Intended for healthcare professionals

Career Focus

Sir Iain Chalmers

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7525.s214 (Published 12 November 2005) Cite this as: BMJ 2005;331:s214
  1. Leyla Sanai, medical journalist and retired consultant anaesthetist
  1. leyla.sanai{at}virgin.net

Abstract

Sir Iain Chalmers was the director of the first Cochrane Centre and is currently editor of the James Lind Library (www.jameslindlibrary.org), which documents the evolution of fair tests of medical treatments.

You have said, “Everything I have done professionally has its origins in my experience in Gaza in 1969 and 1970.” Could you explain?

After doing four house jobs in the UK, and motivated mainly by the shame I felt at the way that Britain had betrayed the Palestinians with the Balfour Declaration in 1917, I decided to work for the United Nations in a Palestinian refugee camp in the Gaza Strip. I learnt a lot of things during my two years there. One of the most important was that, by doing what I had been taught to do, some of my patients were suffering and dying unnecessarily. That shattering experience induced in me a chronic “scepticaemia” and an insistence that therapeutic claims should be informed by reliable research evidence.

Why was the Cochrane Centre set up in 1992?

Michael Peckham, the first director of the NHS Research and Development Programme, felt that a synthesis of the results of controlled trials of care during and after pregnancy and childbirth provided a model that could usefully be extended to other spheres of health care.

How did you come to be involved?

I was director of the research unit which had coordinated the international collaboration that had prepared the systematic reviews in pregnancy and childbirth, and I was an editor of the books and electronic publication through which the results of this work were disseminated.

What were the aims of the Cochrane Centre?

To facilitate the preparation and maintenance of systematic reviews of randomised controlled trials of healthcare interventions. A founding objective of the centre was to internationalise its aims as rapidly as possible, and the international Cochrane Collaboration was founded at a meeting convened by the (UK) Cochrane Centre a year later.

Although Cochrane reviews have been shown to be of higher quality than other systematic reviews, a study in the BMJ in 2001 (BMJ 2001;323:829-32) showed major problems in 29% of them. How were these tackled?

The researchers who reported this audit were all actively involved in the Cochrane Collaboration. They notified the problems they had identified to the editorial groups responsible for the reviews in which problems had been identified. Similar self critical audits have continued (see, for example, BMJ 2003;326:475).

What is the idea behind the James Lind Library?

The James Lind Library (www.jameslindlibrary.org) is a web based resource introducing the principal components of fair tests of medical treatments and illustrating these with examples from history. We were delighted when Scientific American gave the James Lind Library one of only five awards given to medical websites in 2003.

Last year you spoke out about the fact that research findings forming the basis of whether or not to license new drugs were not revealed. Is this going to change?

I sincerely hope so. It is outrageous that prescribers and patients are denied access to information about the effects of licensed drugs.

How do we prevent licensing of drugs that are later found to cause serious long term problems, such as COX2 inhibitors?

First and foremost, all relevant data should be published promptly. There may be something to be said for formalising arrangements that have been evolving anyway. The fact that a drug has been given a marketing licence is no guarantee that NICE (the National Institute for Health and Clinical Excellence) will conclude that it represents good value for the NHS. The marketing licence should be regarded as a provisional licence.

You have previously expressed disquiet about the variations in ethics committee appraisals. How can we standardise ethics approval?

My disquiet about these variations is not because I have strong views about how they might be standardised, but because they reflect implicit disagreements about how committees should use their time and power cost effectively. Their work is not currently informed by any systematic assessment of how best they can serve the public.

Similarly, one could extrapolate that reporting idio-syncratic reactions to drugs or complications of diseases varies widely between centres and individuals.

The potential seems to have improved with the advent of email and the web. The Medicines and Healthcare Products Regulatory Agency has opened up adverse event reporting beyond medical practitioners, and, in principle, the websites of patient groups provide a way of communicating and assembling reports of esoteric complications of diseases. ■

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