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

Abstract

In his seminal work Effectiveness and Efficiency,1 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’.

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