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F. XAVIER BOSCH Archie COCHRANE: back to the front F. XAVIER BOSCH archie cochrane: back to the front archie cochrane 5 THE COCHRANE COLLABORATION FIRST ediTIOn: JULY 2003 EdiTORS: F. XAVIER BOSCH RICARD MOLAS CoordinaTiOn AND SECRETARIAT: CRISTINA RAJO TraNSLATIOn: JOELLEN KLAUSTENMEIER EDITING: MARY KALDOR archie cochrane DESIGN: 6 RICARD MOLAS PHOTOGRAPH : ROBERT CAPA FRANCESC CATALÀ ROCA AGUSTÍ CENTELLES ALBERT FORTUNY PRINTED IN: COPYRIGTH TO ENGLISH EDITION DEPÓSITO LEGAL: C O N T E N T S Introductory note and acknowledgements Preface 1 Joan Clos Preface 2 Do you know Grañén?... by F. XAVIER Bosch archie cochrane Part 1 archie cochrane, The Man Interview to Sir Richard Doll 7 ARCHIE Cochrane and politics Julian Tudor HART The MRC research unit in Cardiff Peter Elwood & dick cohen An informal talk about archie cochrane Rolando Armijo an international profile Lester Breslow A long time friend WillIAM MYalL student’s regards: Susana Sans , Daan Kromhout & OTHER a sensible man: The artistic taste Peter Nicholas Sketches from the family: Maggie and Joe Stalker Part 2 The Context: A man of his time 2.1 The spanish civil war, a war of its own style A touch of friendship The political war and the international propaganda The PARTY militia and the popular army 2.2 The international brigades The brigades at a glance: JOSEP Soler Sabate & hugh Thomas 1937, Arrival to Barcelona: George Orwell & Archie Cochrane C O N T E N T S 2.3 War Medicine : Archie Cochrane in triage health services at the battle front dr. Moises Broggi Death of Julien Bell: Archie Cochrane & reggie saxton 2.4 Farewell to the brigades, farewell to Spain: G. Orwell & A. Cochrane 2.5 II World War. Medical care at the concentration camp prisoner of war Salonica: Trials at the camp 2.6 A research life in Wales: Archie Cochrane and Max Blythe back home Studies on screening: Archie Cochrane, Max Blythe and F. Xavier Bosch 2.7 Back to the front Forty years back: Archie Cochrane a triage of additional TRAVEL anecdotes: F. Xavier Bosch Part 3 The Legacy. The Cochrane Collaboration The roots of the Collaboration: sir Ian Chalmers the collaboration expands: Spanish speaking countries: Xavier Bonfill Italy: Alessandro Lisetti Germany: Gerd Antes China: Youping Li Part 4 Epilogue 4.1 Barcelona remembers the brigades and the civil war Barcelona, Guernica... the trials of a sinister saga: F. Xavier Bosch barcelona and the international brigades: francesc Bonamusa 4.2 The long lasting Scars of the Civil war in spain Unveiling the silence: Montserrat Armengol 4.3 Archie Cochrane wishes you well: Archie Cochrane, sir Ian Chalmers, sir richard peto I n t r o d u c t o r y n o t e a n d a c k n o w l e d g e m e n t s Many contributors have volunteered time materials and efforts to made this work possible and on time. Several of the ones who knew and collaborated with Archie are already well into their 80’s. Some, much younger, joined the effort at their busiest times, earlier in their careers. Our first words of acknowledgement and gratitude go to them. An effort has been made to sketch some of the features of the war and the political scenarios experienced in Spain in 1936-1937 archie cochrane using original fragments written either at the time by the par- ticipants or witnesses or, latter on, by authorized historians. The fragments previously published have been selected by the edi- tors trying to reflect fairly the general position and opinions 11 of the authors. Enjoy this work dedicated to a charismatic personality that tur- ned out to name an international collaboration associated with the use of reproducible methods in the interfaces between science, medicine and public health for the benefit of the sick. A challenge, FOR AN ENTIRE GENERATION, OUR challenge. The editors Archie Cochrane was a man of the 1930s. His character and lifelong convictions were formed by archie cochrane the cataclysmic events that brought Hitler to power and 12 plunged the greater part of the world into a devastating six-year war. In this he was not alone. What distinguished him from so many others of his generation was the depth of his emotional and intellectual reaction to these events and his fiery independence of mind, which prevented him from accepting any of the easy political situations and kept him a rationalist to the day of his death. Richard Doll, June 1989 13 archie cochrane archie cochrane 16 DR. F. XAVIER BosCh EPIDEMIOLOGIST Francesc Xavier BOSCH Barcelona 1947. Graduated in Medicine (University of Barcelona) and specialized in Oncology (Autonomous University of Barcelona) and Epidemiology (University of California at Los Angeles). Active in the student’s movements in the 60’s and 70’s, definitely oriented his career towards population studies and public health research. His recent interests focused in the field of viral infections and cancer, with some success in the investigation of Human Papillomavirus infections and cancer