How have you all been? It's been a bit quiet round these parts, but I'd really love to hear what you've all been up to.
As for me, I went along to the Cochrane Symposium last Friday. It was a great opportunity to learn more about what the Cochrane Collaboration are involved in, and meet lots of great people who work in healthcare... including an old university lecturer of mine!
I wrote a summary for the Policy Team, but thought to share it with you too. I'm posting it below. Let me know if you have any questions, or want to have a chat about the day.
As I mentioned, I went along to the Cochrane Collaboration last Friday, before Raelene's birthday bash. Symposium is a just a fancy word that means meeting or conference.
The theme of the day was 'Evidence, Communication, and Impact'.
It was quite a good turnout, with around 200 people attending. There was a good range of speakers presenting, from Cochrane staff, doctors, researchers, and a lone journalist.
The main things I got out of the day was a clearer understanding of what the Cochrane Collaboration do, and how this assists with policy and decision making. So, without further delay…
What does the Cochrane Collaboration do exactly?
This is probably not new information to you, but it certainly helped me understand what Cochrane do. The Cochrane Collaboration are a not-for profit organisation who work to make sure that the most up to date and accurate information about healthcare interventions are available. The information in the reviews they produce is used to inform policy and healthcare decisions. Research --> Cochrane review to summarise available research --> policy and practice.
They produce what they call 'Systematic Reviews' or 'Cochrane Reviews'. A review will focus on a particular topic and will draw on the research that is currently available in this area, and will provide a summary or a recommendation. For example, say there is a need to produce guidelines to help GPs prescribe drugs for the flu. Cochrane will take a look at all the evidence that is available on flu drugs, and list flu drugs in order of those that are the most effective, to those that are the least effective. An organisation that is producing the guidelines for GPs can then use this information to inform their recommendations.
How do they compare interventions in order to make a recommendation?
Reviews of research are not necessarily straight forward. Say, one research paper finds that Drug A is more effective than Drug B. Another paper finds that Drug B is more effective than Drug A. A third paper finds that Drug B is more effective than Drug C, and yet another finds that Drug C is more effective than Drug A. How does Cochrane determine which drug(s) is the most effective?
Comparing multiple interventions is a real challenge, especially when research is conflicting. Georgia Salanti, who works in a Cochrane statistics group in Greece, spoke about what methods they use to compare multiple interventions to produce meaningful information for their reviews. It is pretty technical stuff, but basically, they have to use indirect evidence as well as direct evidence. An example of indirect evidence - if Drug A is more effective than Drug B, and in another study Drug C is more effective than Drug A, then you can sort of infer that Drug C is more effective than Drug B, even though they weren't directly compared. They use these direct and indirect comparisons to produce a map of the drugs, to help them work out which ones are more effective than others.
What about when things go wrong?
Another session I found particularly interesting was held by Chris Del Mar, who works in the Cochrane Respiratory Infections Group in the UK, and spoke about what can go wrong when using published data to produce a review. In a nutshell, Cochrane found themselves in hot water some time ago, when they produced a review on a flu drug, using an existing published review. It turns out the published review that Cochrane used was actually sponsored by Roche, and did not report on serious adverse effects of the drug, eg suicidal tendencies in young people. The Cochrane review, which also didn't list these complications, came under fire for not using primary data.
Cochrane are currently trying to access all primary data in order to produce an updated review, but Roche are not being too helpful in this regard. The key learning here is to use the primary data when you can, and not published data/reviews. Chris ended by saying that journals are essentially the "marketing arms of pharmas" and not to be too trusting in what they publish. Very interesting indeed!
Cochrane have posted the audio and slides of each plenary session if you're interested in any of the other sessions.