David Sackett Communitysdrake72021-03-04T09:18:20-06:00
David Sackett Community
Physician House Advising Faculty
Dr. Nicole Thompson
Dr.Nicole C. P. Thompson, MD, FAAP, is an Associate Professor of Clinical Anesthesiology in the Department of Anesthesiology at the University of Illinois Health Science System. She is a graduate of Xavier University of Louisiana and Loyola University Stritch School of Medicine. Dr. Thompson completed residency at Rush University Medical Center and fellowship at University of Illinois Hospital & Health Sciences System. She is board certified in Anesthesiology and Pediatric Anesthesiology. Her clinical and academic interests are in difficult airway management and in global health. In addition to her duties at the University of Illinois, Dr. Thompson also provides care for patients at Shriners Hospital for Children Chicago. Dr. Thompson is a fellow of the American Academy Pediatrics and is the immediate past chair for the Academic Section on Anesthesiology within the National Medical Association. She is married and the mother of one boy, three girls, and one dog.
Dr. Holly Rosencranz
Dr. Rosencranz is a board-certified internist with over thirty years of experience in clinical medicine and medical education. She attended the University of Illinois at Chicago (UIC) for medical school and internal medicine residency. She practiced in private groups and community hospitals until 2005, when she returned to the academic setting at the UIC medical center. After earning a master’s degree in public policy in 2012, she began to participate in local and state medical societies to pursue opportunities in advocacy for health care professionals, individual patients, and communities. Her medical career has always encompassed working with medical students and resident trainees. She has served as a residency program director and currently is an internal medicine clerkship site director. Additionally, she has been very active in addressing the health impacts of climate change, including through medical society resolutions, state legislation, and teaching seminars locally, nationally, and internationally.
David Sackett, MD (1934-2015)
David Sackett is considered a founder of the discipline of evidence-based medicine and was at the forefront of developing the medical education strategy of problem-based learning.After graduating from the University of Illinois college of medicine in 1960, he became interested in how methods of epidemiology could be applied to healthcare questions about the diagnosis, prognosis, etiology, and treatment of clinical problems.
At age 32, he became the founding chair of an innovative Department of Clinical Epidemiology and Biostatistics at McMaster University. He served as a mentor to many future scholars. Said one mentee, “He said to me, ‘My job is to make sure you meet your goals and objectives, and I will facilitate that for you….That’s exactly what he did. He didn’t do it for his career, because he already had a fantastic career. He just wanted to support young people.” (Collier)
Sackett was the first head of the first department of Clinical Epidemiology and Biostatistics in the world at McMaster University
1970-Sackett created a graduate program to teach clinicians and others how todo healthcare research
1993-Sackett became the first Chair of the Cochrane Collaboration Steering Group
Sackett published 12 books, 60 chapters, and an estimated 300 papers in medicine
Dr. Sackett Biography
Dr. David Sackett was born November 17, 1934, to DeForest and Margaret Sackett (nee Ross). Sackett described his early life to Brian Haynes, one of his PhD mentee, in an interview close to the end of his life:
…I grew up in a small, semi-rural suburb of Chicago, the 3rd son of a bibliophile mother and artist-designer father. I remember our large Victorian house as filled with love, neighborhood kids, border collies, bagpipe and classical music, and books for every age and interest. My eldest brother became a Madison Avenue publishing magnate and the 2nd, a Stone Age archaeologist who became Chair of Anthropology at UCLA.
Because everything is ‘normal’ to a naïve kid, I enjoyed friendships with both black and white kids in our integrated schools, but raised no objections to my hometown’s racially segregated housing until my later civil rights days. I look back on my childhood as a happy time in a happy family.
I was a prototypical geek: far taller and skinnier than my classmates, my baseball aspirations shattered by monocular vision from severe amblyopia, my shyness exacerbated throughout 8 years of dental braces, and out of commission for half of my 12th year from polio and a post-polio leg contracture. (Sackett)
Sackett’s friend, Richard Smith, editor of the BMJ, commented on the lasting imprint of his childhood, “He lived in such houses all his life and was always a voracious reader” (Smith). In a revealing anecdote about his second-grade teacher’s forecast of Sackett’s lifelong temperament, echoes of Twain’s Tom Sawyer can be heard:
An enthusiastic student, I loved school, and couldn’t stop talking, joking and punning about it, especially in class, especially when I was supposed to be silent. After banishing me to the hall for much of grade 2, my teacher told my mom “Your boy will wind up either President of the United States or hung in a village square.” (Sackett)
New York Times writer, Sam Roberts, reported on what Sackett made of his early adversity: “Bedridden for months as a child with polio, David 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…” (Roberts). Toward the end of his life, Sackett reflected that he felt the polio was a “blessing.” Sacket completed high school at age 16, a year ahead of his class. Since he was too young to go onto college, he took another year of science and choir and kept up with the track team (Sackett).