of the uterine cervix. Following an occasional encounter with Archie Cochrane, they revisited in 1978 some of the battle fields of the Spanish Civil War where Archie had served as part of the medical units of the International Brigades. Twenty-seven years latter, the story of that journey and the few notes and pictures taken at the time inspired the beginning of this book. The support of the Cochrane Collaboration and the enthusiasm of a disperse group of friends, colleagues, family and editors did the rest. The result is a vivid collection of anecdotes and images that attempt to provide in a subtle way a complementary view to the most known scientific contribution of a remarkable human personality. Periodically, Archie helps me to refresh my emotional ties with the Spanish Civil War. It happened at the time I first met him in Los Angeles, at the time of our journey back to the front, and whenever Archie comes into the conversation or a Cochrane review crosses my desk. P R E F A C E Do you know Grañén?... archie cochrane n the sophisticated hills surrounding Los Angeles, in the Westwood and I Bel- Air canyons, the Breslow’s were offering a party to welcome a distin- guished visitor: Archibald L. Cochrane, commonly addressed as Archie. It was almost summer and we enjoyed a beautiful day back in 1978. Lester Breslow 17 was at the time, the Dean of the Public Health School at the University of California in Los Angeles (UCLA) and Devra Breslow, the editor of the UCLA newsletter, was taking care of most of the significant social events around the University. Archie was a prominent epidemiologist and a passionate promoter of the Randomized Controlled Trial concept. He was persuaded this was the proper method to evolve towards evidence-based medicine. He was also an interesting character, a privileged mind and a politically determined gentleman. A guest at the party was Rolando Armijo, a professor of epidemiology at UCLA, arriving from Chile, still under the shock of the military coup and the distressing news from his home country. At the time, I was completing my post graduate studies at UCLA and had developed a personal and long lasting relationship with Rolando, his wife Fanny and the Breslows. I was also at the party. When Archie realized I was from Barcelona, his first words after greetings were plain and to the point: Do you know Grañén? ... and this book was on. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 18 In 1937, an international militia, known as The International Brigades, was organized and sent to Spain to help the Republic against a coup organized by the army with the support of the growing fascist movement in Europe. Archie was part of the English brigades that underwent some of the most fierce combats in the central parts of Spain, Brunete and the Jarama, and in the front line in Aragon, near Huesca, were Grañén, a small village at the time, is located. Archie had spent some time in Grañén and its surrounding whereabouts as part of one of the medical units that gave support to the Brigades. Archie was not a surgeon, he was still a medical student, and most of his work concerned the triaje of the patients at the arrival door, straight from the battle front. Triaje is an intuitive, on- the-spot, decision-making procedure by which a wounded person is classified into a simple scheme of, say, one of three prognostic groups. That inspection reflected (and eventually determined) the estimated probability to survive his or her injuries. Medical efforts were limited to the ones that had a reasonable chance to survive. The exercise probably had an influence on his future view of the cost-effectiveness of the medical decisions and the chances of medical error. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 19 With some occasional short visits, Archie had not returned to Spain and did not want to do so while the dictatorship was in place. However, from his reaction one could easily guess that he had had this trip in mind ever since. The story fascinated me. After Spain, Archie had embarked in the European war, largely as a Prisoner of War, first in Greece, latter in Germany. I was astonished at the idea of attempting a Randomized Trial in a concentration camp to evaluate the hypothesis that a nutritional supplement would solve an outbreak of edema among malnourished prisoners. I admired his simplicity in describing complex political and medical situations in the most conventional and, at the time, dispassionate attitude. The conversation then evolved in a number of ways but the fishhook was in the right place. As a student I had been intensively involved in the student’s union movement at the University of Barcelona and, the Brigades, were part of the leg- end that shaped the fate and the destiny of most of the families in Spain, includ- ing my own. There it was an opportunity to pay back a debt of gratitude to one of the militiamen and a wonderful chance to get to know a man that was close to the work I wanted to do in my medical career. