The Cochrane Collaboration at 20

Just as Archimedes leapt naked from his bath on discovering his principle and August Kekulé dreamt the structure of the benzene ring while sleeping beside a fire, so Iain Chalmers had a vision of the Cochrane Collaboration at 6 am in May 1991 while walking beside a tributary of the Thames in Oxford. The collaboration would fulfil the vision of Archie Cochrane and clean up the Augean stables of medical studies. Specifically it would prepare, maintain, and promote the accessibility of systematic reviews of the effects of health interventions.1 2 The enterprise would need to be global because it was such a huge task.

Twenty years after it was founded the collaboration has more than 31 000 contributors from 120 countries and has published more than 5000 systematic reviews.3 Many see Cochrane reviews as the gold standard, and the collaboration has played a major role in promoting evidence based practice. The collaboration is clearly a success. But like any organisation it has problems and challenges, and Chalmers, who gives an annual prize for the best criticism of the collaboration, described some of them at the 21st gathering of the collaboration in Quebec. Challenges included finding more efficient means of preparing and updating reviews and avoiding duplication of reviews.4

Perhaps the main challenge is whether to extend the collaboration’s mission. It has mainly covered treatments, but should it be extended to, for example, diagnostic tests, qualitative studies of implementation, and products derived from the systematic reviews that might compete with tools like UpToDate and the BMJ’s evidence products.3 Clearly, extension would be desirable because all elements of healthcare need to be evidence based. In addition, evidence based tools beyond systematic reviews …