Sackett attended the small, liberal arts Lawrence College in Wisconsin. In fact, so did his wife and both of his brothers and their future wives. At Lawrence, Sackett discovered his love for science but was conflicted about pursuing zoology or physiology. In the end, Sackett’s consultations with teachers and friends convinced him that becoming a physician was the way to deepen his understanding of physiology and “combat its derangements.” Sackett left Lawrence with Barbara Bennett who would become his lifelong partner and wife (Sackett).
From 1956 -1960, Sackett attended the University of Illinois Medical School. In his interview with Haynes, Sackett’s recollections of medical school elicited mixed feelings. He recalled the hardships of being an impoverished medical student, and the goodness of Dr. Robert Pumper, a virologist who became his first professional mentor. Sackett was glad to be of service to the impoverished patients who visited Cook County Hospital, but he was disappointed with the curriculum, which seemed divorced from the clinical context. He felt disappointed that his superiors were unable to supply evidence for their medical decisions, and instead resorted to explanations like “that’s how we’ve always done it” or “that’s how the ‘experts’ say we should do it” (Sackett). Sacket described his “predilection for marching to a different drummer” since he was in high school (Watts). Eventually, his divergent thought processes were reflected in his clinical decision-making and “constantly offending conventional therapeutic wisdom” (Watts).
Toward the end of medical school, Sackett had a life-transforming experience treating a patient with hepatitis. At the time, the “conventional wisdom” recommended extended bed rest, but Sackett’s patient was adamantly resistant to this therapy. Searching for another therapy, Sackett discovered Dr. Tom Chalmers, a US Army gastroenterologist who conducted a randomized controlled trial on hepatitis in the Korean War field of operations. It was Sackett’s first encounter with high-quality trial evidence from a journal and he convinced his supervisors to successfully utilize the treatment Chalmer’s study demonstrated. At the time RCTs were quite rare. Sackett describes the change wrought by this experience:
My subsequent ‘clinical course’ was far from uneventful. I became a ‘trouble-maker’, constantly questioning conventional therapeutic wisdom, and offending especially the sub-specialists when they pontificated (I thought) about how I ought to be treating my patients. I had a stormy time in obstetrics, where I questioned why patients with severe pre-eclampsia received intravenous morphine until their respirations fell below 12 per minute. I gained unfavorable notoriety on the medical ward, where I challenged a consultant’s recommendation that I should ignore my patient’s diastolic blood pressure of 125 mm Hg “because it was essential for his brain perfusion.” (Sackett)
Sackett undertook his residency training at the University of Illinois Research and Education Hospital between 1960-1963. He trained in internal medicine and nephrology. During this residency period, he was offered and accepted a National Institutes of Health Research Fellowship in nephrology (Haynes).
In 1962, during the Cuban Missile crisis, Sackett was recruited by the United States Public Health Service and stationed in Buffalo at the Chronic Disease Research Institute. Smith summarizes the effect of Sackett’s 1963-1965 sojourn to Buffalo on the arc of his career: “…he met epidemiologists, was diverted from his career in bench science and became interested in how methods of epidemiology could be applied to his ‘first love’ clinical medicine” (Smith). Sackett remembered his career-defining insight and seminal question at Buffalo “…my growing understanding of the strategies and tactics of population-oriented epidemiology and biostatistics made me wonder whether they might be redirected to individual patient-encounters and improve my diagnostic abilities, my prognostic predictions, and my selection and application of therapeutic interventions” (Sackett).
