Dr. David Sackett: Medical Pioneer
Summary
TLDRDr. David Sackett, the founder of North America's first epidemiology department at McMaster University, discusses his award-winning work in clinical epidemiology and evidence-based medicine. He explains the importance of integrating public health methodologies into clinical medicine and the significance of patient-centered care. Sackett also touches on the evolution of medical practices, the challenges of implementing evidence-based approaches, and his experiences in shaping the healthcare system in Canada.
Takeaways
- 🏆 Dr. David Sackett is the recipient of the Gair Award for outstanding leadership in medicine, often referred to as the 'baby Nobels'.
- 📞 Dr. Sackett received the news of his award through a phone call from John Dirks, someone he's known for many years, which left him 'gob smacked' or speechless.
- 🌐 Dr. Sackett is renowned for his work in clinical epidemiology, which involves applying public health methodologies to individual patient care.
- 🔍 Evidence-based medicine, a concept he's credited with, emphasizes the importance of integrating patient needs, clinical skills, and evidence from research.
- 🩺 Historical medical practices, such as bloodletting, were often based on observations rather than evidence, leading to treatments that could be harmful.
- 🚫 The absence of evidence does not necessarily mean treatments are ineffective, but rather that they are used without scientific backing.
- 💡 Dr. Sackett's work has been influential in shifting medical practices towards evidence-based approaches, challenging traditional methods.
- 🌐 McMaster University's pioneering epidemiology department, founded by Dr. Sackett, was a trailblazer in North America for clinical epidemiology education.
- 🌱 Dr. Sackett's legacy is not just his own work but also the brilliant students and colleagues he's mentored, who continue to advance the field.
- 🌟 His impact on healthcare is significant, with a focus on improving patient outcomes through evidence-based practices and challenging the status quo.
Q & A
Who is Dr. David Sackett and what is his significant achievement?
-Dr. David Sackett is the founder of North America's first epidemiology department at McMaster University in Hamilton. He is also the winner of the Gairdner Award for outstanding leadership in medicine.
What is clinical epidemiology as described by Dr. Sackett?
-Clinical epidemiology is the application of methodologies from public health epidemiology and biostatistics to individual patients, integrating public health disciplines into clinical medicine.
What are the three elements of evidence-based medicine according to Dr. Sackett?
-The three elements of evidence-based medicine are the patient's problem and expectations, the clinician's own clinical skills, and the evidence drawn upon to make decisions about the patient's therapy.
How did Dr. Sackett react when he received the news of winning the Gairdner Award?
-Dr. Sackett was initially speechless when he received the news, which he described as a condition that rarely occurs for him, only usually under anesthesia.
What historical example did Dr. Sackett provide to illustrate the importance of evidence-based medicine?
-Dr. Sackett mentioned the case of George Washington, who was treated with bloodletting based on the medical authorities' suggestions of the time, which ultimately led to his death.
What is the issue with medical practices that are based on observation rather than evidence?
-Medical practices based on observation rather than evidence can lead to treatments that appear effective but are not scientifically tested, potentially causing harm to patients.
Can you provide an example of a medical treatment that was once common but later found to be harmful?
-Dr. Sackett mentioned the use of drugs to normalize heart rhythm in patients who had a heart attack. These drugs were found to be harmful when subjected to a randomized trial.
How did the establishment react to the introduction of evidence-based medicine?
-Younger medical professionals were quick to adopt evidence-based medicine, while some senior professors, particularly in England, were resistant to the change as it challenged their established practices.
What is Dr. Sackett's view on web-based self-diagnostic tools like WebMD?
-Dr. Sackett is not particularly familiar with WebMD but acknowledges the existence of many websites providing medical information. He mentions that some groups, like Brian Haynes' team at McMaster, critically evaluate medical literature for accuracy and clinical importance.
Why did McMaster University establish the first clinical epidemiology department in North America?
-McMaster University was able to attract forward-looking and innovative individuals who were interested in integrating epidemiology and biostatistics with clinical skills and community medicine, leading to the establishment of the first clinical epidemiology department.
How does Dr. Sackett feel about his legacy in healthcare and medicine?
-Dr. Sackett sees his legacy in the brilliant young professionals who have come through McMaster University's programs and who are now extending his work in ways that surpass his own contributions.
Outlines
🏥 Interview with Dr. David Sackett: Pioneer in Clinical Epidemiology
Dr. David Sackett, the founder of North America's first epidemiology department at McMaster University and a recipient of the Gerstner Award for outstanding leadership in medicine, is interviewed. He discusses his surprise upon receiving the award, his work in clinical epidemiology, and the concept of evidence-based medicine. Dr. Sackett explains that clinical epidemiology applies public health methodologies to individual patient care, and evidence-based medicine combines patient needs, clinical skills, and evidence for effective treatment. He also touches on the historical reliance on anecdotal evidence in medicine, citing George Washington's death as a result of bloodletting, a treatment based on the authority of the time rather than scientific evidence.
