Cochrane Collaboration joins AllTrials

That’s right, earlier today, the Cochrane Collaboration announced that it has “formalized its commitment to the AllTrials: All Trials Registered | All Results Reported initiative.”

This is great news, but I’m honestly a bit surprised that it took them so long. The Cochrane Collaboration is currently celebrating its 20th anniversary as a leader in the movement for evidence-based medicine. It was started as an answer to Archie Cochrane’s (a British epidemiologist) calls to maintain up-to-date, systematic reviews of randomized controlled trials (RCTs) of medical interventions. Cochrane Reviews, as they are called, are the gold standard in systematic reviews in the medical literature. This is because they use rigorous, standardized methods, published in the Cochrane Handbook, to ensure that the reviews are consistent, transparent, comprehensive, and as objective as possible. They are also accessible for free in over 100 low and middle-income countries (LMICs) (too bad they’re not open access).

When I first heard of Cochrane a few years ago, I couldn’t believe that something like them wasn’t already standard practice across the board. Come to think of it, I felt the same way when I first heard of “evidence-based medicine” for the first time. Wait, you mean huge portions of medical practice (even if you don’t count so-called “alternative” “medical” woo like homeopathy) are not based on evidence? Yes, it’s unfortunately true, or at least it was true before evidence-based medicine began to gather steam in the last two decades. Take, for example, the Cochrane logo:

cclogo300x350

The logo is what is called a forest plot[1] and this one is a tragic reminder of the danger of not using systematic reviews. Each horizontal line shows the results of one study. The vertical line is the point where the treatment does not help people, but it doesn’t hurt them either. The left side of the vertical line means that the treatment is good and the right side means that it’s bad. The length of the line shows how precise the results are (the shorter the line, the more precise it is). If a line touches the vertical line, that means the treatment didn’t make a clear difference. The diamond at the bottom is what you get when you combine all the studies. In this case, it’s for giving hormones called corticosteroids to pregnant women who are going to give birth too early in order to prevent their babies from dying. The study at the top was done in 1972.[2] Ten years later, it should have been clear that the corticosteroids worked (we now know they reduce the odds of babies dying by 30% to 50%). But, a systematic review was not published until 1989, so many doctors did not know how good corticosteroids were. Because of that, tens of thousands of babies probably died.

 It’s not an exact science, and it takes a lot of hard work to develop systematic reviews, but they really do save lives and prevent needless suffering. However, even though Cochrane has the world’s largest database of clinical trials, it is still vulnerable to the effects of not reporting the results of trials, or of not even registering them in the first place. I’m glad to see them join the campaign to get all trials registered and all results reported.

1. Though the plots themselves were being used by at least the 1970s, the term “forest plot” itself was not used in print until 1996 in Pittsburgh in a poster presented at a meeting of the Society for Clinical Trials in May 1996.

2. The 1972 study looks like it should have been clear that corticosteroids are awesome after just one study, but it’s risky to trust just one study. Science works because we’re always testing each other’s theories and questioning our results. If no one else can get the same results, then we throw them out and try something else.

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Take that, Sebelius!

A judge ruled today that Plan B can once again be purchased OTC for women of all ages (well, in 30 days it will be)! For now, they’re still behind the counter and only women 17 and over can buy them without a prescription.

My new favorite judge, U.S. District Judge Edward Korman, had a great quote in his ruling:

The invocation of the adverse effect of Plan B on 11- year-olds is an excuse to deprive the overwhelming majority of women of their right to obtain contraceptives without unjustified and burdensome restrictions.

And to think, Judge Korman was appointed by Reagan!

In response to the ruling, Nancy Northup, president of the Center for Reproductive Rights, said,

“Today science has finally prevailed over politics.”

Planned Parenthood said the ruling was,

“good policy, good science and good sense”

It warms my heart to see social justice advocates invoke science in their victory speeches.

It was only a little over a year ago, Dec. 2011, that Kathleen Sebelius, the Secretary of Health & Human Services, made the unprecedented decision to nix the strong FDA recommendation to make Plan B available to all, because of “cognitive and behavioral” differences in girls of the youngest reproductive age.

The case: Tummino v. von Eschenbach, 05-cv-366, U.S. District Court, Eastern District of New York (Brooklyn)

AllTrials Update

Since I first posted about the AllTrials campaign to have All Trials Registered and All Results Reported, it has gathered considerable support. More than 40,000 people have signed it and hundreds of organizations have joined as well, including GSK (one of the biggest pharmaceutical companies in the world), AMSA (American Medical Student Association), the British Medical Association, many disease-specific research and advocacy organizations.

Their new goals are:

  • One million signatures on the petition
    • Every 10,000 new signatures, they’ll send the petition to health ministers in every country and to regulators.
    • Share this link to spread the word.
  • More international organisations signed up. (unfortunately very few U.S.-based orgs)
  • £40,000 so they can keep going. Donate here.

Here’s a video (~90 min) of Ben Goldacre, one of the leaders behind AllTrials, explaining the problems with clinical trial reporting that make AllTrials is necessary. He was promoting his new book, Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients, but it’s still a good talk. The book’s been sitting on my bedside stand for 2 months now. Hopefully I’ll get around to reading it soon.

Petri dish art

Zachary Copfer has started a Kickstarter campaign to fund his bacteriography, a fusion of microbiology and art. I’m not quite sure of his technique but I’m guessing he rasterizes black-and-white photographs and then uses a special printer to lay down bacteria for the shadows and antibiotics for the lights. I wonder, though, about the medium and diffusion rates, which could require extra adjustment of the image sent to the printer. He’s even used GFP E. coli for glow-in-the-dark images of things like the Milky Way and a “velocirabbit,” a velociraptor-rabbit hybrid, but I’ve gotta say, the Charles Darwin image is my favorite.

Bacteriograph of Charles Darwin.