Cochrane UK: NHS pulls support

Dear Editor

The recent ‘Communication’[1] excites a ‘Nostalgic Conversational Discourse’ concerning the ‘Assurance for Quality Patient Care Outcomes’. The ‘Historical Antecedents’ suggest that ‘Evidence-based Medicine (EBM)’ had its ‘Origin-Locus’ in 1992 to revolutionize ‘Patient Care’ and hinged solely on ‘Best Available Research Evidence (BARE)’ to the complete exclusion of other ‘Considerations’: Clinical Intuition-Unsystematic Clinical Experience-Pathophysiological Rationale regarding the Disease[2]. There have been ‘Issues’ with ‘Evidence’ and ‘Opinion’[3-7].

It was reportedly disposed that ‘Evidence’ was ‘Facts supporting a Conclusion’ while ‘Opinion’ was ‘View-Judgement formed about something and probably not predicated on Facts’[4]. For ‘Guidelines Development’, ‘Facts-Evidence-Opinion should be distinguished’-‘‘Facts and Opinion’ should be regarded as ‘Evidence’’ with ‘Evidence Hierarchy’ to guide ‘Patient Care Decision-making Process’-‘Practice Clarity’ re: Value of Facts-Evidence-Opinion in ‘Patient Care’[3].

Progressively, ‘EBM’ evolved into a ‘Movement’ re: ‘Work in Progress’ as ‘Issues’-‘Parameters’ continuously emerged[8]. Thus, beyond ‘BARE’, other ‘Parameters’ entered the ‘Pyramid of Evidence’-‘Hierarchy of Evidence’: ‘Clinical Expertise’-‘Expert Opinion’ considered as ‘Evidence’ with very ‘Low Quality’-‘Internal to Evidence’[9] and later ‘Patient Perspectives’-‘External to Evidence’[10]. Thus, ‘Three Circles of Influence Model’ including ‘Research Evidence’-‘Clinical Expertise’-‘Patient Values and Preferences’ was disposed from 1997 revolutionizing ‘EBM Movement’ with a strong recommendation for consideration of the ‘Patient Values and Preferences’[11] and the ‘Three Circles of Influence’ changed further to include: ‘Research Evidence’-‘Patient’s Preferences and Actions’-‘Clinical State and Circumstances’[12].

Also, ‘Four Circles of Influence Model’ emerged with the additional infusion of the ‘Circle of Influence of ‘Clinical Expertise’’ with the ‘Clinical Expertise’ in the new ‘Model’ as the ‘Integral Synthesis’ of the other ‘Three Circles of Influence’: ‘Research Evidence’-‘Patient’s Preferences and Actions’-‘Clinical State and Circumstances’. This Author ‘Contextualized’ the ‘Circles of Influence’ as ‘Parameters’ and, therefore, the ‘Four Circles of Influence’ were disposed as a ‘Four-Parameter Model’ for the ‘EBM Movement’ which further included several ‘Other Parameters’ beyond the ‘Four Parameters’ to dispose the ‘Multiparameter-based Medicine (MBM)’[5]. Some of the ‘Additional Parameters’ were: ‘Cultural/ Traditional Parameter’-‘Family Parameter’-‘Societal Parameter’-‘Health-related Governance Parameter’-‘Resources Availability Parameter’ and still adding[4]. To achieve a ‘Holistic Patient Care’, the ‘Thrust’ of the ‘MBM’, these ‘Additional Parameters’ were to be considered for ‘Impactful Patient Care’ integrating ‘Biomedical Medicine-related Patient Care’ with ‘Social Medicine-related Patient Care’.

‘Cochrane UK Defunding’[13] was indicated in this ‘Communication’[1]. With the establishment of the original ‘EBM’ by Scottish Archie Cochrane in 1992, the Cochrane UK, as with other ‘Cochrane Groups’ in other parts of the World, reportedly quickly coalesced into the ‘International Cochrane Collaboration’. While ‘Improved Patient Care’ was initially hinged on ‘EBM’ driven by ‘BARE’ and with the emerging ‘Issues’ occasioning the ‘EBM Movement’ as ‘Work in Progress’, beyond the suggested ‘MBM’ as an ‘Improvement Intervention’, several criticisms arose challenging the ‘EBM’: Quality of Reviews-Timeliness of Reviews-Quality of Review Groups-Focus and Relevance of Reviews to Health and Social Needs of the UK among others[14-16]. Consequently, 21 Cochrane Supporting Groups reportedly stopped their ‘Funding’ the National Institute for Health and Care Research (NIHR) and the latter will discontinue funding Cochrane UK from March 2024 being a year earlier than expected. Other more ‘Locale-specific Approaches for Evidence Syntheses’ will be established-explored using ‘9 New Specialist Research Groups’ to meet the ‘Health and Social Needs’ of the UK-NHS[15-17].

The ‘International Cochrane Collaboration’, with Headquarters in London, will continue its ‘Cochrane Reviews’ despite the ‘Defunded Cochrane UK’ while the NIHR explores its ‘New Evidence Syntheses Approaches’. It was previously disposed by this Author[18] that ‘Improved Patient Care Decision-making Process’ cannot be hinged solely on ‘BARE’ which ‘Evidence Syntheses Modality’ is now threatened by ‘Cochrane UK Defunding’. This is the imperative to further uphold the ‘MBM’ to assure continuous ‘Improved Patient Care Decision-making Process’ for the desired ‘Improved Patient Care Outcomes’.

REFERENCES
1. Christie B. Cochrane UK: NHS pulls support. BMJ 2023; 382:p1756
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Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education), FAMedS, FIPMD, FIMC, CMC, CMS
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.