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| David Sackett obituary | David Sackett obituary |
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| The physician David Sackett, who has died aged 80, was a leading advocate of evidence-based medicine. Born in the US, he spent much of his life in Canada; there and in Britain he promoted a radical way of thinking about diagnosis and treatment that was based on a rigorous assessment of the relevant evidence from a patient’s symptoms and clinical signs, and from results of tests and published trials. This challenged the medical profession’s long-held reliance on subjective judgment, tradition and authority. | The physician David Sackett, who has died aged 80, was a leading advocate of evidence-based medicine. Born in the US, he spent much of his life in Canada; there and in Britain he promoted a radical way of thinking about diagnosis and treatment that was based on a rigorous assessment of the relevant evidence from a patient’s symptoms and clinical signs, and from results of tests and published trials. This challenged the medical profession’s long-held reliance on subjective judgment, tradition and authority. |
| In putting the patient at the centre of every discussion about diagnosis and treatment, Sackett followed the lead of another pioneer of clinical epidemiology, Alvan Feinstein of Yale University. Evidence-based medicine, first termed as such by Sackett’s Canadian colleague Gordon Guyatt in 1990, depends on a belief in the value of systematic reviews of literature and critical assessment of the worth of diagnostic tests and treatments, allied to a consideration of the trade-offs of risks, benefits and costs, and, above all, the patient’s preferences. | |
| For this approach to be accepted, Sackett needed to build a consensus that randomised clinical trials produce the best clinical evidence about the value of treatments. In the 1970s and 80s at McMaster University in Hamilton, Ontario, he devoted much of his efforts and those of his team to examining and improving the methodology, design, conduct, analysis and reporting of clinical trials. His group there also revealed the hidden biases in research and identified measures to prevent such distortion. | For this approach to be accepted, Sackett needed to build a consensus that randomised clinical trials produce the best clinical evidence about the value of treatments. In the 1970s and 80s at McMaster University in Hamilton, Ontario, he devoted much of his efforts and those of his team to examining and improving the methodology, design, conduct, analysis and reporting of clinical trials. His group there also revealed the hidden biases in research and identified measures to prevent such distortion. |
| Seeing the need for hard evidence, he set about performing clinical trials on numerous medical treatments for common conditions. Indeed, he believed in putting everything to the test: the use of aspirin to ward off stroke in heart-attack victims, that of surgery on the carotid artery to prevent stroke, how to improve patients’ compliance with taking blood pressure medication, and whether nurse practitioners can provide adequate primary care. He and his colleagues convinced others because of the rigour of their methods. | Seeing the need for hard evidence, he set about performing clinical trials on numerous medical treatments for common conditions. Indeed, he believed in putting everything to the test: the use of aspirin to ward off stroke in heart-attack victims, that of surgery on the carotid artery to prevent stroke, how to improve patients’ compliance with taking blood pressure medication, and whether nurse practitioners can provide adequate primary care. He and his colleagues convinced others because of the rigour of their methods. |
| In the 1990s, techniques such as meta-analysis – using statistical methods to analyse and integrate the results of different studies – allowed rigorous comparison of trial results. Given the vast array of medical conditions and suggested treatments, comparing therapies was a colossal task that was made possible only by the founding of the Cochrane collaboration, now a global network of volunteers, by Iain Chalmers and his colleagues in Oxford, to where Sackett moved in 1994. | In the 1990s, techniques such as meta-analysis – using statistical methods to analyse and integrate the results of different studies – allowed rigorous comparison of trial results. Given the vast array of medical conditions and suggested treatments, comparing therapies was a colossal task that was made possible only by the founding of the Cochrane collaboration, now a global network of volunteers, by Iain Chalmers and his colleagues in Oxford, to where Sackett moved in 1994. |
| As the final step in bringing evidence-based medicine to the patient, Sackett and colleagues had to persuade a sceptical medical profession, often eager to attack what was unfamiliar, to undertake the intellectual work implicit in the practice of this approach. He led the initiative with a personal effort to teach physicians about the critical appraisal of medical evidence, a job that was soon taken up by his many supporters in articles and books that have become standard texts around the world. | As the final step in bringing evidence-based medicine to the patient, Sackett and colleagues had to persuade a sceptical medical profession, often eager to attack what was unfamiliar, to undertake the intellectual work implicit in the practice of this approach. He led the initiative with a personal effort to teach physicians about the critical appraisal of medical evidence, a job that was soon taken up by his many supporters in articles and books that have become standard texts around the world. |
| At first Sackett found the reception of his ideas by the medical establishment to be “negative, condescending and dismissive”. But gradually he and his supporters won the battle, not least by constant face-to-face engagement. Sackett made teaching visits to more than 200 district general hospitals in the UK and to scores in Europe. In the end, his vision, intellect, drive and tenacity helped to improve the practices and lives of tens of thousands of physicians and their colleagues, and through them the lives of millions of patients. | At first Sackett found the reception of his ideas by the medical establishment to be “negative, condescending and dismissive”. But gradually he and his supporters won the battle, not least by constant face-to-face engagement. Sackett made teaching visits to more than 200 district general hospitals in the UK and to scores in Europe. In the end, his vision, intellect, drive and tenacity helped to improve the practices and lives of tens of thousands of physicians and their colleagues, and through them the lives of millions of patients. |
