McMaster University

McMaster University

Tribute to David Sackett

David L Sackett

David L Sackett, OC, MD, FRSC, FRCP

Professor Emeritus, Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada

"For his leadership in the fields of clinical epidemiology and evidence-based medicine which had major impacts internationally in applied clinical research and in the practice of medicine…”

Sackett established Canada's first Department of Clinical Epidemiology & Biostatistics and chaired the Division of Internal Medicine at McMaster University where he served from 1967 until he accepted a Chair at Oxford University in 1994. He developed and mentored a new breed of applied clinician-scientists and worked with them to create and disseminate the practice of evidence-based medicine throughout the world.

Dave’s contributions are most notable in three arenas: research methods for applied testing of health care innovations; use of these methods to evaluate the scientific validity and clinical merit of numerous medical interventions; and education of clinicians in understanding and applying the results of “current best evidence from research” in clinical practice.

Research methods for applied testing of health care innovations: His methodologic contributions include cataloguing biases inherent in various types of research designs (particularly "case-control studies") and demonstrating their effects on the results of epidemiologic investigations; developing scientific principles and methodologic procedures for screening for the early detection of disease; explicating and illustrating the relationship of the exact questions asked in clinical trials to the attribution of end points; designing, analysing and reporting the findings of clinical trials; and measuring health states and health status. These contributions have greatly enhanced the rigor and power of research methods in clinical epidemiology, leading to its legitimization as a foundation for evidence-based health care.

Use of these methods to evaluate the scientific validity and clinical merit of numerous medical interventions: Sackett has been instrumental in a great many investigations, testing innovations from the basic sciences and in the processes for delivering medical care for their influence or effect on clinical outcomes. These studies have been collaborative in nature, typically involving multidisciplinary teams of clinicians, statisticians, epidemiologists, health economists, social scientists, and always students. The problems tackled have ranged over many clinical disciplines, the common thread being the application of rigorous research methods to provide unbiased, and often unequivocal, evidence concerning the cause, course, diagnosis, prevention, or treatment of human diseases. Exemplars include the first trial of nurse practitioners (led by Walter Spitzer); the first randomized clinical trial of acetyl salicylic acid for secondary stroke prevention (led by Henry Barnett and Michael Gent); the first RCTs of interventions to improve patient adherence to antihypertensive therapy (with Brian Haynes); the first RCT of extracranial-intracranial arterial bypass for stroke prevention (led by Barnett); the first definitive trials of carotid endarterectomy for stroke prevention (with Barnett); and trials of strategies for improving physician interpretation of scientific evidence (led by Kathryn Bennett) and adherence to practice guidelines stemming from scientific evidence (with Ted Evans).

Education of clinicians in understanding and applying the results of “current best evidence from research” in clinical practice: David Sackett’s educational accomplishments are at least as important as his scientific contributions. He is one of three founders of modern clinical epidemiology (along with Archie Cochrane in the UK and Alvan Feinstein in the US) and has likely contributed to the education of more clinical epidemiologists than anyone else in the world, both directly and through his development and stimulation of clinical epidemiology programs around the world. However, Sackett's most outstanding educational contribution has likely been in developing and promulgating strategies for teaching clinical students and practitioners (in medicine and many other health professions) to be better users of evidence from health care research in examining patients, interpreting diagnostic tests, and managing their problems. His teaching of critical appraisal of medical evidence began in 1978 with a course for medical residents and faculty. This led to the publication of a series of very highly cited, disseminated and translated articles in the Canadian Medical Association Journal, beginning in 1980, focusing on accuracy in clinical measurement and on the reading and interpretation of medical literature, followed by a series on clinical interpretation of diagnostic data, very popular texts on clinical epidemiology and evidence-based medicine, and an ongoing series in the Journal of the American Medical Association (as a member of the Evidence-based Medicine Working Group). The initial series and textbooks have been translated into several languages and have become course materials in numerous medical schools around the world.

Sackett is currently founder and director of the Kilgore S. Trout Research & Education Centre now based in Hamilton, Ontario. He received his bachelor's degree from Lawrence University in Appleton, Wisconsin, and then his M.D. at the University of Illinois. He was the Founding Chair of the Department of Clinical Epidemiology & Biostatistics at McMaster University, the Founding Director of the Centre for Evidence-Based Medicine at Oxford University in England, and the Founding Chair of the Cochrane Collaboration Steering Group.

Dave has received various research awards and elections to learned societies, including the Royal Society of Canada, Fellowship in the Royal College of Physicians of London and Edinburgh, the American and Canadian Societies for Clinical Investigation, the Association of American Physicians, the Canadian Society for Internal Medicine, and the Pan-American Health Association. He has also received numerous awards for his educational and clinical work, was elected to the Canadian Medical Hall of Fame in 2000, appointed an Officer of the Order of Canada in 2001 and most recently was presented with the prestigious Canada Gairdner Wightman Award in 2009.

— Special thanks to Brian Haynes for his significant contributions to this tribute.

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