Professor (Dr) Prathap Tharyan
(first published online here): The Indian Council of Medical Research (ICMR) created history in February 2007 when India became the first and only low-income country in the world with a national subscription to The Cochrane Library. This initiative of the ICMR to purchase a national license was widely hailed as an exemplar of responsible leadership in health-research governance, as it gave all people in India with an internet connection free access to the online collection of reliable evidence-based resources to aid health decisions. Easy access to trust-worthy summaries that synthesize all relevant evidence, and that is not influenced by the marketing manipulations of drug companies, is the key step in evidence-informed health care; as it facilitates the working together of public and private health providers and their patients to better understand treatment options.
(first published online here): The Indian Council of Medical Research (ICMR) created history in February 2007 when India became the first and only low-income country in the world with a national subscription to The Cochrane Library. This initiative of the ICMR to purchase a national license was widely hailed as an exemplar of responsible leadership in health-research governance, as it gave all people in India with an internet connection free access to the online collection of reliable evidence-based resources to aid health decisions. Easy access to trust-worthy summaries that synthesize all relevant evidence, and that is not influenced by the marketing manipulations of drug companies, is the key step in evidence-informed health care; as it facilitates the working together of public and private health providers and their patients to better understand treatment options.
The increased use of the
resources in The Cochrane Library
over the three years of the national provision led to the ICMR renewing the subscription
for India-wide free access for a further three years to January 2013. This
renewal created history again, since India became the first middle-income country
in the world with a national provision; having moved in the interim from being
a low-to a middle-income country. The current national provision expired on 31
January 2013, and is up for renewal.
Unless the national license is renewed, before the two-month extension granted by the publishers also expires, people in India will have free access to The Cochrane Library only till midnight on March 31, 2013.
Why should India renew the national license to free, one-click access to The Cochrane Library?
Access to trusted evidence to inform decisions for better health
The Cochrane Library is a collection of six databases that is the world’s single best source
of reliable and timely evidence for the effects of interventions used in
healthcare, and of the accuracy of tests used to diagnose health problems.
One of these is the Cochrane Database of Systematic Reviews
(CDSR) that is produced, updated, and disseminated by The Cochrane Collaboration. This global organisation,
founded in 1993 and registered as a charity, is a partnership of more than 30,000
active contributors, nearly 25,000 of who are authors of Cochrane Reviews. Many
are world leaders in their disciplines and work in reputed academic institutions
and organizations in over 100 countries. These researchers work with editorial
teams (Collaborative Review Groups) to produce high-quality summaries of the
evidence in the form of systematic reviews. Systematic reviews are scientific
studies that follow transparent and pre-stated methods to identify all relevant
research studies on a specific topic; assess them for limitations in their
methods that could result in misleading results; and, if appropriate, combine
the results of similar studies using statistical techniques called meta-analyses
that provides averaged estimates of the effects of the interventions compared
in all the relevant studies. The results for important outcomes are also summarised
in tables that link the numerical results with the confidence that these estimates
are likely to be true; generalizable; and not altered significantly by further
research.
Cochrane Reviews compare the
effects of pharmacological, non-pharmacological, and public health
interventions, as well as the manner in which health services are organized and
delivered. Some assess the accuracy of
tests used for screening and diagnoses of health conditions. Cochrane Reviews are powered by rigorous, constantly
evolving methods that have pioneered and driven the field of research
synthesis. Cochrane Reviews are also independent of funding from the
pharmaceutical industry, and are judged to be more reliable than non-Cochrane systematic reviews.
The Database of Abstracts of Reviews of Effects (DARE) contains
abstracts of systematic reviews published in other journals; many provide a quality-appraised,
structured summary prepared by the Center for Reviews and Dissemination at York
in the UK.
The Cochrane Library is thus a one-stop portal to the full records or abstracts of most of the
systematic reviews published in the world.
The world’s largest database of controlled clinical trials
The
Cochrane Library also contains The
Cochrane Central Register of Controlled Trials (CENTRAL), the world’s
largest database of published and un-published randomized controlled trials.
This register is compiled through contributions from Collaborative Review Groups;
the Cochrane Centers and their branches worldwide; and others within the
international Collaboration.
