Dr. David Sackett: Medical Pioneer

Summary

Dr. 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

00:00

🏥 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.

05:01

📚 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.

10:02

🌐 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.

Keywords

💡Epidemiology

Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems. In the video, Dr. David Sackett, the founder of the first epidemiology department in North America at McMaster University, discusses the importance of this discipline in understanding public health issues and its integration into clinical medicine.

💡Clinical Epidemiology

Clinical epidemiology is a branch of epidemiology that applies its methodologies to individual patients in clinical settings. It focuses on the diagnosis and treatment of diseases in individuals. Dr. Sackett's work in clinical epidemiology is recognized for transforming public health disciplines into practical clinical medicine, as he emphasizes the importance of applying evidence from population studies to individual patient care.

💡Evidence-Based Medicine

Evidence-based medicine is a concept mentioned in the video that involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. Dr. Sackett is acknowledged for his work on this approach, which includes considering the patient's perspective, the clinician's skills, and the evidence from research to make informed decisions about therapy.

💡Gerber Award

The Gerber Award, referred to as the 'baby Nobels' in the script, is an award given for outstanding leadership in medicine. Dr. Sackett is a recipient of this prestigious award, highlighting his significant contributions to the field, particularly in the areas of clinical epidemiology and evidence-based medicine.

💡McMaster University

McMaster University is located in Hamilton, Ontario, Canada, and is noted in the video as the institution where Dr. Sackett established the first epidemiology department in North America. The university is highlighted for its innovative approach to medical education and research, which attracted Dr. Sackett and contributed to his work in clinical epidemiology.

💡Public Health

Public health is the science and art of preventing disease, prolonging life, and improving the quality of life through organized efforts and informed choices of society, organizations, public and private, communities, and individuals. The video discusses how Dr. Sackett's work in clinical epidemiology bridges public health methodologies with individual patient care.

💡Diagnostic Skills

Diagnostic skills refer to the ability of a clinician to identify a disease or condition through its signs and symptoms. In the context of evidence-based medicine, as discussed in the video, these skills are crucial as they inform the clinician's decision-making process alongside patient expectations and evidence from research.

💡Randomized Trial

A randomized trial is a type of scientific experiment that involves random assignment of subjects to treatment or control groups to study the cause-and-effect relationship between a medical intervention and health outcomes. The video mentions the importance of randomized trials in providing solid evidence for medical treatments, contrasting with historical practices that relied on observational evidence.

💡Legacy

Legacy, in the context of the video, refers to the lasting impact or heritage left by an individual's work or achievements. Dr. Sackett reflects on his legacy as the influence and work of the brilliant young professionals he has mentored and collaborated with, who continue to advance the fields of clinical epidemiology and evidence-based medicine.

💡Healthcare System

The healthcare system encompasses all organizations, people, and actions whose primary intent is to deliver healthcare services to individuals. The video discusses the differences in healthcare systems, particularly between the United States and Canada, and how Dr. Sackett's move to Canada and exposure to a universal healthcare system influenced his work and perspectives.

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