Righteous mischief from Archie Cochrane

April 14th, 2010 by Ben Goldacre in bad science, heroes, heroes of bad science, statistics, uncertainty | 10 Comments »

imageWorking on an editorial about the importance of evidence based social policy, I re-discovered this moment of genius from Archie Cochrane which I thought I’d share. It’s 1971, he’s part way through a randomised trial comparing Coronary Care Units against home care, and the time has come to share some results with the cardiologists.

I am not asking you to appreciate the results: this was a long time ago, and the findings will not be generalisable to modern CCU’s.

I am inviting you to appreciate the mischief.

The results at that stage showed a slight numerical advantage for those who had been treated at home. I rather wickedly compiled two reports: one reversing the number of deaths on the two sides of the trial. As we were going into the committee, in the anteroom, I showed some cardiologists the results. They were vociferous in their abuse: “Archie,” they said “we always thought you were unethical. You must stop this trial at once.”

I let them have their say for some time, then apologized and gave them the true results, challenging them to say as vehemently, that coronary care units should be stopped immediately. There was dead silence and I felt rather sick because they were, after all, my medical colleagues.

The quote is from Non-Random Reflections on Health Services Research. It’s a romp.


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10 Responses



  1. Synchronium said,

    April 14, 2010 at 5:58 pm

    What a cheeky fellow!

  2. zeno said,

    April 14, 2010 at 6:27 pm

    If you don’t want to spend the £37.99 for the book Ben is reading, the same story is told in Taking the Medicine by Druin Burch at a slightly cheaper £6.99. Although not solely about Cochrane, it covers the history of medical trials and is a very enjoyable and informative read!

  3. fontwell said,

    April 14, 2010 at 8:24 pm

    Excellent! It has a touch of the Richard Feynman about it.

  4. Hifiwigwam said,

    April 15, 2010 at 9:45 am

    Genius! If only this sort of thing was more common.

  5. MrNick said,

    April 15, 2010 at 2:28 pm

    Wonderful story. Just the sort of thing that Richard Feynman would do.

    Currently out of stock, but the paperback edition is on amazon.co.uk for £17.95.

    Nick

  6. BigEoinO said,

    April 15, 2010 at 4:32 pm

    Saw this and didn’t know if you had…
    Think they’ve captured your hair especially well!
    crispian-jago.blogspot.com/2010/04/skeptic-trumps-ben-goldacre.html

  7. reprehensible said,

    April 16, 2010 at 4:53 pm

    Yeah that’s a good story i’ve had a few lectures tell now. The one Alan Maynard liked to go on about is a bit older, just found this new paper he’s done about it and PROMS.

    “The 1845 UK Lunacy Act required physicians to rate patients in terms of whether they were dead, recovered, relieved or unrelieved, requiring regular collection of data and levying fines on physicians who failed to comply. Although initially focused on psychiatry, this system was also applied to acute hospitals, in part because of the enthusiastic advocacy of Florence Nightingale. Emulating the 1845 legislation, she advocated the measurement of outcomes in terms of whether patients were dead, relieved or unrelieved.”

    Patient reported outcome measurement: learning to walk before we run. Alan Maynard,Karen Bloor J R Soc Med 2010;103:129-132 jrsm.rsmjournals.com/cgi/content/full/103/4/129 (restricted access)

  8. Robert Carnegie said,

    April 18, 2010 at 3:05 am

    I don’t understand the joke. Does “a slight numerical advantage for those who had been treated at home” mean that home patients were slightly more often dying? That doesn’t sound like an advantage – not to the patient.

  9. Robert Carnegie said,

    April 18, 2010 at 3:08 am

    I don’t understand the joke. Does “a slight numerical advantage for those who had been treated at home” mean that home patients were slightly more often dying? That doesn’t sound like an advantage – not to the patient.

    Skeptic Trumps – oh I see, this is like the pack of playing cards with pictures of the people involved in Iraq’s secret weapons of mass destruction manufacture.

    I thought they were saying that a skeptic (the against conventional science kind) had trumped Ben Goldacre.

  10. paddyfool said,

    April 23, 2010 at 10:09 am

    @Robert Carnegie,

    Death is generally considered disadvantageous. A “slight numerical advantage” for being treated at home means that the patients treated at home saw a slightly better outcome, but by a slight enough margin that it might just be random error. And if all-cause mortality were the primary outcome, then that would mean less deaths among those treated at home.

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