Cochrane Collaboration: more than systematic reviews?

The Cochrane Collaboration is an international organisation that aims to help people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health-care interventions1. By providing a reliable synthesis of the available evidence on a given topic, systematic reviews adhere to the principle that science is cumulative and facilitate decisions that consider the totality of available evidence. A decade after it was founded in 1993, the Cochrane Collaboration can boast over 9000 contributors from nearly 90 countries, easily making it the largest organisation involved in this kind of work. As early as 1995, this endeavour was being heralded as the health services research equivalent of the human genome project2. The scale of the Cochrane Collaboration's achievements is evident from The Cochrane Library where the number of completed reviews now exceeds 2000 and the number of protocols stands at nearly 1500. In addition to the reviews, The Cochrane Library includes the Cochrane Central Register of Controlled Trials, which comprises over 415 000 references to completed and ongoing controlled trials compiled by members of the Collaboration in a coordinated global search. Three of the remaining resources include non-Cochrane systematic reviews, health technology assessments and economic evaluations. The Collaboration's achievements in publishing reviews and identifying trials have contributed to greater reliability and reduced bias in research. The Cochrane Methodology Register contains over 5000 reports of empirical studies of trial and review methodology, many of which are now being synthesised in systematic reviews in the Cochrane Database of Methodology Reviews. Members of the Collaboration have also facilitated advances in the quality of clinical trials. The extensive trials register has provided the raw material for trialists to study the effects of different methods and focused attention on the importance of conduct and reporting of trials. These advances have not only led to improvements in the internal validity of systematic reviews and trials, for example in highlighting the importance of allocation concealment and blinding, but also influenced broader issues of research conduct. Recent position statements by the Cochrane Collaboration have addressed the influence of commercial sponsorship on the results of systematic reviews and the importance of prospective registration of clinical trials. The Cochrane Collaboration's policy on commercial sponsorship was developed in response to concerns about the potential influence of commercial sponsorship on the results of Cochrane reviews, and the desire to avoid perceptions that may adversely affect these reviews and the Collaboration's reputation for impartiality and scientific rigour3. The policy prohibits sponsorship of a Cochrane review by any commercial source or sources with financial interest in the results of a review, and sets down clear guidelines for the funding of Cochrane entities (the groups which make up the Cochrane Collaboration). The consequences of failing to disclose the results of clinical trials received a flurry of recent media attention4, but many have long argued that not publishing trials is scientific misconduct5. The recent statement by the Cochrane Collaboration on registering clinical trials prospectively advocates for all randomised trials to be registered at inception, and for this information to be accessible to all interested parties6. Prospective registration not only helps to highlight gaps in research activity and avoid duplication, but is the only the way to prevent biased underreporting of clinical trials and so improve the reliability of systematic reviews. Now in its second decade, the Cochrane Collaboration is increasingly directing attention to the second part of its mission of promoting the accessibility of Cochrane reviews. A recent paper in the Lancet called for global access to health-care information by 20157. The Cochrane Collaboration is a key contributor to achieving this goal. But accessibility has many components; it is as much to do with relevance and ease of understanding as it is with simply making reviews available and easy to find. In a growing number of countries The Cochrane Library is available free to all citizens through the government purchase of a national licence. National provisions to The Cochrane Library make Cochrane reviews available to all people living in that country with access to the Internet, and have the potential to bring reliable health information to those most affected by health-care decisions, such as health-care consumers and their families. The Cochrane Collaboration is working towards improving the usability of reviews. The Collaboration's new publisher, John Wiley & Sons Ltd, and the publication of The Cochrane Library within Wiley InterScience will bring a new look and functionality to The Cochrane Library. There is also an increasing focus on the development and promotion of derivative products from Cochrane reviews. Examples of derivative products include clinical guidelines and summaries, tools to assist consumer decisions and collections of reviews within a defined clinical area. The Canadian Cochrane Centre and Network, on behalf of the Collaboration, has recently compiled an inventory of over 70 resources (print and online) that use and disseminate Cochrane reviews8. Increased availability, access and ease of understanding will facilitate increased use of Cochrane reviews only if they are relevant. It is estimated that at least 10 000 Cochrane reviews are needed to cover a substantial proportion of the existing evidence on the effects of health-care interventions9. This task gets larger daily as more research is conducted. However, without systematic reviews there is a serious risk that some tens of billions of dollars already spent on hundreds of thousands of controlled trials will have been wasted if the findings from those individual trials are not placed in context and made accessible in a standard, structured way10. With such an enormous task ahead, many Cochrane review groups are working to prioritise topics needed to increase the global relevance of The Cochrane Library. Furthermore, the Collaboration's developing countries initiative and projects such as SEA-ORCHID (South-East Asia – Optimising Reproductive and Child Health in Developing Countries)11 aim to encourage representation in the Collaboration from countries with the greatest health-care need. To date, the Cochrane Collaboration has restricted its remit to reviews of the effects of health-care interventions, both therapeutic and preventive. Last year the Collaboration began developing the methodology and infrastructure needed to undertake high quality systematic reviews of diagnostic test accuracy. It will be a few years before these reviews are available, but their inclusion in The Cochrane Library will strengthen the reputation of the Cochrane Collaboration as a provider of reliable up-to-date and relevant information for people making decisions about health care. The past decade has seen the Cochrane Collaboration develop into a mature and devolved organisation meeting its mission of preparing, maintaining and promoting access to systematic reviews. Increasingly, members of the Cochrane Collaboration are becoming involved in areas aligned to, but not encompassed by, this mission. Examples include strategies to close the gap between evidence and practice, calls for equity in the provision and generation of health-care information, promotion of relevance in medical research and development, and the setting of universal standards for the conduct and reporting of research. Whether the next decade will see an expansion of the Cochrane Collaboration's mission and sphere of influence to include activities beyond the production and promotion of systematic reviews will be debated at the 13th Cochrane Colloquium in Melbourne in October 2005. Resources and further information are available from the following websites: The Cochrane Collaboration: http://www.cochrane. org The Cochrane Library: http://www.thecochranelibrary. org We thank Mike Clarke for his comments on this manuscript.

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