Now that I am out of the closet about being a Cochrane reviewer, I will further come clean on the fact that I have attended the Cochrane Colloquia for the last three years as well as the last Campbell Colloquium held in Oslo in 2009. More than just a fabulous networking opportunity, the meetings represent the best way for fledgling reviewers, like myself, to learn much of what is new in synthesis methodology. For example, I made great leaps and bounds with the face-to-face explanation and accompanying group work on how to create a summary of findings table than I ever would have using the on-line tutorial from my desk in Bangladesh. The same is true for risk of bias and realist review.
This year’s meeting was held last week in cold but stunning Keystone, Colorado, and had the added bonus of bringing the Cochrane and Campbell groups together for the first time. For anyone not familiar with Campbell (a.k.a. C2), it does for education, justice, and social welfare what Cochrane does for health. Rather than being in competition, the meeting was permeated by a sense of camaraderie focusing on the similarities rather than the differences. Particularly, plenary sessions seemed to focus on the common challenge of how systematic review can be translated to making a difference in decision making among policy makers, practitioners, and ultimately consumers. Some participants complained that the fire of the struggle for formation (“storming and norming”) had vanished from the groups and that we had reached a comfortable plateau that could only be described as “performing.”
To me, the best plenary session was on Wednesday 20 October when Joia Mukherjee and Prathap Tharyan talked about mobilising management skills for greater success in global evidence and the ulitility of Evidence Aid in recent disasters. The BMJ’s own Fiona Godlee also spoke. Dr Godlee broke the spirit of collective harmony by challenging reviewers to dig deeper than merely designing and running a search strategy and conducting analysis with the results. Using the example of H1N1 and oseltamivir and the controversy surrounding the work of Deborah Cohen and Phillip Carter from June 2010 (1), she pointed out that reviewers must be in-tune to commercial trends without sucumbing to them. It was a call to action to continue the fight beyond demand efforts for products but if needed to serve as investigative researchers on the supply side.
As for me, the only talking that I did was in a session on Evidence for low and middle income countries: Guidance for Campbell and Cochrane Reviews, which I hijacked on the 21 October. The session organisers from the Joint Cochrane-Campbell Equity Methods Group graciously granted me 10 minutes to present the latest version of the document from the working group on health systems synthesis (see my 6 October blog). I presented last in the session and was so nervous by the time I spoke that I was nauseated to the point of blurry vision. However, I made it through my slides and spoke about the possibility of establishing of a new collaboration to serve the needs of health systems researchers, especially from developing countries, policy advisors, and national policymakers for improved decision-making. After the talk I was able to host a break out session on the document.
There was no consensus in the health systems synthesis breakout group, which was attended by very senior and knowledgeable methodologists and reviewers. On one hand, many thought it would be more efficient to build upon the groups that are already conducting synthesis work rather than creating a new entity. Working within existing review structures like the Cochrane Collaboration, the EPPI Centre, or the Campbell Collaboration, would prevent a split in limited, talented human resources as well as perhaps save the energy required to create a new governance structure, synthesis tools, maintenance of a review library and more. The other side seemed bent on the need for something new that will allow for greater methodological flexibility and independence as well as challenging the existing models of synthesis and bring in new types of reviewers from diverse disciplines like political science.
It was a very well-organised colloquium and I am thankful to have had the opportunity to attend, especially I am thankful to the Equity Group for letting me gate crash their session. For those who are interested in the growing discussion on the work around health systems synthesis, the next discussion around the issue will be held in Montreux at the 1st Health Systems Research Symposium on Tuesday, 16 November from 2-3:30 p.m.
1. Cohen D, Carter P. WHO and the pandemic flu “conspiracies.” BMJ 2010;340:c2912.
Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University.