The Cochrane collaboration in the Third World.

T he publ icat ion of a paper by the Cochrane Injuries Group Albumin Reviewers [BMJ 1998; 317(7153):235-240] gives us a good example of the importance of the Cochrane Collaboration for medical practice and rcscarch. In spite 01" have being used for more than 50 years, alburnin infusion in criiical patients has not yet been properly studieel. This syste matic review, initially publisheel in the Cochrane Library, shows that the use of albumin in patients with shock, large burns and even critical diseasc associated with hypoalburninernia increases the mortality Irorn 3% to 6%, when cornpared with nonuse 01' with the use 01' crystalloid. This means that when 15 to 30 patients are treated with alburnin, sueh treatrnent will be associateel with one excessive death. An aelelitional and very relevant fact is that hurnan alburnin is not chcap. In Brazil it costs about US$ 50 per unit anel usually it is prescribed at a rare 01' 3 to 4 units per day. costing US$ 150 to 200 per day, Frorn personal inforrnation. this can be illustrated by the fact that a tcaching hospital such as the Hospital São Paulo ar The Federal Uni vcrsity of São Paulo spends about US$ 260,000 pcr ycar on this kinel of treatrnent. In this case anel in rnany others, lhe use of good evidence in the general internist's practice will reduce dcaths anel costs. The BM.J eelitor received various interesting letters disagreeing with the Cochrane papel'. but none of thern altereel the conclusion. by even one millimeter, that there