📚 The Evolution of Medical Practice: From Anecdote to Evidence
This segment delves into the evolution of medical practice, highlighting the shift from treatments based on anecdotal evidence to those grounded in scientific evidence. Dr. Sackett discusses how treatments once commonly used, such as bloodletting, were later found to be harmful when subjected to rigorous testing. He also addresses the resistance to change within the medical community, particularly among older practitioners, and the importance of evidence-based medicine in challenging long-standing but unproven practices. The conversation also touches on the impact of web-based self-diagnostic tools and the role of McMaster University in advancing clinical epidemiology.
🌐 McMaster University's Innovative Approach to Medical Education
Dr. Sackett recounts the early days of the epidemiology department at McMaster University, emphasizing the institution's innovative and forward-looking approach to medical education. He shares his experience of moving to Canada and the cultural differences he encountered, particularly in the realm of healthcare. Dr. Sackett reflects on the impact of Universal Health Care and social programs in Canada, which resonated with his own values and contributed to his sense of belonging. He also discusses his rapid adoption of Canadian identity and the significant contributions of young professionals to the field of medicine, viewing them as his legacy and the future of healthcare.
Mindmap
Keywords
💡Epidemiology
💡Clinical Epidemiology
💡Evidence-Based Medicine
💡Gerber Award
💡McMaster University
💡Public Health
💡Diagnostic Skills
💡Randomized Trial
💡Legacy
💡Healthcare System
Highlights
Dr. David Sackett, founder of North America's first epidemiology department at McMaster University, discusses his work and the significance of the Gner Award.
Clinical epidemiology integrates public health methodologies into individual patient care.
Evidence-based medicine emphasizes patient problems, clinical skills, and evidence for therapeutic decisions.
Traditional medical decisions were often based on observation rather than evidence, leading to treatments that could be ineffective or harmful.
The story of George Washington's death illustrates the dangers of non-evidence-based treatments.
Modern medicine still faces challenges with treatments that have been used for years but later found to be harmful when tested.
Dr. Sackett discusses the resistance to evidence-based medicine from older generations of healthcare professionals.
The importance of McMaster University in pioneering clinical epidemiology and evidence-based medicine.
Dr. Sackett's experience moving from the United States to Canada and the impact on his views on healthcare.
The development of McMaster's innovative medical curriculum, including problem-based learning and the integration of epidemiology with clinical skills.
Dr. Sackett's legacy in healthcare and his influence on the next generation of medical professionals.
The role of McMaster University in attracting and nurturing brilliant young minds in the field of medicine.
Dr. Sackett's views on web-based self-diagnostic tools and the importance of evidence in medical literature.
The challenges of implementing evidence-based medicine and the need for continuous testing and challenging of established practices.
Reflections on the legacy of Dr. Sackett's work and the future of evidence-based medicine.
Transcripts
and joining us now Dr David sacket he is
the founder of North America's first
epidemiology department at McMaster
University in Hamilton and the winner of
the gner award for outstanding
leadership in medicine welcome to TVO
and congratulations thanks very much
well you know the gers they call them
the baby nobels this is a big deal so I
want to First find out how'd you get the
news goly um I think I had a phone call
from John Dirks who's one of the senior
folks there uh with the news he and I
have known each other for years and
years and years and uh it was a delight
to hear him I wasn't quite sure what he
was on the phone about and then he
dropped the bomb and what' you
think uh well we lived in Britain for
several years and the term there would
be Gob smacked that uh I was speechless
for a bit speechless sure I've only
known you for a few minutes here that
sounds like a condition that you don't
have happened too often yes that's right
only usually only occurs under
anesthesia okay well let's go through
some of the very basic terms of of what
you do that got you this award uh that
may be very familiar to you but probably
are not so familiar to our viewers so
you got it for your work in clinical
epidemiology what is that clinical
epidemiology is taking the disciplines
the methodologies that have been
developed in public health epidemiology
and biostatistics that were responsible
for things like demonstrating that the
Sal polio vaccine was effective or that
tuberculosis screening was effective and
turning those into paying attention to
individual patients so it's taking those
Public Health disciplines and making
them part of clinical medicine and the
other piece of this I gather is that
you're being acknowledged for your work
on evidence-based medicine yes what's
what is that term that is a natural
outgrowth of clinical epidemiology that
has three elements the first and most
important is the patient uh what is
their problem how do they see their
problem what are their expectations what
do they want to get out of the
transaction
the second is your own clinical skills
you got to be a good doctor you have to
be very good at Diagnostics uh and
sorting out exactly what's going on and
then the third would be the evidence
that you draw upon to make decisions
