but not all others!

‘The correlation of cardiovascular mortality with the number of doctors is positive!’ Results which delighted him but not all others!

‘The correlation of cardiovascular mortality with the number of doctors is Paul Luke positive!’ Secretary , Faculty of Public Health

‘A malevolent pixie!’ Paul Luke A study that impressed him...

Archie was a great encourager. He encouraged numerous colleagues and above all he promoted the randomised controlled trial….

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...

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…..

-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! Hard water Soft water

Experiment A randomised controlled trial

Hard water Soft water

Result A massive disparity in population

Hard water Soft Soft water water

Interpretation Is hard water contraceptive? Soft Soft water water

Interpretation Is hard water contraceptive? A study that upset him...

A trial in prison

A most moving study...

Sickness in Salonica: my first, worst and most successful randomised clinical trial. BMJ 1984;289:1726-7 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 John Palmer Retired computer programmer Br J Crim 1967;1:434. 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… What would please him most…

The Cochrane Collaboration

Evidence based medicine Iain Chalmers, Chris Silagy, Dave Sackett et al. What would please him most…

The Cochrane Collaboration

‘Evidence based medicine’ Iain Chalmers, Chris Silagy, Dave Sackett What would please him most…

- 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

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