David Sackett Obituary
David Sackett, a physician who championed evidence-based medicine, passed away at the age of 80. Born in the United States, Sackett spent much of his life in Canada and Britain, where he promoted a radical way of thinking about medical diagnosis and treatment based on a rigorous assessment of relevant evidence. He challenged the medical profession’s traditional reliance on subjective judgment, tradition, and authority.
Sackett believed in putting the patient at the core of the diagnosis and treatment process, following the lead of Alvan Feinstein of Yale University, a pioneer of clinical epidemiology. Sackett’s approach to evidence-based medicine relied on systematic reviews of literature, critical assessment of the value of diagnostic tests and treatments, and the patient’s preference.
To build consensus for his approach, Sackett needed to convince the medical community that randomized clinical trials produced the best clinical evidence about the value of treatments. In the ’70s and ’80s, he worked diligently with his team at McMaster University in Hamilton, Ontario, to examine and improve the methodology, design, conduct, analysis, and reporting of clinical trials. They also revealed hidden biases in research and identified measures to prevent such distortion.
Sackett believed in putting everything to the test by performing clinical trials on multiple medical treatments for common conditions. This approach included examining the effectiveness of aspirin in preventing a stroke in heart-attack victims, surgery on the carotid artery to prevent a stroke, how to improve patients’ compliance with taking blood pressure medication, and whether nurse practitioners can offer adequate primary care.
In the ’90s, meta-analysis techniques enabled rigorous comparisons of trial results. This allowed for comparisons of therapies, a colossal task that was only made possible with the founding of the Cochrane collaboration in Oxford. Sackett moved there in 1994 and helped bring evidence-based medicine to patients by persuading a sceptical medical community to take up the intellectual work implicit in the practice of this approach.
Initially, Sackett found the medical establishment’s reception of his ideas to be negative, condescending, and dismissive. However, Sackett and his supporters won the battle by constant face-to-face engagement. Sackett made teaching visits to more than 200 district general hospitals in the UK and scores in Europe. His vision, intellect, drive, and tenacity helped improve the practices and lives of tens of thousands of physicians and their colleagues, and through them, the lives of millions of patients.
Sackett was born in Chicago to Margaret and DeForest Sackett, a designer and artist. He trained as a doctor at the University of Illinois College of Medicine. After obtaining a research fellowship in renal disease, he was drafted into the armed forces because of the Cuban missile crisis of October 1962. He was then allocated to the US Public Health Service and worked at the Chronic Disease Research Institute in Buffalo, New York, where he became immersed in classical epidemiology.
In 1967, Sackett was appointed as the founding chair of clinical epidemiology and biostatistics at McMaster, where he pioneered new approaches to medicine. He served as physician in chief of medicine and head of the division of general internal medicine at Chedoke Hospital in Hamilton.
Sackett believed that a person’s abilities deteriorate over time, hence it is vital to keep oneself challenged continuously. To exemplify his philosophy, he decided to "retread" himself by repeating his medical residency at the age of 49. This was because he believed his clinical skills needed updating.
His profound conviction in placing the importance of the patient above all else led him to initiate a series of scientific reviews into the benefits of a patient’s history and clinical findings. He advocated putting the patient-physician encounter on a more rational footing for accurate diagnosis.
Sackett upheld a set of guiding principles inspired by his favourite author, Kurt Vonnegut. Among these principles was to serve the youth, and he effectively imparted this to his students by giving them key roles in his research.
In his retirement, Sackett and his wife, Barbara (nee Bennett), whom he married during his first year of medical school, transformed their home near Lake Huron, Ontario, into a hub for conducting teaching workshops.
Sackett is survived by his wife Barbara, his brother Jim, his four sons, David, Charles, Andrew, and Robert, and his eight grandchildren.