about that patient's therapy and putting
all those three together is what we call
evidence-based medicine if there's an
evidence-based approach I presume there
is another based approach what else
could there be well in in medical
history
those sorts of decisions have usually
been based on simply observing patients
who did well who didn't go do well and
what did they receive and the problem
with those sorts of observations is that
if a patient's going to die you can give
them a lethal treatment and you'll never
notice if a patient's going to get
better um you can give them any sort of
treatment and the treatment will look
effective so that we had situations such
as poor old George Washington this is a
great story yes tell this one George was
a very healthy robust 68y old guy who
was out riding his horse around his
Plantation came home got a sore throat
and it fairly rapidly developed into
something uh called epiglottitis that
little flap in the back of our throats
that closes over our wind pipes when we
when we uh swallow and that flap swelled
up uh on on George fancy name is
epiglottitis and the question is how do
you treat that well the way treated if
it gets bad is to make a small opening
in the trachea below then a so-called
tracheostomy would they have done that
in his day tracheostomy has been done
for Millennia really okay uh Homer
describes uh Alexander the Great doing a
tracheotomy on the battlefield on a
severely hurt Warrior and so these very
smart doctors who were called in to see
George knew about his diagnosis knew how
to do tracheostomy but instead of that
they followed the treatment that was
suggested by the authorities of the day
uh the so-called experts who were very
very bright people but had developed
their ideas about what worked simply by
observing folks rather than based on
evidence there was there were no trials
there were no experiments going on in
that era and so the expert treatment was
blood leing so they bled him they bled
poor old George for a guy George's age
and size would probably have about 12
pints of blood in his system they took
eight of them away in 9 hours and and of
course when George died quietly at the
end of all that it shouldn't have been a
surprise to anyone they said we did
everything we could but even our even
our best wisdom would work that's right
that's right that's right now but okay
that's an example that's I don't know
what 150 years old or something like
that we don't still do that today I'm
not talking about blood Ling in
particular but we don't take that kind
of approach to medicine today do we
where we say you know it doesn't matter
what the evidence suggests here here's
what I've always done and that's what
we're going to do well it's not so much
that it's done contrary to the evidence
as it is it's done in the absence of
evidence so that an enormous amount of
what we're able to provide patients
these days is indeed based on solid
evidence but we still have occasions
frequently tragic ones in which a
treatment which has been provided for
years and years and years is put to the
test and is found to be damaging the
most dramatic one of those here in North
America was the way we used to treat
patients they'd had a heart attack after
their heart attack their heart rhythm
was unstable we were concerned because
that was kind of a predictor that they
were going to die in the next 24 months
we had drugs that would normalize that
Rhythm and simply make it nice and
smooth and as a result of that
observation uh we decided we ought to
treat all those folks with those
drugs they'd been in use for quite some
time before a randomized trial was C
carried out in which patients with that
abnormal Rhythm were assigned by System
analogous to flipping a coin to receive
or not receive these drugs they had to
stop that trial in an emergency because
they discovered that for every 20
patients they treated that way they
killed one and the calculation was made
in the United States that more patients
had been killed by those drugs then had
been killed by the Viet Kong oh my
goodness my assumption though is that
you if I'm wrong here what you're
suggesting probably flies in the face of
a lot of common procedure and therefore
hasn't won you many friends in the
healthare system is that fair to say um
I guess we'd have to separate that into
the old guys and the young guys okay uh
the young guys seized on this very very
quickly because perhaps they were more
Curious they were more open to new ideas
uh and of course they tended to uh have
their sorts of difficulties with the old
senior establishment uh this was
particularly marked in in England where
when I first took on a clinical service
in Oxford my chief resident was older
than I had been when I took my first
chair here in Canada and to be able to
arm those young folks with a way of
testing uh politely but testing and
challenging their seniors as to whether
or not the diagnostic test they ordered
really was worth doing whether the
treatment they were going to suggest
really did more good than harm and so
the Young Folks tended to grasp it very
very quickly and then more and more of
the older generation did as well some of
the real pioneers of course had had been
doing this for quite some time but that
uh some of the senior professors
particularly in England uh did did not
like it very much because it meant that
a young upstart medical student could
tell them off I can understand that what
about some of these other new ideas like
web-based self diagnostic things WebMD
that kind of thing are what's your view
on that I'm not particularly familiar
with them there there of course are huge
amounts of websites I did a uh I did a
Google the other day before coming over
and there if you put in Google for
