The Telegraph, Sunday, February 04, 2007
Anyone with a computer in India may soon have free access to information on what works and what doesn't in medicine, allowing them to verify whether the treatment offered by their doctor is the appropriate one.
India has become the first low-income country to buy and offer to residents free access to information on treatment and prevention methods that have passed the toughest of scientific tests — whether it's about ushering a baby into the world, treating infections or combating obesity.
The Indian Council of Medical Research (ICMR) has signed a contract with the international publishing company, John Wiley and Sons, for nationwide access to the Cochrane Library. The library is a vast storehouse of what medical researchers view as reliable information about proven treatment and prevention strategies across myriad medical topics, from surgery to general health.
"This will give doctors in India evidence-based information to challenge or accept what they've been taught," said Prathap Tharyan, a psychiatrist at the Christian Medical College in Vellore and a member of the South Asian Cochrane Network.
"Modern medicine always improves through studies. The Cochrane effort has often challenged what had become conventional medical wisdom," Tharyan told The Telegraph. "Some reviews have plain-language summaries for consumers."
Jose Belizan, a Cochrane collaborator in Argentina, demolished the belief among doctors that it was always good to perform episiotomy — a small surgical incision in the vaginal opening — during the delivery of a baby.
Through a systematic review of medical studies published on episiotomy, Belizan showed that the procedure was not only unjustified, but possibly harmful. It had entered medical practice without real scientific evidence.
In recent times, the Cochrane effort has shown that — contrary to popular concerns — hormonal contraceptive pills do not lead to major weight gain.
Under the licence obtained by the ICMR, anyone in India with a computer will be able to access the Cochrane Library that contains over 4,000 systematic reviews by several thousand doctors worldwide.
The reviews cover hundreds of topics — from root canal treatment to drugs against malaria and pneumonia, from the use of inhalers in childhood asthma to surgical procedures.
All reviews aim to establish whether there is genuine scientific evidence that something works in medicine. One review found that Tibetan and Indian herbal medicines can reduce symptoms of irritable bowel syndrome.
Another Cochrane review that evaluated the role of prayer in treatment of illnesses said it is impossible to prove or disprove in trials any supposed benefit that derives from God's response to prayer.
"We want medical practitioners and consumers to make use of this resource," said Vasantha Muthuswamy, senior deputy director-general at the ICMR.
Medical experts have often expressed concern that doctors in India lack reliable or independent sources of information about advances in medicine. "Most doctors get information about new drugs or procedures mainly through representatives of companies," said Chandra Gulhati, editor of the Monthly Index of Medical Specialities, India, an independent drugs journal.
The Cochrane effort was launched in 1993 by doctors to address concerns expressed earlier by Archie Cochrane, a UK-based medical researcher. He had pointed out that medical practices were not always backed by good science. But some are sceptical about the impact that the Cochrane Library may have on India.
"We have a medical system that does not in any way encourage doctors to keep themselves abreast of the latest research," said a senior health official. "The big question is, will our doctors make use of the database?"
As for the consumers, while the library offers them a way of checking up on the treatment, they should not be tempted to try self-medication.
Visit now The Cochrane Library