Systematic reviews aim to reduce bias and provide accurate information about healthcare interventions by synthesizing evidence from multiple studies. Their evolution began in the early 20th century with early statistical meta-analyses. Later, Archie Cochrane advocated for regularly updating specialized reviews of randomized controlled trials to inform clinical practice. This led to the formation of the Cochrane Collaboration in the 1990s to produce freely accessible systematic reviews and promote evidence-based healthcare worldwide.

1. “The James Lind Library:
explaining the rationale for
and evolution of
systematic reviews”
Iain Chalmers
ichalmers@jameslindlibrary.org
Opening of the Austrian Branch
of the Cochrane Collaboration
14 December 2010

2. Fund raising
advertisement for the
United Nations
Association, just before I
left the UK to work in
the Gaza Strip in 1969

3. Gaza
Learning the hard lesson that
- acting with the best of intentions -
„do gooders‟ sometimes do
more harm than good.

4. One of several
personal examples

5. Should I have given antibiotics
prophylactically to children
with measles?

6. Severe malnutrition following measles

7. Some children developing measles in the Gaza Strip
in 1969 and 1970 suffered and probably died
unnecessarily because I withheld prophylactic
antibiotics, as my teachers at medical school had
told me to do.

8. Six controlled trials,
all reported before I went to Gaza,
showed that:
antibiotics prescribed for children with
measles can reduce their risk of
developing pneumonia

9. Am I the only health professional
who has been misled by
medical authorities and experts?

10. JAMA 1992;268:240-248.

12. Conclusions
“Advice on some life-saving therapies
has been delayed for more than a
decade, while other treatments have
been recommended long after controlled
research has shown them to be harmful.”
Antman et al. JAMA 1992;268:240-248.

13. In brief…
science is cumulative,
and scientists should
cumulate scientifically.
The process of cumulation
(information synthesis) should
use methods to reduce
biases and the play of
chance.

14. Lord Rayleigh, 1842-1919
“One of the very few members of the higher nobility
who won fame as an outstanding scientist.”

16. “If, as is sometimes supposed, science
consisted in nothing but the laborious
accumulation of facts, it would soon come to
a standstill, crushed, as it were, under its
own weight…The work which deserves,
but I am afraid does not always
receive, the most credit is that in which
discovery and explanation go hand in
hand, in which not only are new facts
presented, but their relation to old ones
is pointed out.”
Lord Rayleigh, 1884

17. Because information about the
effects of healthcare interventions
has not been synthesized
systematically and kept up to date,
people have suffered and died
unnecessarily

18. Who was James Lind and
what has he got to do with this?

19. James Lind, 1716-1794

22. www.jameslindlibrary.org

24. Some illustrations of the
evolution of information
synthesis in health research

25. Two definitions relevant in discussions
of information synthesis
(Last, Dictionary of Epidemiology, 2001)
Systematic review: The application of
strategies that limit bias in the assembly,
critical appraisal, and synthesis of all
relevant studies on a specific topic.
Meta-analysis: The statistical synthesis of
the data from separate but similar, i.e.
comparable studies, leading to a
quantitative summary of the pooled
results (so reducing the play of chance).

26. Karl Pearson (1857-1936)

29. Park WH, Bullowa JGM, Rosenbluth NM (1928).
The treatment of lobar pneumonia with refined
specific antibacterial serum. JAMA 91:1503-8.

30. Jan Stjernswärd

34. In 1979, Archie Cochrane awards
obstetrics and gynaecology „the
wooden spoon‟ for being the medical
speciality least informed by scientific
evidence, and observes:
"It is surely a great criticism of our
profession that we have not organised a
critical summary, by speciality or
subspeciality, adapted periodically, of
all relevant randomized controlled trials.“

35. Early 1980s
An international collaboration
is established to prepare and
maintain systematic reviews of
controlled trials in pregnancy and
childbirth.

40. 1989: publication of:
Effective Care in Pregnancy and
Childbirth (ECPC)
A Guide to Effective Care in
Pregnancy and Childbirth (GECPC)
Oxford Database of Perinatal
Trials (ODPT)

41. 1992
This ‘pilot experience’ leads the
NHS R&D Programme to fund
‘a Cochrane Centre’
'to facilitate the preparation of
systematic reviews of randomized
controlled trials of health care'

42. The Cochrane Collaboration:
an international, independent, not-for-profit organisation
of over 27,000 contributors from more than 100
countries, dedicated to making up-to-date, accurate
information about the effects of health care readily
available worldwide.

43. A reminder
“The work which deserves, but I am afraid
does not always receive, the most credit is
that in which discovery and explanation go
hand in hand, in which not only are new
facts presented, but their relation to old
ones is pointed out.”
Lord Rayleigh, 1884

44. Austin Bradford Hill, 1965
Four questions to which
readers want answers
when reading reports of
research.
1. Why did you start?
2. What did you do?
3. What answer
did you get?
4. And what does it
mean anyway?

45. *
*actually, the non-use
Only 11 of 24 responding authors of trial reports
that had been added to existing systematic
reviews were even aware of the relevant reviews
when they designed their new studies.

46. Austin Bradford Hill, 1965
Four questions to which
readers want answers
when reading reports of
research.
1. Why did you start?
2. What did you do?
3. What answer
did you get?
4. And what does it
mean anyway?