title: Who cares? The lost legacy of Archie Cochrane.
abstract: Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's bookEffectiveness and Efficiencyfrom 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, isnotpart of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences inEffectiveness and EfficiencyFrom these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner.
authors.affiliation: Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Clemet
authors.initials: C
authors.lastname: Askheim
authors.affiliation: Faculty of Humanities, Department of Cultural Studies and Oriental Languages, University of Oslo, Oslo, Norway.
authors.forename: Tony
authors.initials: T
authors.lastname: Sandset
authors.affiliation: Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Engebretsen
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D008093:Literature, Modern / Q000266:history*; D016032:Randomized Controlled Trials as Topic; D006113:United Kingdom
keywords: Health policy