From 1965 to 1966, Sackett was the Chief Teaching Fellow in Buffalo where he honed his sensibilities about how to relate to students, sometimes through painful trial and error. Sacket revealed to Haynes such a painful episode at Buffalo with the approximately 30 interns he supervised. From this we have gathered a sense of what guided Sackett to become a humble and forbearing mentor eventually:
Not all my educational efforts were appropriate. To teach my house staff to avoid costly but unnecessary lab tests, at [one] of their ‘grand rounds’ I asked an intern to describe the end-of-life care he had given a terminal cancer patient who was well-known to our service. After praising his compassionate care, I took a strip off him in public for the unnecessary lab bill he’d run up on the patient’s last day. I took him aside later to apologize, but he remained quiet and wary of me for months thereafter. Although lots of senior clinicians still practice ‘education through humiliation’30, I rejected it from that day forward. (Sackett)
In 1966, Sackett determined to take an additional course of study with Harvard’s School of Public Health in Boston. He attended under the GI bill and took his wife and 4 boys to live in student housing. Sackett reports that the Chair of Epidemiology at Harvard SPH, Brian MacMahon, met with him and “kindly took me under his wing.” Sackett followed MacMahon’s advice not to take an MPH, rather take epidemiology and biostatistics courses, supplement with research, and finish with an MSc. Thus, Sackett was guided toward a course of studies supportive of his clinical orientation.
At Harvard and MIT, Sackett met an abundance of new friends, participated in the Framingham Heart Study at Dr. Kannel’s invitation, and deepened his understanding of epidemiological research and curricular design. Sackett’s work in this period moved him away from curricula focused on public health broadly toward a clinical epidemiological approach concerned with clinical examination accuracy and harm-benefit ratio analysis for therapeutics. Sackett reflected on the trend of thought he came to at Harvard, which led him to the next position at McMaster University: “I began to think about clinical ‘cases’ that might be introduced into classroom settings to illustrate and solve relevant clinical problems in precision, accuracy, and efficacy” (Sackett).
In 1967, Sackett was recruited to establish an innovative department at the newly formed McMaster University medical school in Canada. Haynes summarized some of Sackett’s achievements in the leadership of this tremendously innovative department, which eventually supported an evidence-based medicine revolution across the world:
… at Harvard University, he learned the methods of “population-based” epidemiology and convinced himself and others that he should work on applying them to healthcare questions about the diagnosis, prognosis, etiology, and treatment of clinical problems. He was given a surprising opportunity to do so by the new medical school at McMaster University, where, at the age of 32, he became the founding chair of the department of Clinical Epidemiology and Biostatistics. As a member of the then small faculty, he contributed heavily to the pioneering problem-based curriculum, including integrating clinical epidemiologic principles into the health care problems that provided the stimulus and framework for learning.
In 1970, Sackett created a graduate program to teach clinicians and others how to do health care research. Now named the Health Research Methodology Program, it has trained and launched the careers of hundreds of clinical epidemiologists, biostatisticians, and health services and policy researchers.
He saw that the sound research being done to answer important clinical problems was likely to whither on the vine unless clinicians learned more about how to identify, interpret, and apply sound studies while quickly side-stepping weak studies. Initially, this newly deﬁned set of clinical skills was called critical appraisal of the medical literature, but it soon became evidence-based medicine. (Haynes)
Smith tells a slightly more behind the scenes version of Sackett’s coming to McMaster at the invitation of John Evans, who was shaping his new medical school in Hamilton. The story, retold with Smith’s characteristic flair for narrative, conveys the Sackett’s wry humor and galloping optimism:
…in 1966 it was Holland who suggested Sackett to John Evans, who was starting a new medical school at McMaster University in Hamilton, Canada.
After getting a letter from Evans “out of the blue” Sackett went to visit him, but, he didn’t want to leave the US, was 32 years old, and had, he told me in an interview, “never done anything.” Evans contacted him because he wanted “a different kind of medical school” and wasn’t taken with the traditional public health people in Canada. Sackett didn’t want the job and so could be very frank. Evans asked him about what sort of department of social medicine and community medicine they should have in the new school, and Sackett answered “none.” His point was that all clinicians should be concerned about these issues. In fact Evans had already reached the same conclusion.
