From Cochrane to NICE: effectiveness, efficiency and the social-democratic origins of evidence-based medicine in the British NHS

Evidence-based medicine (EBM) has become the dominant mode of validation in health research, with the randomized control trial (RCT) the gold standard tool for treatment evaluation. This article traces the slow but certain rise of the RCT in Britain since 1948, where evidence was inextricably linked with management of the National Health Service, socialized and free at the point of use. It uses the 1971 publication and reception of epidemiologist Archie Cochrane’s book Effectiveness and Efficiency: Random Reflections on the Health Service as a lens through which to understand the political and clinical motivations for applying EBM in the health service, reducing clinical autonomy in order to ensure cost efficiency. Cochrane’s work had a direct causal link to the establishment, in 1998 under New Labour, of the National Institute for Clinical Excellence (NICE), a body that used a mixture of RCT evidence, stakeholder engagement and cost–benefit analysis to determine treatment approval, and which was made possible by 1990s innovations in information technology and library science. The article argues that there was a strong connection between evidence-based medicine based on RCTs and socialist medical thought in Britain, in relation to validation, the regulation of market interests and restriction of consumer choice, in order to maintain the economic feasibility of a socialized health service.