Cochrane on Communism: the influence of ideology on the search for evidence.

Abstract Archie Cochrane imagined a map of the world shaded unevenly according to the density of randomized controlled trials. He commented: 'It appears in general that it is Catholicism, Communism, and underdevelopment that appear to be against RCTs.' This article reviews the complex and changing relationship between Soviet science and evidence. It concludes that the dominance of communist ideology seriously inhibited the development of evidence based health care. However, it also argues that the rejection of scientific evidence fulfilled a useful function for a regime that otherwise would have been confronted by demands for modern technology and pharmaceuticals that it could not meet. The article continues by arguing that the USSR was not unique and there are other situations in which ideology and political expediency override scientific enquiry, drawing on the contemporary politicization of American science.