Evans’s next question was what sort of course should there be to teach medical students epidemiology and statistics. Again Sackett answered “none,” arguing that these disciplines needed to be taught within the clinical disciplines. “Otherwise it would be just as awful as everywhere else. The students would hate the faculty. The faculty would hate the students. And it would be a shambles.” Again it’s what Evans wanted to hear: there weren’t going to be any courses in anything, students would learn from the problems of patients. This concept of medical education had come from William Spaulding, a Toronto physician and internist who had thought deeply about medical education and was another of Sackett’s mentors.
As Sackett put it, Evans mistook “a novice for a sage” and asked him to come back for a second interview. Eventually Sackett was appointed and started in 1967, with the first students arriving in 1969. “I was scared,” Sackett said, “I was a kid, I’d never really had a research grant, my previous publications were on basic science, so who would want to come and work with me or give me money for research?” Yet he was ambitious. He recognized that being scared was not compatible with being a new chair in a new medical school. He needed to be “incurably optimistic, convinced that everything was going to be great, incredibly positive, and get his kicks out of the successes of others.” So Sackett displayed those characteristics and attracted outstanding staff and lots of money. The author Kurt Vonnegut, a hero of Sackett’s, says you become what you pretend to be, so be careful what you pretend. (Smith)
Thus, from 1966-1994, Sackett was at McMaster University, Hamilton, Ontario, Canada. Thoma recollects Sackett’s transformation from a reluctant US transplant to a Canadian embracing an entirely different healthcare system:
In his own words, he fell in love with Canada within the first 3 months after arriving at McMaster. Although Canada and the USA share a common border, same language, and generally the same culture, in the late 1960s Canada decided to follow a different course in terms of health care. It decided to adopt a universal health care system. Sackett was excited about the prospect of universal health care and all the other social support systems available in Canada then but not available in the slums of Chicago, Buffalo, and Boston, where he had worked before. (Thomas)
At the age of 49, Sackett’s dedication as a clinician for patients was on full display when he undertook a 2-year residency program because he was concerned about his skills being stale. Robert and Suzanne Fletcher relate Sackett’s belief in lifelong learning: “David took time to foster his own career in an unusual way. At age 49 years, he went back into a “retreading” medical residency. He already had been chief resident years ago but decided he was out of date clinically. After “retreading,” he was more active in clinical settings than he had been in years” (Fletcher). Following this retread training, Sackett was appointed the Hamilton Health Sciences Chief of Medicine (Haynes).
In 1993, Sackett became the first Chair of the Cochrane Collaboration Steering Group (“In Memoriam…”). At the invitation of Muir Gray and the National Health Service, Sackett then founded and directed the Oxford Centre for Evidence-Based Medicine in the UK in the 1994-1999 period. He also worked in Oxford as a clinician at the John Redcliffe Hospital. Sackett’s clinical work at the hospital and directorship of the Centre for Evidence-Based Medicine during the 1990’s was sometimes met with resistance. In an interview Sackett stated “The Establishment saw EBM as an affront to their omniscience and authority, and dismissed it as an ‘old hat’ (‘everybody’s already doing it’) and a ‘dangerous innovation perpetuated by the arrogant to serve cost cutters and suppress clinical freedom.’” (Sackett Interview). “During this period of controversy, a 1995 Lancet editorial was published, “Evidence based medicine, in its place.” The article was offensive to Sackett, who had been involved in the civil rights movement, because it evoked the familiar American phrase “black guys are OK, in their place” (Smith). Fortunately, history saw the place of evidence-based medicine expand.
Sackett was interested in spreading evidence-based healthcare practice and principles not just to Oxford but to the rest of the UK, Europe, and beyond. He visited most of the district general hospitals in the UK and many in Europe, and he would begin his visit by doing a “post-take ward round” with young doctors, showing evidence-based medicine in action. In 1998 he made 100 visits. The young doctors realized that they could challenge their seniors in a way that wasn’t possible with expert or authority-based medicine. It was liberating and democratizing. Smith relays the experience of another renown advocate of the evidence-based medicine movement:
Paul Glasziou, a general practitioner and professor of evidence based medicine at Bond University in Australia, 25 years later still remembers vividly a ward round with Sackett: a student used a decision aid to calculate the chances that a patient had an anemia and the clinicians consulted a systematic review on the value of treating the patient with ferritin. It was completely different from the traditional ward rounds he’d experienced. (Smith)
In 2000, Sackett returned to Canada to focus on teaching health research methodologies in clinician-oriented “Trout Workshops.” Smith points out that when he returned from Oxford, Sackett retired from clinical practice. He devoted his time at the Trout Research and Education Centre to reading, research, writing, and teaching (Smith). The objective of the Trout Workshops was to support graduate students and new faculty understand the principles of clinical epidemiology applied to clinical practice research (Sackett).
