OB-GYN-L Messages for June, 1996: Re: Cochrane Peer Review

Re: Cochrane Peer Review

From: Murray Enkin

enkin@fhs.csu.McMaster.CA

Tue Jun 4 16:47:41 1996

First, to clarify, I am no longer on the Cochrane Pregnancy and Childbirth editorial team, although I am still strongly committed to the importance of systematic reviews of the best evidence. The editors now are Jim Neilson in Liverpool, Mary Renfrew in Leeds, Marc Keirse and Caroline Crowther in Adelaide, and just recently added have been Ellen Hodnett in Toronto and Justus Hofmeyr in Johannesburg. I know that the new editorial team will bring fresh ideas, and continued improvement in both the content and format of the database.

For the next while, to the best of my knowledge, there will be no further releases of the Pregnancy and Chilbirth database as a separate disk issue; subscribers will receive, instead, copies of the Cochrane Library, which will be updated quarterly. The Cochrane Library contains those systematic reviews from the Pregnancy and Childbirth database that have been updated into the Cochrane format (as well as a great deal of other important and useful information). 'Pre-Cochrane reviews' will not be included in the Cochrane library, but I understand that most of these will be updated to the Cochrane format and included as soon as possible.

I am satisfied that the editors are as anxious as you to see 'an iterative process that can take into account published comments and criticisms'. I do not personally think that they mean published elsewhere (although I of course cannot speak to what is in their minds). I think (no inside information) that the plans are to publish these comments and criticisms along side the reviews, perhaps as an integral component. In any case, I certainly hope that is the case. I agree with you that this feed-back is essential.

In any case I hope that you, other users of the database, and members of the ob-gyn-l list will communicate your concerns and suggestions directly to the editors. The Pregnancy and Childbirth team can be reached by email at: sonjah@liverpool.ac.uk and the Cochrane Collaboration at: general@cochrane.co.uk

Despite their growing pains, I think that The Pregnancy and Childbirth database, and the Cochrane Library, are extremely important sources of the best available evidence on the effectiveness of maternity care procedures. I hope that they will be both constructively criticized and nurtured.

-- Murray W. Enkin, Professor Emeritus Depts of Obstetrics and Gynaecology, Clinical Epidemiology and Biostatistics McMaster University, 1200 Main St. W., Hamilton, Ontario, Canada L8N 3Z5

********************** At 11:53 AM 6/4/96 -0500, Jason Gardosi wrote: >The Cochrane Pregnancy and Childbirth database is being quoted increasingly >on this list, as elsewhere, and this is surely a good thing. Any push >towards evidence based medicine is to be applauded. The two principal roles >I see for Cochrane is as a reference of published and ongoing controlled >trials; and for the reviews and meta-analyses. > >I am feeling increasingly uncomfortable though with the way this latter role >has been adopted and reviews are taken at face value without being subject >to independent review themselves. I am reading reviews which just do not >seem to stand up to scrutiny yet are quoted as Gospel. Some RCTs have been >included and heavily weighted even though their methodology is less than >adequate. Two good examples are the selection of trials in the sections on >Induction of labour and EFM. > >The element that is sorely missing is a mechanism in which the reviews >themselves can be peer-reviewed, or at least alternative views published on >the appropriateness of some of the trials which are included. > >There is a section within the Database which acknowledges that there need to >be <snip> .....Procedures and strategies for maintaining and raising the >standards of Cochrane Reviews: ... One of the most important of the proposed >strategies is to facilitate comments and criticisms, both of electronically >published protocols and of 'completed' Cochrane Reviews. As outlined by >Chalmers and Haynes (BMJ 1994;309:862-5), it should be possible to establish >an iterative process through which the reviewers and editors in >Collaborative Review Groups can take into account published comments and >criticisms when preparing and maintaining the reviews for which they have >accepted responsibility....<snip> > >Ideally, such comments/criticisms should not have to be first published >elsewhere, but allowed for in some sort of correspondence / second opinion >section as part of the review in question. This would require active >encouragement for a response and to allow space to publish appropriate >feedback - critical or otherwise - with the next 6 monthly disk issue, as a >section of each review. > >There seems to be space for this in the new format but this is not utilised. >Any further progress on this matter? I am sure Cochrane himself would not >have wanted the debate to be stifled. Several years since the database has >started to be marketed, this is one publication which is not peer reviewed >nor even has a correspondence section. We ought to take this into >consideration when we see reference made to this - otherwise potentially >most valuable - endeavour. > >I wonder whether Murray Enkin or any other editors/members of the Cochrane >collaboration who might be on this list would share their views? > >Jason >Jason Gardosi MD FRCS MRCOG >OB/GYN, Queen's Medical Centre >Director, PRAM (Perinatal Research, Audit & Monitoring) >University of Nottingham, UK >Tel +44 115 9709211 Fax +44 115 9709791 >jason.gardosi@nottingham.ac.uk >

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