The Archie Cochrane Lecture
Archie Cochrane (1909-1988) made many highly significant contributions to medicine and to medical research. Many of us will remember his urgings to ‘randomise’ – even though he himself never conducted a RCT. The nearest Archie got to randomisation was in a remarkable study of the treatment of famine oedema in prisoners of war (BMJ 1984;289:1726-7)! He will however best be remembered for his challenge that the reports of medical research, and in particular, randomised trials, be organised, evaluated and up-dated at intervals to give a valid evidence-base for medical and surgical practice. His frequent challenges led Iain Chalmers to set up the Cochrane Collaboration, which, in turn, led to a paradigm shift in clinical practice summarised in the phrase: ‘evidence-based medicine’.
Archie was a founding member of both the Society of Social Medicine and the International Epidemiological Association. He valued both and was a very frequent attender at their meetings. He often expressed delight at the inclusion of disciplines other than medicine, and later, in playing a key role in the setting up of the Faculty of Community Medicine he was concerned lest this, being within the Royal College of Medicine, might become exclusive to those who were medically qualified.
Archie was a lateral thinker with almost unlimited interests in medicine, and the encouragement he gave to others, and especially to junior research workers – whatever the topic of their research – enriched many a career. On the other hand, he was deeply concerned at the lack of rigour in the evaluation of clinical interventions. Perhaps his attitude to some of the more pompous senior clinicians was summed up by Paul Luke, the first Secretary of the Faculty of Community Medicine, who, having watched him taunt an eminent physician, referred to Archie as ‘a malevolent pixie’!
Archie yearned for more attention to be given to the prevention, rather than the treatment of disease. The origin of this concern of his predates his involvement in clinical activities and was expressed in a poem, written in a prisoner of war camp in Salonica, in 1941:
Let doctors leave the centre stage,
And usher in the prophylactic age.
The first Cochrane Lecture of the Society of Social Medicine was given by Peter Elwood at the Annual meeting of the Society in Glasgow in 1990. Elwood had joined Archie in the MRC Epidemiology Unit in Cardiff in 1963 and later, in 1974, succeeded him as Director. Elwood however arranged for Archie to continue as an active member of the Unit, and Archie continued his research work until very shortly before his death in 1988. Archie was a much loved and valued colleague and friend, but despite his many successes and honours, he was a lonely bachelor, who lacked, in his own words, ‘the consolation of a wife, a religious belief, or a merit award’. The Unit did what it could to compensate for these deficiencies.