In February 2007, India created history by becoming the first, and only, low-income country to purchase a national provision for all its residents to access the online resources of The Cochrane Library (www.thecochranelibrary.com).
This initiative of the Indian Council of Medical Research (ICMR), is an example of responsible leadership in healthcare, as it enables all people in India with an internet connection to access without further payment, reliable, independent, and updated evidence for the safety and efficacy of the myriad treatments in use covering all branches and specialties of medicine, surgery, nursing, dentistry, rehabilitation, as well as other aspects of healthcare delivery.
The first step
The first step in effective healthcare is ready access to reliable evidence of whether treatments work, and if they do, how effective they are likely to be; and how safe.
The Cochrane Library provides a one-stop portal for the best evidence available on the efficacy and safety of interventions that healthcare professionals, health policy makers, and consumers of healthcare interventions need to make well-informed decisions that concern their health.
The Cochrane Library is a collection of six databases at the core of which is The Cochrane Database of Systematic Reviews (CDSR). The April 2011 release of this resource has over 6500 articles, making this the world's largest collection of such reviews.
Well-conducted trials
These systematically assembled research articles summarize the results of well-conducted clinical trials from around the world that evaluate how effective and safe healthcare interventions are for a particular condition compared to other interventions in use for that condition, or to no interventions.
In addition to these reviews of interventions, the CDSR also contains systematic reviews of how accurate diagnostic tests are that are used to detect and diagnose particular diseases or healthcare conditions.
No biases
These reviews are prepared according to pre-determined methods that reduce the chances that biases and the effects of chance would influence the results. They are prepared by members of the Cochrane Collaboration (www.cochrane.org), an international organization of over 28,000 researchers, clinicians, and health professionals from over 100 countries, who are not funded by drug companies, and who use the best available methods to locate, select, evaluate, and summarize the effects of relevant research.
Standard methods
Cochrane Systematic Reviews are peer-reviewed and supported by strong editorial teams who use standard methods to ensure a high degree of accuracy and transparency, and scientific rigor.
They have been found to be more trustworthy than reviews from other sources, particularly those from the pharmaceutical industry.
These systematic reviews are used by many international and international organizations, such as the World Health Organization, to frame guidelines for the management of healthcare conditions such as tuberculosis, malaria, reproductive health, childbirth, cancer, anemia, nutritional disorders, etc.
For the lay person
All reviews have, in addition to the full article that can be downloaded, short abstracts, as well as plain language summaries meant for the lay person to understand.
The Cochrane Library also contains the Cochrane Central Register of Controlled Trials (CENTRAL), the world's largest collection of bibliographic information, often with a summary, of clinical trials from published and unpublished sources, identified by groups within the Cochrane Collaboration.
There are currently over 6, 45,000 records of clinical trials in CENTRAL, far more than in PubMed or other commonly used databases. These records include over 2500 clinical trials of clinical trials conducted in India and other countries in South Asia that are not available in PubMed and similar databases.
South Asian database
These trials were identified by the South Asian Cochrane Centre in India and are also available in the South Asian Database of Controlled Clinical Trials (www.cochrane-sadcct.org). They are now available to be included in Cochrane Systematic Reviews, thereby increasing the relevance of these reviews to healthcare in India and the region.
The other databases in The Cochrane Library include the Database of Abstracts of Reviews of Effects (DARE) that contains quality-appraised summaries of systematic reviews published in other journals; The Cochrane Methodology Register(CMR) that provides bibliographic information about publications that report on the methods of conducting clinical trials; the Health Technology Assessment (HTA) Database that provides details of completed and ongoing assessments of the medical, social, ethical, and economic implications of healthcare interventions from around the world; and The NHS Economic Evaluation Database (EED) that provides details of quality-appraised economic evaluations of healthcare interventions from around the world.
A seventh database provides information about the 81 groups that contribute to the Cochrane Collaboration.
India, a user
India is now not only a user of health research generated by others but also a significant contributor to providing evidence of the effects of healthcare interventions.
Statistics provided by the Cochrane Collaboration on the top 50 reviews (http://www.cochrane.org/cochrane-reviews/top) accessed on April 26, 2011 places the review titled “Zinc for the common cold” as the Cochrane Review that was the most accessed review worldwide with 3363 hits in the last 30 days of the abstract from www.cochrane.org alone.
This review was conducted by a team from the Postgraduate Institute at Chandigarh, and the press release by the publishers of The Cochrane Library in February 2011 that accompanied its publication saw over 800 articles in various media around the world in the first two days after publication, and about 1000 references to it by day 10 — twice as many as any other Cochrane press release to date (http://www.cochrane.org/features/widespread-media-coverage-cochrane-review-zinc-common-cold).
Data provided by the publishers also indicates that in 2008, a full text article was downloaded from The Cochrane Library by users in India every 7 minutes and over 70,090 such downloads took place that year.
Still growing
The usage continues to grow every year and there are an ever increasing number of contributors, as authors and editors, and peer-reviewers to the Cochrane Collaboration from India.
However, if this investment by the Indian government to ensure that people in India have access to research evidence they can trust are to be fully realized, more people should use resources in The Cochrane Library as the first point of reference for evidence to inform health decisions.
( The author is Director of the South Asian Cochrane Network & Centre (www.cochrane-sacn.org) based at the Prof BV Moses and ICMR Centre for Advanced research In Evidence-Informed Healthcare at the Christian Medical College, Vellore )
