MCKEOWN,THOMAS AND COCHRANE,ARCHIBALD - A JOURNEY THROUGH THE DIFFUSION OF THEIR IDEAS

In the 1970s Thomas McKeown and Archibald L Cochrane were two of the m ost influential voices in criticising the dominance of medical thinkin g. A bibliometric study of the citations to McKeown's The Role of Medi cine: Dream, Mirage or Nemesis and Cochrane's Effectiveness and Effici ency: Random Reflections on Health Services was performed from the pub lication of each book until 1988 to study how their ideas have been di sseminated. During the study period 430 papers in the Science Citation Index or the Social Sciences Citation Index cited Cochrane's book, 13 3 cited McKeown's, and 166 cited both. The citations came mainly from original papers published in journals of internal medicine or public h ealth and epidemiology (35%) and written by authors from the United St ates or the United Kingdom. Cochrane's book was cited most frequently in medical journals, suggesting a higher degree of penetration of his ideas among medical scientists. Although the dominance of original pap ers among the citations suggests that these books have been important in stimulating new knowledge, the main problems that McKeown and Cochr ane identified-namely, the relatively small impact of clinical medicin e on health outcomes and the poor use of scientific methods in clinica l practice-are still with us.