Cochrane library's database not an unequivocal blessing
The Indian Council of Medical Research (icmr) has recently purchased access rights to contents published in the uk-based Cochrane library's website. It contains evidence to assist decision-making related to healthcare, including reviews, clinical trials and results of research worldwide.
The contract is for three years and the database is available at www.thecochranelibrary.com. "icmr is a progressive organisation. We hope to do more good work in this part of the world and produce many Cochrane reviews with Indian contributors," says Lorne Becker, co-chair of the Cochrane Collaboration steering group. Experts develop these reviews, putting out conclusions for doctors and consumers. There are three-monthly updates.
The database provides information on about 50 topics, such as infectious diseases, on which around 105 reviews are available. Even neglected tropical diseases are included. "This will help bring evidence-based medicine to the forefront of medical practice in India," says Prathap Tharyan of the Christian Medical College, Vellore, and coordinator, South Asian Cochrane Network.
But there are pitfalls, say experts. "It is easy for pharmaceutical companies to influence reviews," says Jacob M Puliyel, head of the paediatrics department, St Stephen's Hospital, Delhi. He cites a study by him and some colleagues to find whether it would be worth stocking surfactant--supposed to decrease mortality in premature babies. They found it didn't. A Cochrane review, however, supported its use. When the group analysed the review, it found the analysis did not suggest better survival. The conclusion was based on the fact that fewer children died if data for 30 days after birth was considered.
"How many parents would consider survival for 30 days a crucial end point if their baby did not survive to go home?" ask the researchers in a letter in the British Medical Journal (October 2004). The reason is obvious, Puliyel says. The principal investigator for trials of pulmonary surfactant, R F Soll, was a consultant for companies manufacturing it.