The Cochrane Collaboration and Evidence for Better Health Dr David Tovey FRCGP Editor in Chief The Cochrane Library

Knowledge is important!

“There had been reports that Chloe was not given the anti-viral drug Tamiflu after her doctor misdiagnosed her illness as tonsillitis......”

“Between 1999 and 2002 Roche sold just 5.5 million treatments. Next year the total sales of oseltamivir are projected at 150 million. Roche's share price has soared this year by 60%. 1 ” 1 BMJ 2005;331:1277 (26 November), doi: /bmj

“There had been reports that Chloe was not given the anti-viral drug Tamiflu after her doctor misdiagnosed her illness as tonsillitis......” “Between 1999 and 2002 Roche sold just 5.5 million treatments. Next year the total sales of oseltamivir are projected at 150 million. Roche's share price has soared this year by 60%. 1 ” 1 BMJ 2005;331:1277 (26 November), doi: /bmj

BMJ editor Dr. Fiona Godlee, said "claims that oseltamivir reduces complications have been a key justification for promoting the drug's widespread use. Governments around the world have spent billions of pounds on a drug that the scientific community has found itself unable to judge.“

Does it matter?

Archie Cochrane “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials.”

Mission The Cochrane Collaboration is an international organisation that aims to help people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions.

Cochrane Principles Keeping up to date Striving for relevance Promoting access Ensuring quality Continuity Collaboration Building on the enthusiasm of individuals Avoiding duplication Minimising bias

Cochrane Principles Keeping up to date Striving for relevance Promoting access Ensuring quality Continuity Collaboration Building on the enthusiasm of individuals Avoiding duplication Minimising bias

Cochrane Principles Keeping up to date Striving for relevance Promoting access Ensuring quality Continuity Collaboration Building on the enthusiasm of individuals Avoiding duplication Minimising bias

Cochrane Principles Keeping up to date Striving for relevance Promoting access Ensuring quality Continuity Collaboration Building on the enthusiasm of individuals Avoiding duplication Minimising bias

The Cochrane Collaboration: a success story ,000 active volunteers 1.2m website hits/month and > 1000 recorded media hits for a single issue >4000 systematic reviews plus access to summaries of thousands more?

Cochrane geographical spread

Cochrane Review Groups Acute Respiratory Infections Group Airways Group Anaesthesia Group Back Group Bone, Joint and Muscle Trauma Group Breast Cancer Group Childhood Cancer Group Colorectal Cancer Group Consumers and Communication Group Cystic Fibrosis and Genetic Disorders Group Dementia and Cognitive Improvement Group Depression, Anxiety and Neurosis Group Developmental, Psychosocial and Learning Problems Group Drugs and Alcohol Group Ear, Nose and Throat Disorders Group Effective Practice and Organisation of Care Group Epilepsy Group Eyes and Vision Group Fertility Regulation Group Gynaecological Cancer Group HIV/AIDS Group Haematological Malignancies Group Heart Group Hepato-Biliary Group Hypertension Group Incontinence Group Infectious Diseases Group Inflammatory Bowel Disease and Functional Bowel Disorders Group Injuries Group Lung Cancer Group Menstrual Disorders and Subfertility Group Metabolic and Endocrine Disorders Group Methodology Review Group Movement Disorders Group Multiple Sclerosis Group Musculoskeletal Group Neonatal Group Neuromuscular Disease Group Oral Health Group Pain, Palliative and Supportive Care Group Peripheral Vascular Diseases Group Pregnancy and Childbirth Group Prostatic Diseases and Urologic Cancers Group Public Health Group Renal Group Schizophrenia Group Sexually Transmitted Diseases Group Skin Group Stroke Group Tobacco Addiction Group Upper Gastrointestinal and Pancreatic Diseases Group Wounds Group

Global reach Australia Canada Denmark Finland India Ireland Latin America &Caribbean Low-Income Countries New Zealand Norway South Africa* Spain Sweden United Kingdom State of Wyoming*

Impact and impact factor Up from in th highest General Medical journal Up from 14 th in seconds

Impact and impact factor Up from in th highest General Medical journal Up from 14 th in seconds

Impact and impact factor Up from in th highest General Medical journal Up from 14 th in seconds

Top countries – 2008 visits to The Cochrane Library CountryVisits% of total United States (US)1,545, % United Kingdom (UK)856, % Australia (AU)457, % Canada (CA)203, % Netherlands (NL)143, % Germany (DE)98, % Italy (IT)97, % Taiwan (TW)97, % Sweden (SE)87, % Norway (NO)74, % Japan (JP)69, % Visits by country

Top countries – 2008 visits to The Cochrane Library CountryVisits% of total United States (US)1,545, % United Kingdom (UK)856, % Australia (AU)457, % Canada (CA)203, % Netherlands (NL)143, % Germany (DE)98, % Italy (IT)97, % Taiwan (TW)97, % Sweden (SE)87, % Norway (NO)74, % Japan (JP)69, % Visits by country

Increasing usage

Review TitleWorld Rank India Rank Interventions for preventing falls in elderly people147 Interventions for preventing obesity in children2178 Cranberries for preventing urinary tract infections3410 St John's Wort for major depression4439 Interventions for enhancing medication adherence5351 Nicotine replacement therapy for smoking cessation669 Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases 761 Water for wound cleansing8127 Support surfaces for pressure ulcer prevention9700 Midwife-led versus other models of care for childbearing women11 38 Top 10 Reviews - Worldwide

But We are not complacent There are obstacles ahead!

Where are we going? Content development Delivery of content

Content TimelyValidAccessibleRelevant

Content developments Summary of findings tables Diagnosis reviews Multiple comparison meta-analysis Overviews of reviews

Content developments Global Health commitment – Advocacy – Capacity building – Work with WHO and other partners Complex reviews Health Equity Methods Group

GRADE and Summary of Findings table

Delivery: the web programme Increasing publication frequency (publish changed data only) Improved search and browse Clarification of content Web 2.0 / interactivity etc

Delivery: different vehicles Cochrane Journal Club Cochrane PICO Cochrane on handhelds Cochrane decision support

FormatDescriptionObjectiveFrequency Web programme Improved web presentation and frequency of publication To improve quality and timeliness of content, and engage users Monthly! Cochrane Education Education materials related to the content of reviews building on Journal Club To improve accessibility of our reviews and engage with users Not yet determined Cochrane Response Responsive review service to customers To improve relevance and increase use of cochrane reviews in guidelines On demand! Cochrane PICOAn concise summary of evidence from Cochrane Reviews aimed at a specific question To improve accessibility, to act as a user friendly spring board into the evidence Pilot due May 2010 New for The Cochrane Library in 2010

Participation Quality Usage How can we measure success? Global health progress

thanks for listening