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Remembering David Sackett, “The Father of Evidence Based Medicine”

Remembering David Sackett, “The Father of Evidence Based Medicine”

This past week, Canadian medicine lost one of its greats. One of the fundamental tenets of medical education and practice today, is that treatment should be guided by evidence. It seems so logical and fundamental, and yet, the “science of evidence-based medicine” is relatively young. Arguably, the father of that science[1], David Sackett, just recently passed away at age 80. Ostensibly, Sackett was able to pioneer and champion the marriage of statistically based epidemiology with the practice of clinical medicine.

“Born in Chicago, Illinois, Sackett earned his medical degree at the University of Illinois, trained as an internist and nephrologist, and then received a master’s degree in epidemiology from Harvard University in Boston, Massachusetts. He joined the faculty of McMaster University’s brand new medical school in Hamilton, Ontario, Canada, in 1967, where he established the world’s first department of clinical epidemiology.”[2]

Sackett was instrumental, if not foundational, to the teaching of how physicians generate evidence, how they critically appraise the literature, and how they practice evidence based medicine (EBM)…which is arguably the most important movement in medicine in the past 25 years.”[3]

Early in his career, Sackett “became interested in how the methods of epidemiology could be applied to his ‘first love,’ clinical medicine. He called this combination “clinical epidemiology,” a term that had been used in the 1930s, only then it aimed to pull physicians away from individual patients while Sackett wanted them to go in the opposite direction.”[4]

Evidence-based medicine has had its critics. In the early part of Sackett’s career, he had to defend concerns that he was promoting “cookbook medicine”. To this suggestion, Sackett has responded: “Evidence based medicine is not ‘cookbook’ medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individual patient care.”4

Sackett has had an illustrious career. He has authored 10 books, over 300 peer reviewed articles, and over 50 book chapters. Sackett was inducted into the Canadian Medical Hall of Fame in 2000, was made an Officer of the Order of Canada in 2001 and received the 2009 Canada Gairdner Wightman Award.[5]

There are several terrific videos reflecting Sackett’s views; one with Steve Paikin is particularly interesting.[6]

If you have any thoughts about Sackett, the early days of McMaster, or EBM, respond to the blog, or better yet, please drop by the Macklem House, my door is always open.

Richard

 

 

[1] http://www.cmaj.ca/site/misc/david_sackett.xhtml

[2] http://www.medscape.com/viewarticle/844845

[3] http://www.bmj.com/content/350/bmj.h2639

[4] Sackett, D. L. (2000). Evidence-based medicine: How to practice and teach EBM (2nd ed.). Edinburgh; New York: Churchill Livingstone

[5] http://cdnmedhall.org/inductees/dr-david-sackett

[6] http://www.bodyinmind.org/david-sackett-father-of-evidence-based-medicine/

 

Henry Dinsdale

Fri, 06/30/2017 - 08:40

I had the pleasure of working with Dave on a number of clinical trials, particularly the multicentre effort that first demonstrated the preventive value of aspirin in patients with risk factors for stroke. In addition to Dave’s clinical and investigative skills, an endearing quality was an impish sense of humour that, for example, certainly enlivened his reports to the Council of the Royal College.

Henry Dinsdale

Henry,

Thanks for your contribution to the memory of David Sackett. Your personal recollections of his contributions is appreciated.

Richard

reznickr

paul armstrong

Fri, 06/30/2017 - 08:41

Dave Sackett was a legend in his own time, generous, thoughtful, incisive, articulate and wise.
As a fledgling Queens’ clinical researcher in the 1970’s I went to his office in Hamilton to seek advice on how to analyze clinical data: I well recall his advice; “what you need here young man is a Fisher’s exact test “ which indeed was key to publishing one of my early papers. Many of us went to McMaster for the workshops he conducted to help us with research methods. We then sent our trainees to Dave and had a few follow him to Oxford and then ultimately back to the brilliant and much admired Ontario Trout Lake workshops for research trainees.
His enormous contributions and legacy are of lasting value and cause for celebration of a professional life that contributed much to many.

paul armstrong

reznickr

Fri, 06/30/2017 - 08:42

Paul,

Thanks for your reflections and comments about Sackett. he was truly a giant in Canadian medicine.

Richard

reznickr

Dale Loewen

Fri, 06/30/2017 - 08:43

I met Dr.Sackett,circa 1970,in Prince George,BC at a course for GP’s.I remember thinking this guy has got some clues and is a breath of fresh air.His challenging of the routine physical exam as something not so important at all on the evidence based paradigm and the SOAP model for organising,assessing and recording patient data was something I stuck with from that day forward.It wasn’t long before his conclusions were widely accepted in the GP arena.

Dale Loewen

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