Archie describes his principals in his influential book, Effectiveness and Efficiency: Random Reflections on Health Services. Here he stressed the importance of using evidence provided by randomized controlled trials (RCTs) because this evidence is more likely to provide reliable information than other sources of evidence. Archie urged that we should be moving towards decisions based on unbiased synthesis of reliable and relevant research. The Cochrane Collaboration is founded on his work. The first Cochrane center opened in 1992 in the United Kingdom.

The Present

It has been estimated that a physician would need to read 17 journal articles a day in order to keep abreast of all research relevant to a particular area of clinical practice (Davidoff 1995). There has thus been increasing interest in the use of pre-appraised and synthesized evidence resources such as systematic reviews, meta-analyses, and evidence based clinical practice guidelines, as aids for clinical decision making.

In the past, review articles have not been subject to the same scientific rigor as the actual primary research that they summarize. Consequently, the Cochrane Collaboration has developed rigorous methods for reviewing and synthesizing scientific literature.

Cochrane Reviews are developed using a strict protocol and with well-described methods. Cochrane systematic reviews are particularly useful as they are kept up-to-date as new studies of good quality are published. This means that as new research is added to what is known on the topic new findings are rapidly disseminated. Thus:

The Cochrane Collaboration is an international network of individuals and institutions committed to preparing, maintaining, and disseminating systematic reviews of the effects of health care.

In pursuing its aims, the Collaboration is guided by ten principles:

• collaboration
  
• building on the enthusiasm of individuals
  
• avoiding duplication
  
• minimizing bias
  
• keeping up to date
  
• striving for relevance
  
• promoting access
  
• ensuring quality
  
• continuity
  
• enabling wide participation

The Cochrane Musculoskeletal Group (CMSG) is just one of 52 international Collaborative Review Groups responsible for covering evidence relating to a specific health condition (cystic fibrosis, for example) or groups of conditions. In addition, there are groups looking at statistical methods and ways of disseminating results so they are rapidly brought into practice (EPOC).

Contributors of these groups are responsible for seeking and selecting relevant research articles, and then preparing and maintaining the systematic reviews of the reliable evidence. The majority of the people who make up the Collaboration are not paid to review the literature, but are enthusiasts who recognize the urgent need to provide accurate, updated information to those making health care decisions so that ultimately patients may receive the best available treatment. Please let us know if you would like to be part of this team: if you are a consumer click here or a health-care professional click here.

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The Future

The Cochrane Collaboration is still very young but has achieved a great deal. Participation will grow as Cochrane's mission attracts more people, and the coverage of medical topics will expand even more rapidly.

With this growth, the Collaboration will be looking for financial support from new institutions, such as non-profit research funding organizations and industry. Forming alliances with groups at a local, national, and global level promises to increase Cochrane's visibility and accessibility. The goal is collaboration at multiple levels, from community groups on the consumer end of review preparation to clinical guideline development programs. For example, the CMSG has a strong, symbiotic relationship with The Canadian Arthritis Society as well as Arthritis Victoria and posts consumer summaries of reviews on their website.