Equality, efficiency and effectiveness: going beyond RCTs in A. L. Cochrane's vision of health care

Sociology of Health & Illness
Susanna Trnka, Tereza Stöckelová

Abstract

A. L. Cochrane's Effectiveness and Efficiency frequently appears as a key reference in debates over, and a justification for, contemporary evidence-based medicine. Cochrane's concern in this text with the equality of care as the ultimate rationale for why effectiveness and efficiency of cure are needed has, however, largely disappeared from debate. In this article, we reconsider Cochrane's approach through the use of case studies of plural forms of medicine in the Czech Republic, namely traditional Chinese medicine, homeopathy and spa care. In addition to bringing equality back into the picture, we also identify four expansions to Cochrane's original vision arising from the difficulties of separating cure from care; the overlap between prevention and cure; the complex actions of some multi-faceted therapies; and recent reconceptualisations of the placebo effect. In conclusion, we suggest that instead of the widely used strictly vertical "evidence pyramid", a descriptor of the horizontal and additive ordering of evidence might be more appropriate. We also argue that in healthcare systems characterised by a multiplicity of approaches, if we want to truly benefit from this heterogeneity, we must take seriously each medical traditi...Continue Reading

References

Jan 1, 1990·Medical History. Supplement·C Hamlin
Jan 29, 2002·Isis; an International Review Devoted to the History of Science and Its Cultural Influences·G Weisz
Jul 4, 2002·QJM : Monthly Journal of the Association of Physicians·A J S Coats
Jun 27, 2006·BMC Medical Research Methodology·Harald WalachWayne B Jonas
Apr 12, 2011·Medicine, Health Care, and Philosophy·Kirsten Hansen
May 23, 2014·BMJ : British Medical Journal·Karolina WartolowskaAndrew J Carr
Sep 13, 2016·Medical Anthropology·Charlotte BrivesEmilia Sanabria
Oct 22, 2016·The Lancet Global Health·Pratik Khanal, Navaraj Bhattarai
Jun 3, 2017·Journal of Paediatrics and Child Health·Rowena L McMullanMichael R Skilton
Oct 28, 2017·The Gerontologist·Jim VandenBosch
Jun 21, 2018·Medical Anthropology·Jaroslav Klepal, Tereza Stöckelová

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Citations

Apr 21, 2021·The Journal of Alternative and Complementary Medicine : Research on Paradigm, Practice, and Policy·Kim D GrahamJon Wardle

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