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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



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                  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
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                  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
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                  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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