Other databases provide
records of economic evaluations, health technology assessments, and of studies
evaluating research methods.
No other single resource can match The Cochrane Library for the scope and
quality of data provided to guide health decisions.
The Cochrane brand: Trusted evidence for better health
The Cochrane Collaboration represents the health-research
and health-services equivalent of The Human Genome Project, according to an article in The Lancet. The Cochrane Collaboration
is a Non-Governmental Organization in Official Relations with the
World Health Organization (WHO) and has a seat on the World Health
Assembly. This provides the Collaboration an opportunity to influence the way
research evidence is generated and used by the WHO in developing policies and
guidelines for use worldwide.
The Cochrane Collaboration enters
the 21st year of its existence as the world’s leading provider of
independent, trusted, high-quality systematic reviews, and derivative products,
to inform health decisions.
It’s steady growth and global influence is a vibrant testament to the view
that, “with collaborative partnerships, rigorous scientific methods and a
principled approach, evidence of, by, and for the people, can indeed be a
reality.”
Evidence of the people, by the people, and for the people
The evidence in The Cochrane Library is about the health
conditions that affect all people; and embodies the efforts of many millions of
people with diverse health conditions who consent to participate in research
that may, or may not, directly benefit them. It also reflects the efforts and
skills of researchers who conduct the primary studies and of those who synthesize
the results. To ensure that this collaboratively-generated body of evidence is actually
made available to everyone is a priority for The Cochrane Collaboration. The
abstracts of all Cochrane Reviews are free to everyone in the world to read, but
access to the full text of these high-quality reviews and to the other content
in The Cochrane Library requires a
subscription. The Collaboration and its publishing partner, Wiley-Blackwell,
have promoted various funded initiatives since 2007 to ensure that people in
109 countries in some of the most impoverished parts of the world have free one-click access to reliable evidence regarding their
healthcare needs.
Ensuring that reliable
evidence is accessible to all people, particularly to those living in
low-income countries with a disproportionate burden of disease and who are most
in need of this evidence, yet who have competing priorities for their limited
resources, is a major challenge. This is because some countries, who fall in
the category of upper, low-income countries, in the World Bank listings, like
India did in 2007, do not qualify for free access. This challenge of ensuring
wider global access has been complemented by the increasing numbers of provisions funded by governments or other agencies in middle-
and high-income countries that now ensure that more than half the world’s
population have free access to Cochrane evidence. For example, in 2012, new
national provisions were funded by governments in Oman and Egypt; and the
National Health and Medical Research Council of Australia funded the renewed licence
for Australia-wide access to The Cochrane
Library for the next five years.
These examples signify the
importance placed by governments, of ever increasing numbers of countries, in Cochrane
evidence; and for wide-spread access to this evidence.
Investing in evidence for better health: Evaluating the impact of the national subscription to The Cochrane Library in India
Negotiations continue,
I am given to understand, between the ICMR and Wiley-India on renewal of the
national subscription for India. Meanwhile, I invite your comments on what you consider
was the impact of spending hard-earned, tax-payers’ money to provide free
access in India to The Cochrane Library. I shall enumerate herein, different ways that
I consider that this impact can be measured. I request your additional
contributions, as well as alternative, even if contradictory, views by which
this re-investment in reliable evidence should be evaluated.
These comments may help the ICMR to fully appreciate the impact that their initiative has had
on the health of people in India, and in other parts of the world; and also
reveal the views of people who use this evidence, so that decisions regarding
the renewal of the national subscription may be better informed.
1. Compiling and comparing statistics on usage of The Cochrane Library
Compiling
and comparing incremental statistics of the number of page views of each of the
online databases of The Cochrane Library,
and the number of full text-downloads of Cochrane Reviews from the CDSR,
provides valuable data on the interest people in India have shown in accessing these
resources.
The problem with this traditional approach to evaluating the impact
of the national subscription is that reliable statistics are only available for
those accessing The Cochrane Library directly
from the online Wiley-interface (www.thecochranelibrary.com) and not from other sources
by which readers can access The Cochrane
Library such as PubMed, PubMed Health, the OVID platform, the EBSCO platform,
summaries viewed in www.cochrane.org, those accessing Cochrane Reviews on handheld/mobile
devices, etc. These statistics do not also include access to individual reviews
from institutional or other repositories that authors may have deposited their
reviews in; or from the DVD version of The
Cochrane Library that the contact authors of new and updated reviews are
provided. It is therefore an under-estimate
of the usage and impact of Cochrane evidence.
