Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

Perhaps the most famous and respected authority in this field is the Cochrane Collaboration, a global network of experts coordinated via its headquarters in Oxford. Firmly adhering to the principles of evidence-based medicine, the Cochrane Collaboration sets itself the goal of examining clinical trials and other medical research in order to offer digestible conclusions about which treatments are genuinely effective for which conditions. Before revealing the Cochrane Collaboration’s findings on acupuncture, we will first briefly look at its origins and how it came to be held in such high regard. In this way, by establishing the Cochrane Collaboration’s reputation, we hope that you will accept their conclusions about acupuncture in due course.

The Cochrane Collaboration is named after Archie Cochrane, a Scotsman who abandoned his medical studies at University College Hospital, London, in 1936 to serve in the Spanish Civil War as part of a Field Ambulance Unit. Then in the Second World War h e joined the Royal Army Medical Corps as a captain and served in Egypt, but he was captured in 1941 and spent the rest of the war providing medical help to fellow prisoners. This was when he first became aware of the importance of evidence-based medicine. He later wrote that the prison authorities would encourage him by claiming that he was at liberty to decide how to treat his patients: ‘I had con siderable freedom of choice of therapy: my trouble was that I did not know which to use and when. I would gladly have sacrificed my freedom for a little knowledge.’ In order to arm himself with more know ledge he conducted his own trials among his fellow prisoners — he earned their support by telling them about James Lind and the role of clinical trials in working out the best treatment for patients with scurvy.

Whilst Cochrane was clearly a fervent advocate of the scientific method and clinical trials, it is important to note that he also realized the medical value of human compassion, as demonstrated by numerous events throughout his life. One of the most poignant examples occurred during his time as a prisoner of war at Elsterhorst, Germany, when he found himself in the hopeless position of treating a Soviet prisoner who was ‘moribund and screaming’. All Cochrane could offer was aspirin. As he later recalled:

I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying.

After the war, Cochrane went on to have a distinguished career in medical research. This included studying pneumoconiosis in the coal miners of South Wales and becoming Professor of Tuberculosis and Chest Diseases at the Welsh National School of Medicine in 1960. As his career progressed, he became even more passionate about the value of evidence-based medicine and the need to inform doctors about the most effective medicines. At the same time, he realized that doctors struggled to make sense of all the results from all the clinical trials that were being conducted around the world. Hence Cochrane argued that medical progress would be best served if an organization could be established with the responsibility of drawing clear-cut conclusions from the myriad research projects. In 1979 he wrote, ‘It is surely a great criticism of our profession that we have not organised a critical summary, by speciality or subspeciality, adapted periodically, of all relevant randomised controlled trials.’

The key phrase in Cochrane’s statement was ‘a critical summary’, which implied that whoever was doing the summary ought to assess critically the value of each trial in order to determine to what extent it should contribute to the final conclusion about whether a particular therapy is effective for a particular condition. In other words, a carefully conducted trial with lots of patients should be taken seriously; a less carefully conducted trial with just a few patients should carry less weight; and a poorly conducted trial should be ignored completely. This type of approach would become known as a systematic review. It is a rigorous scientific evaluation of the clinical trials relating to a particular treatment, as opposed to the sort of reports that the WHO was publishing on acupuncture, which were little more than casual uncritical overviews.