David Sackett

David Lawrence Sackett

David Sackett made seminal contributions to the science of health care and the teaching and practice of medicine. He did so through vision (about how to improve health care through research), innovation (in research methods for health care and education of researchers and clinicians), and engendering collegiality and collaboration. Among his more important randomized clinical trials, and in collaboration with colleagues around the world, he was a Principal Investigator in the trials that showed, for the first time anywhere, the life-saving benefits of aspirin for patients with threatened stroke and threatened heart attack, that surgically repairing the "hardened" arteries of patients with threatened stroke (carotid endarterectomy) prevented both stroke and death, and the ability of nurse practitioners to provide effective, high-quality primary care. In addition, his "debunking" trials showed the futility of traditional health education in helping hypertensive patients take their medicine, and that a popular "bypass" operation for stroke-prone individuals did more harm than good.

He repeated his residency in medicine some 20 years after first training because, although a professor in medical school, he 'wasn't a good enough doctor.'"^[4]

His contributions to research methodology included ways to detect and reduce bias in clinical research, and ways to design, conduct, and report randomized clinical trials. David Sackett is widely regarded as one of 3 "fathers" of modern clinical epidemiology (along with Archie Cochrane of the UK and Alvan Feinstein of the USA). Clinical epidemiology is a research discipline based on the methods of epidemiology (and other scientific pursuits, notably biostatistics, the behavioral sciences, and health economics), applied to understanding the nature of health care problems and, especially, their management. Thus, it is a bridging discipline, linking research to clinical practice. Typical topics include the cause, diagnosis, course (prognosis, clinical prediction), prevention, treatment, and amelioration of health disorders, and the improvement and cost-effectiveness of health services.

Sackett was the founding chair of the first department of Clinical Epidemiology and Biostatistics in the world at McMaster University in Hamilton, Ontario, in 1967, and extensively contributed to the development of research methods through his books and published articles, as well as through education and lectures at McMaster and around the world. Notably, he turned clinical research into a scientifically sound and practical, multidisciplinary "team sport" and has changed for the better the quality of health care research and clinical practice.

In the late 1970s, Sackett began to popularize the use of clinical epidemiologic principles in the practice of medicine and other health care disciplines, working with his former students, Brian Haynes, Peter Tugwell, Gordon Guyatt and eventually many other clinician scientists at McMaster University and around the world. Initially termed "critical appraisal of the medical literature", to help practitioners keep up with scientific advances in health care, this became "evidence-based medicine". Evidence-Based Medicine: An Oral History documents some of the highlights of the role that he and others played in the evolution of EBM. Sackett led the writing of seminal articles on clinical disagreement and how to read clinical journals books, beginning in 1980 in the Canadian Medical Association Journal, followed by seminal books, beginning in 1985 with Clinical Epidemiology: A Basic Science for Clinical Medicine.

In 1994, Sackett accepted an invitation from (later, Sir) Muir Gray of the UK National Health Service to start the first Centre for Evidence-Based Medicine in Britain, as Professor of Clinical Epidemiology, Nuffield Department of Clinical Medicine, University of Oxford.

Clinically, Sackett practiced as a general internist and was appointed Physician-in-Chief of Medicine at the Chedoke-McMaster Hospital in Hamilton Ontario in 1986, then Head of the Division of General Internal Medicine in 1988. In Oxford, he practiced as Honorary NHS Consultant in General Medicine.

Retired from clinical practice in 1999, he returned to Canada and created the Trout Research & Education Centre, where he read, researched, wrote and taught about randomized clinical trials. He also authored, with Sharon Straus, the definitive guide about mentorship for clinician scientists.

• David L Sackett: Interview in 2014 and 2015. Haynes RB (editor). 2015. https://fhs.mcmaster.ca/ceb/docs/David_L_Sackett_Interview_in_2014_2015.pdf
• Sackett DL, Haynes RB (editors). Compliance with Therapeutic Regimens. Baltimore: Johns Hopkins University Press, 1976.
• Haynes RB, Taylor DW, Sackett DL. Compliance in Health Care. Baltimore: Johns Hopkins University Press, 1979.
  ISBN 0-8018-2162-2
  .
• Sackett DL (1979). "Bias in analytic research". J Chronic Dis. 32 (1–2): 51–63.
  PMID 447779
  .
• "Clinical disagreement I: how often it occurs, and why". Can Med Assoc J. 23 (499): 504. 1980.
• "Clinical disagreement II: how to avoid it and learn from one's mistakes". Can Med Assoc J. 123 (613): 617. 1980.
• "How to read clinical journals: I. Why to read them and how to start reading them critically". Can Med Assoc J. 124 (555): 558. 1981.
• Laupacis A, Sackett DL, Roberts RS (June 1988). "An assessment of clinically useful measures of the consequences of treatment". N. Engl. J. Med. 318 (26): 1728–33.
  PMID 3374545.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Sackett DL (February 1986). "Rules of evidence and clinical recommendations on the use of antithrombotic agents". Chest. 89 (2): 2S–3S.
  PMID 3943408
  .
• Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine, First edition. Boston: Little, Brown, 1985.
  ISBN 0-316-76595-3
  .
• North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM; Taylor, D. W.; Haynes, R. B.; Sackett, D. L.; Peerless, S. J.; Ferguson, G. G.; Fox, A. J.; Rankin, R. N.; Hachinski, V. C.; Wiebers, D. O.; Eliasziw, M. (1991). "Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis". N Engl J Med. 325 (7): 445–53.
  PMID 1852179. {{cite journal}}: |author1= has generic name (help
  )
• Guyatt GH, Sackett DL, Cook DJ (December 1993). "Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group". JAMA. 270 (21): 2598–601.
  PMID 8230645.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Guyatt GH, Sackett DL, Cook DJ (January 1994). "Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group". JAMA. 271 (1): 59–63.
  PMID 8258890.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Jaeschke R, Guyatt G, Sackett DL (February 1994). "Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid? Evidence-Based Medicine Working Group". JAMA. 271 (5): 389–91.
  PMID 8283589.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Jaeschke R, Guyatt GH, Sackett DL (March 1994). "Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group". JAMA. 271 (9): 703–7.
  PMID 8309035.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Cook RJ, Sackett DL (February 1995). "The number needed to treat: a clinically useful measure of treatment effect". BMJ. 310 (6977): 452–4.
  PMID 7873954
  .
• Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (January 1996). "Evidence based medicine: what it is and what it isn't". BMJ. 312 (7023): 71–2.
  PMID 8555924.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Barnett HJ, Taylor DW, Eliasziw M; et al. (November 1998). "Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators". N. Engl. J. Med. 339 (20): 1415–25.
  PMID 9811916.{{cite journal}}: CS1 maint: multiple names: authors list (link
  )
• Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM, 2nd ed. Edinburgh & New York: Churchill Livingstone, 2000.
  ISBN 0-443-06240-4
  .
• Haynes RB, Sackett DL, Guyatt GH, Tugwell P. Clinical epidemiology: how to do clinical practice research, 3rd edition. Philadelphia: Lippincott, Williams and Wilkins, 2006.
  ISBN 0-7817-4524-1
  .
• Straus SE, Sackett DL, Mentorship in Academic Medicine. John Wiley & Sons, 2014. Print
  doi:10.1002/9781118446065

• Gordon Guyatt
• David-Sackett-Preis [de]

References