Figure 1 (provided by Wiley-India)
records the dramatic increase in the number of full text articles downloaded
from The Cochrane Library by users in
India over the six years of the national provision.
Figure 1: Usage statistics
for full text downloads from The Cochrane Library in India (2007-2012)
The growth in full text
downloads mostly relate to full texts of Cochrane Reviews (~85%) and reflects
an absolute increase of 162,401 reviews downloaded by people from all regions
in India in 2012 compared to the 9,338 reviews downloaded from 11 institutions
in India with an institutional subscription in 2006. This represents an 18-fold
increase in downloads of the full-text of Cochrane Reviews, over a wider
geographical spread in India, through the six years of the national provision.
Before
the national subscription was purchased in 2007, downloads of full-text
articles averaged around 500 per month (in 2006). By 2009, at the end of the
first contract for national provision, this had increased to an average of 4500
per month. In 2012, the last year of the second national license, on average
14,311 full text articles per month were downloaded from The Cochrane Library in India. This represents a 29-fold increase
in downloads per month over the six years of the two periods of national provision,
compared to 2006.
The Cochrane Library is accessed by numerous
users from all walks of life in India. Wiley-Blackwell, the publishers,
estimated that in 2009 someone in India downloaded an article from The Cochrane Library every 12 minutes;
this is likely to have been considerably more frequent in 2012.
The
increase in usage was appreciably greater during the period of the second
national provision (2010 to 2012) compared to the first three years of national
access. This could partly be due to the publicity that accompanied the 2nd
South Asian Regional Symposium on Evidence- Informed Health Care and Health
Policy hosted by the South
Asian Cochrane Network and Centre (SASIANCC) at the Christian Medical
College, Vellore in January 2010 that saw over 650 participants and witnessed
44 plenary talks (including one by the Department of Health Research and the
ICMR) and 22 skills-building workshops. Other dissemination workshops organized
by Wiley-India, and also by Network
Sites of the SASIANCC and the Centre in various parts of the country through
2011 and 2012, undoubtedly contributed to increased usage of The Cochrane Library during the last two
years. This suggests that usage over the next few years is likely to grow
rapidly, especially with the publicity and participation envisaged by the 22nd
Annual Cochrane Colloquium that will be hosted by the SASIANCC at the Hyderabad International Convention
Centre from 21-25 September 2014.
Figure 2: Full text
downloads from 2006-2012 from the top ten countries with a national provision
India
ranked fourth worldwide in 2012, after the UK, Australia, and Canada (all
countries with a longer history of engagement with Cochrane), for the number of
full text articles downloaded from countries with a national provision. India
ranked fifth when downloads were compared overall for all countries; with the
US that has a mixture of academic subscriptions and funded provisions in some
states and provinces leading the list of countries accessing Cochrane content
worldwide (Figure 2: courtesy Wiley-Blackwell).
India
does not figure so prominently in any other worldwide ranking of indicators of
good health, healthcare, or healthcare governance.
These
statistics do not completely capture the usage of the resources in The Cochrane Library in India: during
2009, 47,024 additional visits were made in India to The Cochrane Library and 84,441 abstracts were viewed. During 2012
there were 55,096 additional visits from readers in 20 Indian states and union
territories to The Cochrane Library homepage.
Surveys
using Google-analytics as a proxy indicator of interest in Cochrane in India,
and to reflect healthcare information-seeking behaviour of healthcare
professionals, researchers, students, and consumers, were presented during the
regional symposium at Vellore in 2010. They revealed that “Cochrane‟
consistently scored more frequently than the four top-ranked Indian health
portals (MedInd, Health Library, Doctor NDTV and Web Health Center, over the
period 2004 to 2009; with a dramatic increase following the national provision,
and periods of increased activity reflecting national Cochrane-related
workshops or symposia.
“Cochrane‟
also scored above Indian journals (Indian Journal of Medical Research, National
Medical Journal of India, Journal of the Association of Physicians of India,
the Postgraduate Medical Journal and others) and international journals (NEJM,
The Lancet, BMJ and JAMA) for the most commonly-searched term in Google during
these years.
