Wednesday, 18 January 2012

Cochrane for Dummies

by Anna Joseph,
laywoman-turned-Cochrane enthusiast

The South Asian Cochrane Network and Centre, which I joined two weeks back, kicked off its training workshops for the year 2012 with one on ‘Understanding and Using Systematic Reviews and Meta-Analyses in Informing Health Decisions’.

That’s quite a few unpalatable words for a laywoman and under previous circumstances, this would have been one workshop that I would have avoided, especially if I knew it had anything to do with medicine. I’m married to a doc and I live in a medical community. So I get more than my fair share of ‘medicated talk.’

But as their newly appointed communications officer, I wanted to have a clear idea of what exactly it is that I am trying to disseminate and so, sat in. I couldn’t make sense of it all but here’s what I did make sense of.

But before that… though this was supposed to be the report on the workshop, it has now turned into this blog-like article. How did it go from drab, professional to involved, personal?

Because after the workshop, it suddenly struck me that this place, one of the 13 world-wide centres of the international, non-profit organisation known as the Cochrane Collaboration, actually has something to offer.

But don’t just take it from me. Allow me to help you find out for yourself.

Let me start with something that really piqued my interest, for the simple reason that it is a woman-centric topic.
Did you know that hormone replacement therapy actually does more harm than good?

How about - that Tamiflu, into which millions are being pumped in, is really not the wonder-drug that it’s supposed to be?
Or that electric or powered toothbrushes are not better than manual toothbrushes?
Or that administering oxygen to a person who was having a heart attack might actually harm him?!

These are claims made by the Cochrane Collaboration and the reason they can be believed is because these guys chase after the truth like a shark that has caught the scent of blood.

Time for some shark trivia from the amazing
Sharks are able to respond to one part blood for every one million parts of water; this is like being able to smell one teaspoon of something in a swimming pool. What's more, sharks can smell these small amounts from hundreds of meters away.

Picture courtesy:
The shark metaphor, which came to mind more as an after-thought, is actually a great one for the work of the Collaboration. Because that’s what their authors, the ones who write for their on-line Cochrane Library, do - go through a million parts of matter on a chosen topic and sift out that one part of matter that is The Truth (or as close to it as it gets). And their million actually covers not just the swimming pool, but all the water-bodies in the world. 

In other words, why the stuff that comes out on the Cochrane Library can be trusted is because a conclusion is reached only after two or more people go through everything written about a particular topic. And that includes non-English data, and even stuff that has not been published. 
These studies are then run through extremely stringent and scientific methods of assessment to get to the truth of the matter.

Technically, that final review that shines the light on The Truth (or as close to it as it gets!) is what is called the ‘systematic review’. And in the medical community, a Cochrane systematic review is the gold standard for a systematic review.

For the curious layperson, for the scribe looking for facts to back up an interesting lead, for the anxious parent or for the patient who wants to know what his / her best treatment options are, the information the Cochrane reviews offer are simply the best out there. And they have it all plain and simple in what is called their plain language summaries. No wonder then that the Collaboration, begun in 1993, now spans over 100 countries and boasts more than 28,000 enthusiastic volunteers, which include people from all walks of life.

Now, to wind up, let me finish the job I left incomplete – what the workshop was about! I think I already dealt with the bit on understanding and using systematic reviews. The second half talks about meta-analyses and about informing health decisions.

Assuming you really want to know, a meta-analysis synthesises the analyses of various studies and informing health decisions means using the findings pro-actively to influence policy making in healthcare.

So that’s what the workshop was about.