Ben Toth has raised an interesting issue relating to the Cochrane (click here). In addition to Ben’s comments I’m going to add a few criticisms of Cochrane. Ben highlights that the UK taxpayer (via the Department of Health) has spent tens of millions of pounds on Cochrane. has that been money well spent?
We answer thousands of clinical questions from primary care every year. You’d like to think Cochrane would answer a significant chunk. In our experience Cochrane rarely answers a genuine clinical query on it’s own. A recent analysis of over 300 dermatology questions revealed that Cochrane systematic reviews answered 2. The analysis was carried out with the help of the Cochrane Skin Group so they cannot be accused of not trying to examine their ‘offering’.
A number of years ago I had a chat with Sir Iain Chalmers (who founded Cochrane). This was while DUETs was being formed. During the course of the conversation it became clear that the choice of systematic reviews (SR) is – generally – not based on any rational system. Generally, a keen researcher has a desire to do a specific SR and Cochrane helps them to do it. The thinking is that they will then go on to do additional SRs. In other words it was personal preference, not clinical need (or should that be information need). Interestingly, the respiratory SRs were much more useful for our Q&A activities than others. Apparently they had a different system. If a researcher wanted to undertake their own SR they were told that the respiratory group (probably the airways group, I forget the proper name) would help them to carry out a SR that was useful to the group. After that the researcher would be trained and could carry out their own personal SR.
The hope is that DUETs will help this situation, but results will not come quickly, if at all. I raise this additional point as many of the uncertainties are generated from within Cochrane. Also, there is currently little input from clinical Q&A services.
Ben highlights that Cochrane is potentially using an outdated business model. Is Cochrane itself outdated?