These
surveys mirror data from Wiley-Blackwell on usage of The Cochrane Library from 2007-2009.
However under-estimated these statistics are
of actual usage, they nevertheless do tell us that people in India are
increasingly using The Cochrane Library
to access and download Cochrane Reviews.
2. Providing clinicians and patients with information relevant to their evidence requirements
Indian
users of The Cochrane Library are
reading Cochrane Reviews on a range of topics relevant to their needs. Table 1 (provided by Wiley-India) below,
shows the 10 most downloaded Cochrane Reviews in India in 2012.
Table 1: Top 10
downloaded Cochrane Reviews in India: 2012
Rank
|
Cochrane Review Title
|
Authors
|
Topic
|
1.
|
Green S, Buchbinder
R, Hetrick SE.
|
Rheumatology
|
|
2.
|
Panpanich R,
Garner P.
|
Child health
|
|
3.
|
Pollock A,
Baer G, Pomeroy VM, Langhorne P.
|
Neurology
|
|
4.
|
Galappaththy
GNL, Omari AAA, Tharyan P.
|
Infectious
disease
|
|
5.
|
Waters E, de
Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R,
Prosser L, Summerbell CD.
|
Heart &
Circulation
|
|
6.
|
Holloway EA,
Ram FSF
|
Lungs &
airways
|
|
7.
|
Li Y, Tang X,
Zhang J, Wu T.
|
Kidney
disease
|
|
8.
|
Bleakley C,
McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW.
|
Orthopaedics
& trauma
|
|
9.
|
Teixeira LJ,
Valbuza JS, Prado GF.
|
Neurology
|
|
10.
|
Rutjes AWS,
Nüesch E, Sterchi R, Jüni P.
|
Complementary
& alternative medicine
|
This
table also demonstrates the range of clinical topics provided by Cochrane
Reviews that Indian readers consider relevant; they differ considerably from
the top 10 reviews accessed worldwide (Table 2- courtesy: Wiley-Blackwell).
Table 2: Top 10 most
accessed Cochrane Reviews worldwide in 2012 with comparative 2011 ranking
3. Dissemination of news in the Indian media about the results of Cochrane Reviews
International
newspapers and other media channels regularly carry stories based on Cochrane
Reviews. Indian media are consistently among the top five countries that carry
news about Cochrane Reviews. This ensures that readers from a wide-spectrum of
the public are regularly informed about the evidence (or lack of evidence) for
benefits and harms regarding health interventions that they might be
prescribed. Many of these news stories are archived in web
pages of The Cochrane Collaboration, and reflect the in-depth understanding of
these reviews that go into the preparation of these reports. The media has also
seen debates around the relevance of evidence-based medicine in India that have
provided opportunities to educate the public on the nuances of evidence-informed health care.
4. Contributing to global evidence for better health: from passive recipients to active contributors
India
is considered by many, including its politicians and many of its business
leaders, as an emerging economy with an impressive record of domestic growth,
and with an increase in its demands for inclusion and influence in global
politics and commerce. Moving out of the World Bank listing of low-income
countries to the status of a middle-income country requires a change in
mind-set: from being a passive recipient of foreign aid, to assuming greater
responsibility for ensuring equity and quality in healthcare for its people.
Contributing to building the evidence-base to inform health decisions that
affect its people is an important part of this greater responsibility;
contributing evidence to inform the health of people in other parts of the
world is an extension of this responsibility.
The national provision to The Cochrane Library provided clinicians and researchers in India free access to the best that research synthesis could offer, and stimulated interest in them to contribute to this global collection of reliable evidence.
In
February 2013 the Information Management System (IMS) of the Collaboration
listed 75 Cochrane reviews and 73 published protocols of reviews with a contact
author living in Bangladesh, India, Pakistan, Nepal and Sri Lanka (countries
represented by the SASIANCC). The contact authors of 59 full reviews and 48
protocols of reviews in progress were from India. In contrast, in 2006 there
were 11 reviews and protocols with a contact author from India.
