Nephrol Dial Transplant (2014) 0: 1–7 doi: 10.1093/ndt/gfu232 Full Review Celebrating 20 years of evidence from the Cochrane Collaboration: what has been the impact of systematic reviews on nephrology? Suetonia C. Palmer 1,2 , Jonathan C. Craig 1,3 , Ann Jones 1,3 , Gail Higgins 1,3 , Narelle Willis 1,3 and Giovanni F.M. Strippoli 1,3,4,5,6,7 1 Cochrane Renal Group, Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 2 University of Otago Christchurch, Christchurch, New Zealand, 3 Sydney School of Public Health, Sydney, Australia, 4 Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy, 5 Diaverum Scientific Office, Lund, Sweden, 6 University of Bari, Bari, Italy and 7 Amedeo Avogadro University of Eastern Piedmont, Piedmont, Italy Correspondence and offprint requests to: Giovanni F.M. Strippoli; E-mail: strippoli@negrisud.it ABSTRACT It has been 20 years since the Cochrane Collaboration started the global effort to synthesize evidence to improve healthcare. Since 1997, the Cochrane Renal Group has produced over 100 system- atic reviews that have collectively had an important impact on nephrology care, guidelines and policy. In this article, we reflect on the ongoing need for randomized trials and systematic reviews in contemporary nephrology and the achievements of the Cochrane Collaboration so far. We also describe some of the challenges in clinical research still faced by the nephrology community today. Keywords: evidence, meta-analysis, randomized trial, system- atic review COCHRANE: WHY THE NAME? HOW WAS IT FORMED? Cochrane is named after Archie Cochrane. In 1971, Archie, a Scottish physician and epidemiologist, wrote a book ‘Effective- ness and Efficiency: Random Reflections on Health Services’ [1]. In many ways, he was way ahead of his time, and his argu- ments are as relevant now as they were then. The book starts with a simple premise that ‘all effective treatment must be free’. This leads on to a discussion of methods for evaluating the effects of healthcare interventions, and he identifies randomized trials as the most reliable way of doing so. He also recognizes in publicly funded healthcare systems that equal attention must be paid to efficiency, ensuring that scarce resources are used to maximize outcomes—perhaps even more relevant now, given the ever-increasing costs of health care in times of austerity. Cochrane noted that the hypertension research community had failed to conduct randomized controlled trials, and attributed this to the tradition of ‘pure’ research that had always considered randomized trials a rather borderline activity. This criticism could be equally levelled at the nephrology community today. In 1979, Cochrane participated in a forum on ‘Medicines for the year 2000’ organized by the UK Office of Health Eco- nomics. During this he commented, ‘It is surely a great criti- cism of our profession that we have not organized a critical summary by specialty or sub-specialty, updated periodically, of all relevant randomized controlled trials (RCTs)…’. Co- chrane also speculated in the same commentary on which branch of medicine was the least scientifically based, judging by ‘the extent that they had used RCTs to evaluate what they were doing and the extent to which they acted on their results’. It was the gynaecologists and obstetricians who received the unwelcome award of ‘the wooden spoon’, because of their failure to randomize home- and hospital-based delivery for low-risk women, cervical cancer screening, induction of labour, use of ultrasound, foetal monitoring and placental function tests. He suggested that GO (gynaecology and obstetrics) could ‘stand for GO ahead without evaluation!’. © The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. 1 NDT Advance Access published July 12, 2014 by guest on February 19, 2016 http://ndt.oxfordjournals.org/ Downloaded from