By Tom Perry
University of British Columbia
and Alan Cassels
University of Victoria
Imagine you’re Justin Trudeau. You’re flush with energy and idealism in a country where “better is always possible.” But the priorities you face as Canada’s new prime minister are many.
Now imagine you’re Canada’s new minister of health. Trudeau hands you a list of priorities: improve the health of First Nations, develop a national seniors health strategy and advance the files related to dementia, diabetes, marijuana and assisted dying. Oh, and the provinces want bigger health budgets and there’s a clear call for a national pharmacare plan.
Clearly you’d want to approach these daunting challenges with the most reliable, comprehensive and unbiased information available, instead of being swayed by lobbyists. Assuming you expect that policies and programs should be based on treatments or interventions that are optimal, safest and give best value, where would you turn?
Since 1993, the internationally-acclaimed Cochrane Collaboration has been a key global health resource. It is comprised of some of the world’s leading health scientists, and supported by nearly 40,000 volunteers who sift, organize and summarize healthcare evidence. Among the eminent founders of Cochrane was the late Dr. David Sackett of McMaster University, considered the godfather of evidence-based medicine (EBM). Sackett worked tirelessly to develop methods for assessing the evidence to enlighten healthcare and make it more successful.
The first Cochrane review looked at whether it is helpful to give corticosteroids to a woman during premature labour, to help her baby’s lungs develop and prevent complications after birth. Some studies were positive; others not. Synthesizing all the evidence from seven trials of prenatal corticosteroids revealed what single studies could not. As Cochrane’s founder, Sir Iain Chalmers, said of that systematic review, “We made the point that tens of thousands of babies had suffered and died unnecessarily (and cost health services more than they need have done) because information had not been assembled in a systematic review and meta-analysis to show the strength of the evidence.”
There are now many Cochrane researchers preparing systematic reviews in a huge variety of areas, ranging from drugs and surgical treatments to nursing, physiotherapy and education. The Cochrane Library contains thousands of systematic reviews, painstakingly organizing evidence that helps patients, health professionals and policy makers make sound healthcare decisions.
Canada has always pulled its weight in the Cochrane Collaboration, leading in such areas as hypertension, back pain, arthritis and child health. In the last five years alone, Cochrane Canada has completed or updated more than 300 systematic reviews and trained nearly 3,000 people in review methods.
The cost? A mere $2 million per year, within the range of a rounding error in the overall budget of the Canadian Institutes for Health Research (CIHR), which has funded Cochrane Canada for the last decade.
That’s why it was such a surprise to hear that the CIHR terminated Cochrane Canada’s funding in September of this year. It was yet another blow to scientific research in what has been a dark decade for scientific independence in Canada. Internationally, Cochrane Collaborations have always depended on government funding, including in the U.K., U.S., Australia, Denmark and dozens of other countries that recognize the value of independent, unbiased research synthesis.
Cochrane reviews supply vital, independent information for patients, doctors and health policy-makers around the world, and Canada needs to be at the table preparing those reviews. The Canadian Medical Association Journal recently called for Cochrane Canada’s base funding to be reinstated, knowing what a vital source this organization is for our doctors.
It would be a prudent first step for Dr. Jane Philpott, Canada’s new health minister, to reinstate funding to Cochrane Canada. It needs the funding to continue to provide the necessary base of quality, balanced and comprehensive evidence from which federal and provincial health officials can make informed decisions.
If Canadian scientists aren’t allowed to play an international role during this era of real health change, the repercussions will affect us all.
Dr. Tom Perry is a medical specialist at UBC in Vancouver, and a former minister of Advanced Education, Training and Technology in B.C. Alan Cassels is a pharmaceutical policy researcher at the University of Victoria. He is the author of the new book, The Cochrane Collaboration: Medicine’s Best Kept Secret.