However,
the numbers of authors who are involved in producing Cochrane reviews as
co-authors (and not the contact author) are far greater. In February 2013 there
were 186 protocols and 185 Cochrane Reviews listed in the IMS that had an
author from one of the countries represented by the SASIANCC; authors of 110
Cochrane reviews and protocols were living in India. This system also listed
435 people from India as registered active authors in February 2013; this
represents a 36-fold increase in the number of authors compared to the 12
authors from India in 2006.
There
are also 10 editors of Cochrane Review Groups in India. India now hosts the
South Asian Cochrane Center one of the 13 independent Cochrane Centers around
the world that advocates regionally for evidence-informed health decision
making.
None
of these would have been possible if India did not have universal free access
to the reliable evidence from Cochrane Reviews.
Cochrane
Reviews with Indian authors are contributing to global evidence for better
health. The Cochrane Review “Zinc for the Common Cold” authored by Prof Meenu
Singh and Rashmi Das from the Post Graduate Institute (PGI), Chandigarh received
6886 full-text downloads globally in 2011, and was also the most widely disseminated news report of a Cochrane Review
in the world, “getting over 800 mentions across various media in the first two
days after publication, and about 1000 mentions by day 10 in newspapers,
television and radio (including in about 21 non-English languages)”.
The
Cochrane Review “Corticosteroids for acute
bacterial meningitis” that lists Prof Kameswar Prasad from the All India Institute of
Medical Sciences (AIIMS), New Delhi, as an author, has been cited 184 times. One of the top 10 most-accessed reviews
globally in 2008 (Ayurvedic medicine for schizophrenia) was authored by
Indian contributors, further evidence of
The Cochrane Library’s role in extending
the global reach and international profile of medical research from India.
5. Influencing local, national and international health policies
Cochrane
Reviews, with and without Indian authors, have influenced decisions in Indian
medical institutions; and have contributed to Indian and International health
policies and health decisions. An example of a local decision where Cochrane
evidence helped was presented by Dr Kadhiravan Tamilarasan, a Cochrane author
who is on the faculty of the nationally-funded Jawaharlal Institute for
Postgraduate Medical Education and Research (JIPMER) at Pondicherry, and was a
member of a institutional committee formed to rationalise the use of free
prescriptions for intravenous immunoglobulin that were being used for a variety
of conditions. Evidence from 35 Cochrane Reviews on the effects of intravenous immunoglobulin
for various indications, and of alternatives, was used to generate a list of
conditions where immunoglobulin therapy was reported to be effective and safe,
and to drive a policy that provides free immunoglobulin treatment only for these
indications.
One
of the most down-loaded Cochrane Reviews in India in 2012 evaluated primaquine dosing for malaria due to Plasmodium vivax, with authors from Sri Lanka, UK and India, and
was published in January 2007. The
results were actively disseminated with the help of the ICMR, and were incorporated
in the updated Indian Malaria guidelines in May 2007. The results of this
review were also incorporated in subsequent editions of Park & Park’s textbook
of community medicine that is widely used in medical schools in India. An updated version of this review will inform
forthcoming revisions of the WHO Malaria treatment guidelines.
A Cochrane
Review with authors from South Africa, India and the UK, informed the
Government of India’s decision to not provide nutritional supplements for people with tuberculosis (TB)
in India, based on limited evidence of benefits. Updates of this review will
also inform forthcoming revisions of the WHO guidelines on treating TB.
An
updated Cochrane Review of deworming drugs in children that included primary studies
from India demonstrated a lack of many of the postulated benefits; however, deworming
programmes are still in vogue in many states in India. Access to the full content of this review was
important in order to inform policy makers about considering changes to Indian
policies regarding targeted deworming of children. Access also helped us in
preparing and disseminating shorter evidence summaries of the rationale, methods, results and public-health
implications of this review, accompanied by a commentary by a clinical expert.
Another
Cochrane Review showed a lack of benefit on mortality and morbidity from routine health checks of healthy adults; yet such “master
health checks” are very common, and are a source of considerable income to hospitals
in the private sector in India; they are also funded by employers and by health
insurance. Here too, access to the full text can inform policy revisions; and
was used to prepare evidence summaries with a clinical commentary
for dissemination.
These
are but selected examples of Cochrane evidence informing policy decisions; and
many other examples, no-doubt, exist that you may be aware of.
