The key thing that differentiates modern medicine from the healing arts of the past is its embrace of science. And few people did more to advance that cause than David Sackett.
Many people might wonder, "Wasn't medicine always evidence-based?" Not necessarily. Until researchers like Sackett started to push the profession in a more scientific direction in the 1990s, a surprising amount of medical practice was simply rooted in expert opinion and whatever doctors learned in medical school — not the best or most up-to-date knowledge.
Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
One of the key insights here was that doctors needed accessible and trustworthy research to inform their decisions. As McMaster University professor Brian Haynes explained, Sackett paved the way by founding "clinical epidemiology," which uses research methods — from epidemiology, biostatistics, and other scientific disciplines — to answer questions about health care.
"This became the basis for evidence-based medicine, which is transforming health care, greatly enhancing its benefits," Haynes said. Haynes and others, including his McMaster colleague Gordon Guyatt, helped develop methods for synthesizing research and getting the best-available evidence into the hands of clinicians.
The evidence-based approach laid out in medicine trickled into other domains, including social policy. "Millions benefited from the seeds they planted," said the Mayo Clinic's Victor Montori. "Randomized trials are contributing to identify policies that are more likely to do more good than harm, and clinical practice has become more scientific."
In recent years, evidence-based medicine has had its moments of crisis and there have been many conversations about whether it lost its way. Some have wondered if the approach over-values certain types of evidence (i.e., randomized control trials) at the expense of clinical experience or individual patients' needs.
Other critics have pointed out that industry has "misappropriated and distorted" evidence based medicine, so that "[the movement] has not resolved the problems it set out to address (especially evidence biases and the hidden hand of vested interests), which have become subtler and harder to detect."
Still, the original intention — to be more exacting at the bedside — was a notable one. Sackett's death and his contributions should remind us that, especially when it comes to health, scientific thinking should always trump magical thinking. As this tribute to Sackett in the BMJ nicely illustrates, this isn't only an approach to medicine; it's an approach to life:
...[Sackett] is perhaps most appreciated by doctors for repeating his residency in medicine some 20 years after first training because, although a professor in the medical school, he "wasn’t a good enough doctor." This was an act of great courage and shows how Sackett, although at one time a professor in Oxford, had no pomposity whatsoever. Of Oxford he said, "They have 20 ways of saying ‘interesting,’ all of them negative." ...
Sackett was well known for arguing that after 10 years of being an expert you should stop — because your views are given too much weight and get in the way of new thinking. He was an expert on compliance, but in 1980 stopped all his work on compliance, and in 1999 he gave his last lecture on evidence based medicine, in Krakow, Poland.