Effectiveness and Efficiency: Random Reflections on Health Services

Archie Cochrane was an epidemiologist with a maverick streak. In 1935, as a lone medical student, he marched through London carrying a home made placard that read, “All effective treatments must be free.” According to him, nobody noticed. In this seminal book, first published in 1972 by the Nuffield Provincial Hospitals Trust and issued in this imprint in 1999, he called for an international register of randomised controlled trials, and for explicit quality criteria for appraising published research, but neither goal was achieved in his lifetime. Today, the Cochrane Controlled Trials Register has more than 400 000 entries, and an international movement to improve the methodology of research synthesis also bears his name (http://www.cochrane.org/index0.htm). A passionate early advocate of the NHS, Cochrane described it in Effectiveness and Efficiency as “a favourite child who is now showing signs of delinquency.” …