Haynes summarizes Sackett’s work as a teacher and his philosophy, “He estimated that he had mentored more than 300 students and colleagues during his career. He also taught his mentees how to mentor, creating a huge multiplier effect” (Haynes). In his memorialization of Sackett, Roger Collier wrote about Sackett’s students who are themselves among the stellar lights of teaching and EBM-conceptual framework development—clear proof of Haynes correctness in ascribing a “huge multiplier effect” to Sackett, the teacher of teachers:
It was not only his intellect, however, that attracted people to Sackett. That was but one of many traits that made him popular among those he took under his wing. “He was a wonderful mentor in terms of being a superb role model and in terms of critical thinking and kindness and skepticism and dedication and hard work and commitment, and he was great at bringing young people together and helping them work together,” said Dr. Gordon Guyatt, a distinguished professor in the department of clinical epidemiology and biostatistics at McMaster. “The other thing that he conveyed was that as hard as you work and as seriously as you take it, it should all be fun.” (Collier)
According to Collier, another of Sackett’s mentees, Sharon Straus, “was struck by his genuine interest in helping young physicians develop their careers.” Straus related her conversation with Sackett:
“He said to me, ‘My job is to make sure you meet your goals and objectives, and I will facilitate that for you’,” said Straus. “Nobody had ever said that to me and it was very empowering. And he lived it. That’s exactly what he did. He didn’t do it for his career, because he already had a fantastic career. He just wanted to support young people.” (Collier)
From 2000-2015, Sackett lived in Irish Lake, Ontario, Canada (Fletcher). During this period, he continued to have enthusiastic exchanges with his colleagues, friends and family. In 2001 he was made an Officer of the Order of Canada, which he styled as “the Canadian equivalent of a knighthood, but without the swordplay” (Daily Telegraph).
Sacket published 12 books, 60 chapters, and an estimated 300 papers in medicine (Smith).
Richard Smith writes warmly about his friend David Sackett in semi-retirement and at the end of his life:
A big, warm, and emotional man Sackett lived his final years with his wife, Barbara, in a wooden cabin beside a lake that was frozen for much of the year. Sackett always described himself as a man of the north. They had many family and friends to stay and would invite them all to canoe on the lake. Asked by students and colleagues for the reasons for his success, Sackett included among several reasons: “An insuppressible capacity for finding and injecting fun into everything I did (sometimes to the distress of others).” He also included “The enduring, loving support, encouragement, and understanding of Barbara and our four sons.” He leaves Barbara; four sons; and grandchildren. (Smith)
Peter Tugwell, who was Sackett’s student and remained close to him towards the end of his life, shared excerpts from Sackett’s note to him after his cancer diagnosis.
Now in our 80th years, we’ve repeated the calculus for the new cancer and its treatment options, and have again identified life-quality as the over-riding goal. All of this is made easier by our happiness and life-satisfaction; First, our kids are wonderful people, independent and happy; we have switched from ‘parenting’ to ‘doting.’ Second, I am simply delighted with what I’ve accomplished in my career, have had a wider range of experiences and opportunities than I could ever have imagined, working with brilliant/inspiring/loving and fun-loving colleagues like you, have been guaranteed immortality through the continuing accomplishments of the young people I have mentored, have no more axes to grind, and am not mad at anybody! I am at peace. Love and hugs, Dave.” (Tugwell)
Collier, R. (2015). Dr. David Sackett, a giant among giants (1934-2015). CMAJ : Canadian Medical Association Journal = Journal De l’Association Medicale Canadienne, 187(9), 640-641. doi:10.1503/cmaj.109-5072. Accessed May 2020 at: https://www.cmaj.ca/content/187/9/640.short
Thomas, A., & Eaves, F. F. (2015). A brief history of evidence-based medicine (EBM) and the contributions of Dr David Sackett. Aesthetic Surgery Journal, 35(8), 261-263. doi:10.1093/asj/sjv130. Accessed May 2020 at: https://academic.oup.com/asj/article/35/8/NP261/251339