| A native of Chicago, Sackett was the son of Margaret (nee Ross) and DeForest, a designer and artist. After training as a doctor at the University of Illinois College of Medicine, he obtained a research fellowship in renal disease, and had just set up a laboratory when the Cuban missile crisis of October 1962 resulted in his being drafted into the armed forces. He was allocated to the US Public Health Service, and in 1963 found himself at the Chronic Disease Research Institute in Buffalo, New York. There he became immersed in classical epidemiology – the study of the occurrence, transmission and control of epidemic disease – while acting as a chief teaching fellow and studying for an MSc at the Harvard School of Public Health. | A native of Chicago, Sackett was the son of Margaret (nee Ross) and DeForest, a designer and artist. After training as a doctor at the University of Illinois College of Medicine, he obtained a research fellowship in renal disease, and had just set up a laboratory when the Cuban missile crisis of October 1962 resulted in his being drafted into the armed forces. He was allocated to the US Public Health Service, and in 1963 found himself at the Chronic Disease Research Institute in Buffalo, New York. There he became immersed in classical epidemiology – the study of the occurrence, transmission and control of epidemic disease – while acting as a chief teaching fellow and studying for an MSc at the Harvard School of Public Health. |
| In 1967, at the age of 32, he was made the founding chair of clinical epidemiology and biostatistics at McMaster, where a revolutionary new medical school was being put together by John Evans. Sackett had impressed Evans with his declaration that unless epidemiology and statistics were integrated into every part of the curriculum – rather than taught separately – they could not be usefully taught at all. | In 1967, at the age of 32, he was made the founding chair of clinical epidemiology and biostatistics at McMaster, where a revolutionary new medical school was being put together by John Evans. Sackett had impressed Evans with his declaration that unless epidemiology and statistics were integrated into every part of the curriculum – rather than taught separately – they could not be usefully taught at all. |
| It was at McMaster that Sackett’s work on evidence-based medicine took shape and then flourished. He served simultaneously as physician in chief of medicine and head of the division of general internal medicine at Chedoke hospital in Hamilton. | It was at McMaster that Sackett’s work on evidence-based medicine took shape and then flourished. He served simultaneously as physician in chief of medicine and head of the division of general internal medicine at Chedoke hospital in Hamilton. |
| In 1994, having moved to Oxford, he co-founded the Centre for Evidence-Based Medicine and established close contact with the Clinical Trial Service Unit, directed by Richard Peto and Rory Collins, as well as the Cochrane centre, the steering group of which he chaired. He retired from clinical practice in 1999 and returned to Canada. | In 1994, having moved to Oxford, he co-founded the Centre for Evidence-Based Medicine and established close contact with the Clinical Trial Service Unit, directed by Richard Peto and Rory Collins, as well as the Cochrane centre, the steering group of which he chaired. He retired from clinical practice in 1999 and returned to Canada. |
| Sackett believed that people lost their edge over time, and so had to be constantly challenged. Perhaps the most extraordinary illustration of his commitment to that philosophy had come at the age of 49, when he decided to repeat his medical residency – in what he called a “retreading operation” – because he felt his clinical skills were out of date. | Sackett believed that people lost their edge over time, and so had to be constantly challenged. Perhaps the most extraordinary illustration of his commitment to that philosophy had come at the age of 49, when he decided to repeat his medical residency – in what he called a “retreading operation” – because he felt his clinical skills were out of date. |
| His strong belief in the importance of the patient led him to start a series of scientific reviews into the utility of the patient’s history and clinical findings, putting the patient/physician encounter on a rational basis for diagnosis. | His strong belief in the importance of the patient led him to start a series of scientific reviews into the utility of the patient’s history and clinical findings, putting the patient/physician encounter on a rational basis for diagnosis. |
| Sackett lived by maxims he took from a favourite author, Kurt Vonnegut, one of which was to serve the young. Students were often given a leading part in his studies. | Sackett lived by maxims he took from a favourite author, Kurt Vonnegut, one of which was to serve the young. Students were often given a leading part in his studies. |
| In retirement, he and his wife, Barbara (nee Bennett), whom he had married after his first year of medical school, turned their home near Lake Huron, Ontario, into a centre for teaching workshops. | In retirement, he and his wife, Barbara (nee Bennett), whom he had married after his first year of medical school, turned their home near Lake Huron, Ontario, into a centre for teaching workshops. |
| He is survived by Barbara, by a brother, Jim, by four sons, David, Charles, Andrew and Robert, and by eight grandchildren. | He is survived by Barbara, by a brother, Jim, by four sons, David, Charles, Andrew and Robert, and by eight grandchildren. |
| • David Sackett, physician and researcher, born 17 November 1934; died 13 May 2015 | • David Sackett, physician and researcher, born 17 November 1934; died 13 May 2015 |
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