6. Building capacity in India to undertake high-quality Cochrane Reviews and to use Cochrane evidence in informing health decisions
Forthcoming
Cochrane Reviews with author teams from India will provide high-quality
evidence on a variety of health questions of regional and global importance, such
as alternatives to isoniazid in treating HIV-negative people with latent-TB
infection; the role of intermittent treatments in treating childhood TB;
interventions to prevent reactions due to anti-snake venom; and the role of
Ayurveda in the management of rheumatoid arthritis. These and other such
reviews of relevance to healthcare in India and other low- and middle-income
countries are mentored by the Effective Health Care Research Consortium that is funded by
UKaid (Department For International Development) to improve health outcomes in
low- and middle-income countries.
The
ICMR funded for five years an ICMR Center for
Advanced Research and Training in
Evidence-Informed Healthcare at CMC Vellore, and is currently funding
a Center for Advanced Research in Evidence-Based Child Health at PGI
Chandigarh. The
main activities of these centers are to build capacity in India to
undertake
relevant systematic reviews.
The
Cochrane Collaboration has also invested some of the royalties from the global
sales of The Cochrane Library in funding
four global projects that aim to increase the capacity in authors in low and
middle-income countries to produce Cochrane Reviews that will impact on health
outcomes locally and globally.
The
South Asian Cochrane Centre is partnering the Centre for Innovations in Public Systems (CIPS) that
functions out of the Administrative Staff College at Hyderabad, to ensure that
health policy-makers in the Ministries of Health and Family Welfare at the
national and state levels are familiar with the resources in The Cochrane Library and the role of
Cochrane evidence in informing national and state health spending.
Full access to Cochrane content is crucial for these initiatives to have any of the intended benefits for people in India.
7. Identifying gaps in the evidence base and driving high-quality research
Cochrane
Reviews also provide an opportunity to identify those interventions and conditions
for which insufficient evidence exists to adequately inform health decisions;
these interventions could be prioritized for funding and for undertaking primary
research.
Examples
of such evidence gaps that have spawned primary studies in India include two
pragmatic
trials evaluating the role of interventions used in the management of
psychosis induced aggression. Insufficient evidence from a search of The Cochrane Library and other sources
regarding the optimal dose of anti-snake venom to deal with snake envenomation,
that claims the life of more than 50,000 people in India, led to the
development of protocols for observational studies. These studies will see
a unique partnership of herpetologists, clinicians, venom detection experts and
anti-venom manufacturers collaborating to ensure better health outcomes for the
many thousands of Indians in rural areas who are bitten, often fatally, every
year by venomous snakes.
The
rigorous methods used in Cochrane Reviews ensures that those undertaking these
reviews, as well as those using these reviews, learn about good research
methods, such as assessing the risk of bias in primary studies; the importance
of using appropriate outcomes and estimates of effects such as risk ratios with
their confidence limits; and about assessing the overall quality of the
evidence using the GRADE
approach. These methods also stress the importance of incorporating the
elements of transparent
and reliable reporting of research that are specific for the type of research
question, in study protocols. The
Cochrane Handbook for Systematic Reviews of Interventions and of Diagnostic
Test Accuracy, provided free for anyone to download and use, are excellent
resources to understand the challenges and approaches to research synthesis. The
propriety software used to prepare Cochrane Reviews and for meta-analysis (Review Manager), and
to prepare summary tables of the important findings of systematic reviews (GRADE
Profiler), are also free to download
and use by anyone. Many non-Cochrane
reviews by researcher in India (and elsewhere) regularly search The Cochrane Library and its Central Register of Controlled Clinical Trials. Many also use
the methods used in Cochrane Reviews and prepare their reviews using Cochrane
software; thus improving the quality of their reviews.
The
impact that The Cochrane Collaboration has had in India is exemplified by the ICMR’s
recent call for proposals for researchers in India to undertake systematic
reviews. The ICMR has invested in six funded-systematic reviews dealing with topics
in maternal and child health, following a call for proposals, with members of
the SASIANCC helping with the selection process. These reviews will be
conducted by teams trained in Cochrane methods and will use Cochrane software to
prepare these reviews.
