F. XAVIER BOSCH
F. XAVIER BOSCH
FIRST ediTIOn: JULY 2003
F. XAVIER BOSCH
CoordinaTiOn AND SECRETARIAT:
FRANCESC CATALÀ ROCA
COPYRIGTH TO ENGLISH EDITION
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
Part 1 archie cochrane, The Man
Interview to Sir Richard Doll
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
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
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
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.
Archie Cochrane was a man of the 1930s.
His character and lifelong convictions were formed by
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
16 DR. F. XAVIER BosCh
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?...
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
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.
by f. xAvieR bosch
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.
by f. xAvieR bosch
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.
by f. xAvieR bosch
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.
by f. xAvieR bosch
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-
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.
by f. xAvieR bosch
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.
by f. xAvieR bosch
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.
to the brigades,
II World War:
Medical care at a
a research life
and the civil
Scars of the
wishes you well ..