evidence-based now you will get 60
million hits so that they're all over
the place uh the ones that I know most
about are ones developed by group such
as Brian Haynes and his team at McMaster
where they go through the world
literature they test it to see is this
clinical article likely to be true and
if true is it likely to be clinically
important when they put that screen on
the clinical journals they discover that
98% of it either ain't true or ain't
useful and they take then that remaining
2% and put it in various formats
journals Journal supplements on the web
of various kinds of of of circumstances
in which folks can get at that better
evidence gotcha you mentioned McMaster
so let me pick up on that yes you were
there at the beginning of the
epidemiology department at Mac the first
one ever in North America it was the
first clinical epidemiology Department
yeah and we're talking what is this 1960
19677 take us back to those days first
of all why I'm from Hamilton so you will
not misinterpret the the meaning behind
this question but why would the first
Leading Edge Of Anything be in Hamilton
Ontario Canada at that time um I guess
you can say people people people rather
than location location location there
were simply an astonishing group of
folks who who came there John Evans uh
the the then President Harry th Arthur
bornes who was a vice president who did
all the groundwork uh just such a
remarkable group of folks that when I
came up for my interview uh from the
states I didn't want to come to Canada
certainly didn't want to come to
Hamilton um when I met these folks and
started talking with them they were just
so
exciting uh so forward-looking um for
example they asked me what sort of
Department of Social Community
preventive medicine should we have at
this new medical school and I said none
that unless the surgeons and the
pediatricians and the psychiatrists are
concerned about social community and
preventive medicine medicine you could
never have a department big enough to
make any difference they then said well
okay what sort of course should we have
in epidemiology and biostatistics for
our medical students and I said none
then unless it's integrated with
clinical skills clinical pharmacology
Diagnostics that sort of thing it would
be just as awful as it is every place
else well they had already been bringing
in folks like Elvin zap perski and Nate
Epstein who are putting their faculty
out in the town not in the Ivory Tower
they already had brought in the
brilliant man named Bill Spalding from
Toronto who had begun to design a
curriculum that had no courses in
epidemiology and biostatistics or
anything else that they of course had
come up with the problem-based learning
program so that they mistook a novice
like me for a sage and and offered me
this incredible opportunity now you're
from Illinois originally right yes how
long well I should ask you do you feel
Thor Canadian today oh sure how long did
that take uh 3 months three months after
moving to Hamilton yes you felt
thoroughly Canadian yep yep and and it
was uh perhaps best exemplified by when
we moved to this small town of
Ancaster um up on the mountain above
Hamilton and we went down to sign up for
things uh you know garbage and that sort
of stuff and this very nice woman uh
behind the counter said this form I have
to fill out is very long and very
complex but I know about it it and you
don't can I just sort of interview you
and and fill in the blanks and so we
went through it all and she got to the
end of it and she said and what's your
religion and we said oh golly ma'am I
mean you know we've just moved to your
country we don't want to get off on the
wrong foot but we don't think our
religion is any of your business and she
said oh you must be a
yank because what she was interested in
was where we wanted our school tax to go
oh of course and the easiest way to do
that is to ask religion and no can would
object to that sort of question um so
that the difference between the
countries was not really very great uh
the huge difference of course was in
health care uh and my work in in the
United States had always been in the
slums of Chicago and buffalo and Boston
uh where my patients there were just so
much up against it uh you know they
couldn't afford medications they
couldn't afford diagnostic tests they
certainly couldn't afford to come into a
hospital so that I never felt I could
send a bill when I was down there and to
move from that system to the system up
here where Universal Health Care was
coming in and where the dramatic
dramatic social programs were being
developed uh just made me feel so much
more at home here than I did down there
I should ask you one last thing and that
is um it's an odd question to ask
because people don't want to think that
they've stopped contributing and you
haven't stopped contributing but you
know when you win an award like this you
start start thinking about your legacy
so what do you think your legacy is to
this country to healthcare to your work
uh gee young people um they they are
both my legacy and of course responsible
for my getting this award because one of
the marvelous things that happened at
McMaster is that we attracted simply
brilliant brilliant young folks who came
through our school who came through our
graduate programs who are now my
colleagues and my mentors uh at at uh
master and so it's going to be people
and and The Marvelous marvelous things
that they're doing extending what I
started far beyond my wildest dreams Dr
David sackin winner of the gner award
for outstanding leadership in medicine
you are quite some Pioneer sir and thank
you for visiting us at TVO tonight thank
you
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