Without
free access to The Cochrane Library, these contributions to global evidence
from India will decline considerably.
8. Inspiring initiatives to facilitate the practice of evidence-based medicine in India
The
Cochrane Student’s
Journal Club is a student-led online journal club, launched by students in
India and endorsed by The Cochrane Collaboration. It uses clinical scenarios to
help students frame answerable research questions, and guides them in finding
and interpreting evidence from a relevant Cochrane Review in order to help
students understand the steps of evidence-based medicine (EBM).
Many
leading institutions have training programmes for undergraduate and post-graduate
students to ensure that tomorrow’s doctors will be better equipped to ensure
the practice of EBM
in India.
The
International
Society for Evidence-Based Health Care (ISEHC) held their inaugural
conference at Delhi recently with the mission of developing, and encouraging
research in, the appropriate usage of evidence in health care decision making
and to promote and provide professional and public education in the field. The
Indian Chapter of the ISEHC was also established to ensure better practice of
EBM in India. These initiatives will complement that work of The Cochrane
Collaboration in India and elsewhere.
None
of these initiatives will succeed without the cornerstone of evidence-informed
health care- reliable evidence from Cochrane Reviews.
Investing in a national provision to The Cochrane Library: the bottom line- value for money
The special introductory price that was brokered by the SASIANCC, and facilitated by well-wishers in The Cochrane Collaboration, and the World Health Organization, with John Wiley, the publishers in 2007, and the ICMR, was considerably lower than the astronomical initial asking price that was based on the formula used for other national provisions, where every head of the population is charged 10 to 15 US$ for national access. A realistic re-assessment of those among the over 1 billion Indians with sufficient literacy in English who also had regular access to the internet and were likely to access The Cochrane Library, reduced the pool of potential users of The Cochrane Library to around 60 to 100 million people. The introductory price was reflective of this reduced pool of potential users. The price for renewals follows the same principle, with marginal increases to account for inflation. Considering the number of full-text downloads in 2012 and the cost to India for the national license for 2012, the cost of each download works out to less than one US$. The cost of accessing an article in the Cochrane Database of Systematic Reviews currently is 35 US$.
The many instances detailed herein indicate that renewing the national license will provide richer dividends than can be evaluated by the usage statistics; or the cost per download; or impact factors- of which the CDSR has one of the fastest growing among medical journals.
The true
impact lies in the lives saved through the use of effective treatments and the
withholding of ineffective or harmful treatments.
True
leadership facilitates the realisation of the vision of others that are aligned
to achieve mutual objectives. The SASIANCC salutes the ICMR and the Department
of Health Research for exemplary leadership in research governance that
facilitated considerable progress towards achieving the vision of The Cochrane
Collaboration: that all health decisions (in India, the region, and the world)
will be informed by reliable evidence. So
much more remains to be done and world continues to need visionary leadership
to achieve better health outcomes for all people.
For
value of money, I believe that the ICMR and the Department of Health Research
can do very little to better the impact on health that renewal of the national
license can achieve in India.
What do you think?
Declaration of Interest: I am the Director of The South Asian Cochrane Network & Centre (SASIANCC). Without free national access to The Cochrane Library, the SASIANCC will find its work largely irrelevant to the people of India. We are committed to finding ways to ensure nation-wide access in India continues.
Professor (Dr) Prathap Tharyan
(Author is the Director of South Asian Cochrane Network and Centre (SASIANCC), Christian Medical College (CMC), Vellore)
March 2013
Published in:
Citizen News Service, India.
Asian Tribune, India/Thailand/Sri Lanka
News Wala, Hyderabad, India
Modern Ghana, Ghana
Scoop World, New Zealand
Manglorean.com, Mangalore
World Tribune, Pakistan
Pakistan Christian Post, Pakistan
World News Network, USA
News Blaze News, USA
I4U News, India
Silobreaker.com
Published in:
Citizen News Service, India.
Asian Tribune, India/Thailand/Sri Lanka
News Wala, Hyderabad, India
Modern Ghana, Ghana
Scoop World, New Zealand
Manglorean.com, Mangalore
World Tribune, Pakistan
Pakistan Christian Post, Pakistan
World News Network, USA
News Blaze News, USA
I4U News, India
Silobreaker.com