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 20 Not long after this encounter, a trip was organized attempting to revisit the places where the English Hospital (locally called the Blood Hospital) were installed. Archie came first to Barcelona where he gave a seminar at the Hospital de Sant Pau, proba- bly on Randomized Trials involving Health Services evaluation. The expectation was high and the room was full. I was glad that my colleagues appreciated his presence and his talk. The next day we were on the road for a unique experience. Travelling with Archie was a pleasure and an intellectual challenge. Archie was keen in finding the houses where the hospitals were located as well as some more difficult targets such as finding the tomb of a British pilot of whom he vaguely remembered the name. The searching strategy was developed. On arrival to a vil- lage, we went to the local coffee shop, the bar, or the central plaza if the sun was out, and introduced ourselves to the elderly hat looked nicer to us. The story was initiated and, soon after introduction and greetings, it was clear who from the audience was our contact and who was not. Then we were escorted to the relevant places, which most of the times included a mansion or its remaining, where an impressive scene was reproduced once and once again. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 21 Archie wandered the space trying to remember while repeating for him names and places. We were listening to the stories and lived trough some very emotional expe- riences. On return to Barcelona, it was clear that Archie had accomplished what he want- ed and did not attempt further travelling. He soon published a travel report in the British Medical Journal, here reproduced in the section Back to the front, and we kept correspondence ever since. He become a member of honor of the Spanish Epidemiological Society and was able to contribute to some of the scientific events. Visiting Archie at Rhoose Farm was a rare pleasure. On two occasions I spent time there while getting acquainted with the MRC research Unit in Cardiff, driving along the Rhonda Fach and visiting epidemiologists in the UK. Over the weekend, Archie would keep an interested eye on the news but never left the TV set on any time beyond the news. Visitors were received constantly and the conversation never decayed. Occasionally Archie smoked cigarettes. His argument was that for a late starter, the time interval to lung can- cer easily overlaped his life expectancy. With time that proved to be true. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 22 I saw him for the last time in 1986 during a brief strop-over in Rhonda. He was as cheerful as ever and showed interest for the projects in which I was working at the time. He told me on the latest analyses and publications of the cohort of miners of the Rhonda valley that occupied him for several decades. We only touched mar- ginally on his health. Twenty five years after sharing with Archie his travel back to the front line, we had the opportunity to put together this little homage to the man. We wished to present his commitment to the anti-fascist movement by compiling descriptions and images of some of the scenarios that evolved in Spain in that unfortunate period. Several of Archie’s friends contributed generously memories, pictures and anecdotes and we are grateful to them. We have also wanted to pay homage to the Brigades and to the city and the pop- ulation of Barcelona. The city, as latter on other cities in Europe, suffered some of the first aerial bombardments in history. Barcelona keeps alive the memory of the volunteers that tried to help and of the victims of the madness. preface by f. xAvieR bosch EPIDEMIÒLoGist archie cochrane 23 We also want to recognize the work and the contributions of the Cochrane Collaboration, a considerable effort that involves the generous work of hundreds of scientists in the world. They have expanded and taken to a worldwide dimen- sion the most ambitious dreams of the founders of the randomized trial philoso- phy. Archie would probably have been pleased. One could speculate that, if alive, he would now be promoting a critical evaluation of the impact of the Cochrane reviews on the quality of care delivered at the bedside of the patients. On behalf of the many authors I sincerely hope that you enjoy the effort. Xavier Bosch Barcelona 2003 archie cochrane the MAN Archie Cochrane a man of his time spanish civil war (1936-1939) The international brigades War Medicine: Archie Cochrane in triage Farewell to the brigades, farewell to Spain archie cochrane II World War: Medical care at a concentration camp archie cochrane a research life in wales back to the front The Legacy The Cochrane Collaboration Barcelona remembers the brigades and the civil war The long lasting Scars of the Civil war Archie Cochrane wishes you well ..
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