Time to restore Cochrane funding
Imagine you’re Canada’s new Minister of Health, Dr. Jane Philpott. Prime Minister Justin Trudeau hands you a new list of priorities: improve the health of First Nations, develop a national seniors health strategy and advance the files related to dementia, diabetes, marijuana and assisted dying. Oh, and by the way, the provinces want bigger health budgets and there’s a clear call for a national pharmacare plan.
Clearly, you’d want to approach these daunting challenges with the most reliable, comprehensive and unbiased information available, instead of being swayed by the best-connected lobbyists. Assuming you expect that healthy policies and costly health care programs should be based on the best evidence to determine which treatments or interventions are optimal, safest and best value, where would you turn?
Since 1993, the internationally acclaimed Cochrane Collaboration has been a key global resource comprised of some of the world’s leading health scientists and supported by nearly 40,000 volunteers who systematize, sift and summarize health care evidence. Among the eminent founders of Cochrane was the late Dr. David Sackett of McMaster University, considered the godfather of evidence-based medicine. Like other leading medical scientists, Sackett felt compelled to stop medicine from operating in ignorance, and worked tirelessly to develop methods for assessing the evidence to enlighten health care and make it more successful.
The first Cochrane review looked at whether it is helpful to give corticosteroids to a woman during premature labour, to help her baby’s lungs develop and prevent complications after birth. Some studies were positive; others not. Synthesizing all the evidence into a “systematic review” of seven trials of prenatal corticosteroids revealed what single studies could not. As Cochrane’s founder, Sir Iain Chalmers said of that systematic review, “We made the point that tens of thousands of babies had suffered and died unnecessarily (and cost health services more than they need have done) because information had not been assembled in a systematic review and meta-analysis to show the strength of the evidence.”
There are now many Cochrane researchers preparing systematic reviews in a huge variety of areas, ranging from drugs and surgical treatments to nursing, physiotherapy and education. The Cochrane Library contains thousands of systematic reviews, painstakingly organizing evidence that helps patients, health professionals and policy makers make sound healthcare decisions.
Over the years, Canada has always pulled its weight in the Cochrane Collaboration, leading in such areas as hypertension, back pain, arthritis and child health. Our output has been momentous and in the last five years alone, Cochrane Canada has completed or updated more than 300 systematic reviews and trained nearly 3,000 people in review methods.
The cost? A mere $2 million per year, within the range of a rounding error in the overall budget of the Canadian Institutes for Health Research (CIHR), which has funded Cochrane Canada for the last decade.
That’s why it was such a surprise to hear that the CIHR terminated Cochrane Canada’s funding in September of this year. It was yet another blow to scientific research in what has been recognized internationally as a dark decade for scientific independence in Canada. Internationally, Cochrane Collaborations have always depended on national governments around the world, including branches in the UK, US, Australia, Denmark and dozens of other countries that recognize the value of independent, unbiased research synthesis.
Cochrane reviews supply vital, independent information for patients, doctors and health policymakers around the world and Canada needs to be at the table preparing those reviews. The Canadian Medical Association Journal recently called for Cochrane Canada’s base funding to be reinstated, knowing what a vital source this organization is for our doctors. We couldn’t agree more. It is essential for Canadian health science – but also for Canadian health governance.
It would be a prudent first step for the Health Minister to reinstate the funding for Cochrane Canada so that Cochrane can continue to provide the necessary base of quality, balanced and comprehensive evidence from which the new Minister, along with their provincial counterparts, will have to weigh so many future decisions. It would be a shame to pull Canadian health scientists from the global stage now in what’s been promised as an era of real change. The repercussions would affect us all.
Dr. Tom Perry is a medical specialist at UBC in Vancouver, and a former Minister of Advanced Education, Training and Technology in B.C. Alan Cassels is an expert advisor with EvidenceNetwork.ca and a pharmaceutical policy researcher at the University of Victoria. He is the author of the new book, The Cochrane Collaboration: Medicine’s Best Kept Secret.
This blog is reprinted with the kind permission of the Evidence Network.