Cochrane on Communism: the influence of ideology on the search for evidence.

Introduction In his seminal work Effectiveness and Efficiency, Archie Cochrane asked why, despite their enormous potential, randomized trials were much less widely used that they should be. At the time that he was writing, their geographical distribution was very uneven. He wrote ‘If some such index as the number of RCTs per 1,000 doctors per year for all the countries of the world were worked out, and a map of the world shaded according to the level of the index, one would see the UK in black, and scattered black patches in Scandinavia, the USA, and a few other countries. The rest would be nearly white. It appears in general that it is Catholicism, Communism, and underdevelopment that appear to be against RCTs. In underdeveloped countries this can be understood but what have Catholicism and Communism against RCTs? ’ In this article, I will focus on Soviet communism. Cochrane had a strong commitment to social justice, commenting that ‘The difference in the medical care of the rich and the poor was sufficient to touch the hardest-hearted student in the 1930s.’ He memorably went on a demonstration in favour of the creation of a National Health Service holding a placard stating that ‘All effective treatment must be free’ but, as he recalled, ‘the only person who noticed it damned me for having Trotskyite tendencies’. His political views were shaped by his experiences in the 1930s. Between 1931 and 1934, he had been in Berlin and Vienna, where he observed the rise of Nazism. In 1936, he enlisted with the International Brigade in the Spanish Civil War. However, there he saw another aspect of authoritarianism in the atrocities committed by the communists against followers of other parties on the Republican side, as well as the incompetence of some of the Soviet commanders whose actions led to military disasters. Len Crome, the senior medical officer in the Brigade, reported, in relation to the communists, that ‘Archie is hostile’ (J Tudor Hart, personal communication). Thus, it is clear that Cochrane was certainly no naı̈ve observer of communism.