A pi­o­neer of ev­i­dence­based medicine

McMaster doc­tor’s be­lief in im­por­tance of clin­i­cal tri­als led to shift in pa­tient care

Toronto Star - - INSIGHT - CARMELA FRAGOMENI THE HAMIL­TON SPEC­TA­TOR

Dr. David Sackett was con­sid­ered the fa­ther of ev­i­dence-based medicine and was cred­ited with putting McMaster Uni­ver­sity on the map for it.

Ev­i­dence-based medicine in­te­grates the best re­search data with clin­i­cal ex­per­tise and pa­tient val­ues. The goal is to use the best ev­i­dence to give pa­tients the best pos­si­ble care.

“Un­til ev­i­dence-based medicine, we were func­tion­ing from pure ob­ser­va­tion (in treat­ing pa­tients),” said Dr. John Kel­ton, McMaster’s dean of health sciences. “He made very im­por­tant changes to how we think about health care.”

Sackett died on Wed­nes­day at the age of 80, from can­cer.

In1967, at age 32, he es­tab­lished the world’s first depart­ment of clin­i­cal epi­demi­ol­ogy at the still-new McMaster med­i­cal school and cre­ated a train­ing pro­gram in health re­search meth­ods. He went on to win the Canada Gaird­ner Wight­man Award for out­stand­ing lead­er­ship in medicine, was named an of­fi­cer of the Or­der of Canada and was in­ducted into the Canadian Med­i­cal Hall of Fame.

Kel­ton read Sackett’s re­search pa­pers long be­fore com­ing to McMaster, while living in the U.S. He likens the ex­pe­ri­ence to that of some­one hear­ing the Bea­tles or the Rolling Stones for the first time.

“His writ­ings were so unique and cu­ri­ous. I started con­tact­ing peo­ple at McMaster to learn more and to let me come here,” Kel­ton said.

Sackett’s be­lief in ev­i­dence-based treat­ment led to the bench­mark of us­ing clin­i­cal tri­als to prove a treat­ment was ef­fec­tive, Kel­ton ex­plained. “Now to get a drug ap­proved, you have to prove it works.”

Dr. Gord Guy­att, a spe­cial­ist in in­ter­nal medicine and a pro­fes­sor of clin­i­cal epi­demi­ol­ogy and bio­statis­tics at McMaster, said Sackett’s work en­sured pa­tients were get­ting the right treat­ment.

Sackett was in­stru­men­tal in run­ning ran­dom­ized tri­als. Through them he es­tab­lished, for ex­am­ple, that tak­ing As­pirin re­duces the risk of stroke in peo­ple who’ve had mi­nor strokes, Guy­att said.

“His in­flu­ence led McMaster, de­spite be­ing a rel­a­tively small uni­ver­sity, to main­tain its pre-em­i­nence world­wide as the in­sti­tute pro­vid­ing more lead­er­ship (in ev­i­dence-based medicine) than any­where else.”

In ad­di­tion to bench­mark stud­ies on the benefits of As­pirin, Sackett’s re­search teams showed the value of sur­gi­cally re­mov­ing ar­te­rial plaque, de­vel­oped new ways to treat high blood pres­sure and demon­strated the ef­fec­tive­ness of nurse prac­ti­tion­ers.

Doc­tors now rou­tinely rec­om­mend daily doses of As­pirin for many pa­tients who have had a stroke or heart attack or who face even a rel­a­tively low risk of one in the next decade.

Sackett was the au­thor or co-au­thor of 10 books, in­clud­ing Ev­i­dence­Based Medicine and Clin­i­cal Epi­demi­ol­ogy: A Ba­sic Science for Clin­i­cal Medicine. He re­mained at McMaster for 26 years and served as physi­cian in chief of medicine and head of the di­vi­sion of gen­eral in­ter­nal medicine at Che­doke Hos­pi­tal, also in Hamil­ton.

In 1994, he left to es­tab­lish the Cen­tre for Ev­i­dence-Based Medicine as a pro­fes­sor at the Uni­ver­sity of Ox­ford in Eng­land. He re­tired from clin­i­cal prac­tice in1999 and re­turned to Canada.

Sackett was born on Nov. 17, 1934, in Chicago. Bedrid­den for months as a child with po­lio, he re­cov­ered and ex­er­cised to de­velop into an ac­com­plished run­ner. He also be­came a vo­ra­cious reader and, he said, the youngest mem­ber of the So­ci­ety for the Preser­va­tion and En­cour­age­ment of Bar­ber Shop Quar­tets Singing in Amer­ica (also known as the Bar­ber­shop Har­mony So­ci­ety).

Teach­ers and friends con­vinced him that he could bet­ter un­der­stand phys­i­ol­ogy by be­com­ing a physi­cian. He re­ceived his med­i­cal de­gree from the Uni­ver­sity of Illi­nois col­lege of medicine and a mas­ter of science de­gree from the Har­vard School of Public Health be­fore be­ing re­cruited by the U.S. Public Health Ser­vice and sent to the Chronic Dis­ease Re­search In­sti­tute in Buf­falo.

Sackett, who lived in Mark­dale, Ont., is sur­vived by his wife, the for­mer Bar­bara Bennett; four sons, David, Charles, An­drew and Robert; eight grand­chil­dren; and a brother, Jim.

He said in an oral his­tory that he was most proud of “the bril­liant young peo­ple I taught and men­tored” and of his “abil­ity to trans­late, de­mys­tify, ex­plain, pro­mote and pop­u­lar­ize re­search meth­ods.” With files from the New York Times

BORIS SPREMO/TORONTO STAR FILE PHOTO

Dr. David Sackett’s re­search showed the benefits of As­pirin in re­duc­ing the risk of stroke. But he was most proud of his role as a teacher.

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