in worldwide scheme to widen knowledge and improve patient
can you find out whether fish oil cures schizophrenia,
whether praying will alleviate ill-health or whether alternative
Chinese medicine can help your stomach ache? How effective
is the latest drug or treatment you've been offered? Although
clinical trials are carried out into all new drugs, and
some of the more surprising alternative treatments, it's
not always easy to draw clear conclusions from them, either
as a healthcare professional or as a patient.
groups at Leeds are part of an international collaboration
seeking to put that right. The Cochrane collaboration
is reviewing clinical trials to provide an overview of
the evidence. There are 63 groups worldwide relating to
different conditions; at Leeds one looks at schizophrenia,
and the other at upper gastrointestinal and pancreatic
diseases. Each group is managed by an editor, who oversees
the reviews carried out by volunteers, whether academics,
healthcare professionals or even interested parties.
of the Cochrane schizophrenia group Professor Clive Adams
said: "Lots of things influence medical practice, such
as accessibility to treatment, commercial priorities,
history and habit, patient preferences and a doctor's
own clinical experience. It's always better to work from
proven clinical trials but there are too many to
keep all the findings in your head. Cochrane groups provide
an overview, by scientifically evaluating the trials,
how well they were carried out and their findings.
reviews follow a set procedure, to ensure that any bias
on the part of the reviewer is taken out of the equation.
Reviewers may themselves wish for a certain outcome, but
our system ensures a balanced result. In fact, the trials
of fish oil as a treatment for schizophrenia were reviewed
by two former fishermen, one of whom had a daughter suffering
from schizophrenia. They were both greatly disappointed
that nothing could be proved in the treatment's favour."
of the Cochrane upper gastrointestinal and pancreatic
diseases group, Professor David Forman (pictured
below), said: "Cochrane groups look at
a huge range of treatments from traditional Chinese medicine
for stomach ache to the latest drug treatment for a potentially
trials we review are not just of drugs, but also of mundane
bits of treatment or equipment which can transform patients'
lives. For example, when people with oesophageal cancer
have problems swallowing, there is a type of 'spring'
which, placed into the oesophagus, can help. It's made
of either plastic or metal and one of our reviews looked
at which material was best.
such evidence should be available in a GP's consulting
room or at a hospital bedside. It should form part of
every medic's training. The aim of the groups is to ensure
the instinctive reaction of every medic when faced with
a new problem or unsure if a treatment is up to date becomes:
what does Cochrane say?"
Cochrane collaboration is widely respected by health professionals,
and is used as the basis for many official guidelines
and recommendations for treatment, including those put
together by the new government body, the National Institute
for Clinical Excellence (NICE). However, ensuring that
the reviews provided by Cochrane filter through to medical
practice is not always straightforward, as the recent
study by obstetrics and gynaecology researchers at Leeds
has shown (see page 1).
reviews themselves have begun to set the agenda, by identifying
areas where treatments are used which have never been
truly tested. One such area is the use of anti-psychotic
medicines for people with learning difficulties, also
suffering from schizophrenia.
Adams: "People with learning difficulties require long-term
care from the health service, and so a substantial amount
of resources go to this group. Yet there is no data on
the long-term effects of the drugs they are given.
when patients suffering from schizophrenia are admitted
to hospital during a psychotic episode, they are routinely
given a prescription for 'drugs as required'. There have
been no studies into the necessity or effectiveness of
such a practice, which gives no clear indication of drugs
or dosage. Cochrane helps to identify such 'black holes'
where unquestioned practice and habit continue without
any real scientific or medical basis."
as reviewers may come from anywhere in the world, so the
trials studied are worldwide. The Cochrane collaboration
has also helped show which countries carry out the most
trials, and which are not 'pulling their weight'.
greatest number of trials are carried out in the US, but
comparison of number of trials with GDP shows the US produces
124 percent of the trials they should. The UK however
is well in the lead, carrying out 200 percent. Other economically
developed counties like Germany and Japan are falling
well short of the number of trials which could be expected
from them, at 35 and 15 percent respectively.
reviews enable trials to be collected together and properly
surveyed, to find out which, if any, have value. Reviews
can consider anything from five to several hundred trials,
involving sometimes just 60 people, sometimes thousands.
The reviews sometimes reveal poor quality of analysis,
or flawed methodology, rendering the results clinically
is now a Cochrane database of trials, and each group has
a database for its own specialist area. In schizophrenia
there are about 5,000 trials; in the upper gastrointestinal
and pancreatic diseases around 15,000, reflecting the
broader scope of the group.
goal of all this work is to ensure patients receive better
treatment. But ultimately the role of the Cochrane groups
is to provide the evidence, after which it is for the
health services in each country to ensure their doctors
use that valuable resource to provide care based on the
best scientific evidence available.
doctors 'Cochrane should be part of every medic's
training, so their instinctive reaction when faced with
a new problem becomes: what does Cochrane say?'