David Sackett 1934–2015: The Father of Evidence-Based Medicine
- Autores: James D. Anderson
- Localización: The International Journal of Prosthodontics, ISSN-e 1942-4426, Vol. 28, Nº. 4, 2015, págs. 343-344
- Idioma: inglés
- Enlaces
-
Resumen
In recent months, the dental profession has lost two of its most influential modern figures—both of them physicians. Prof Per IngvarBrånemark characterizedthe process we know as osseointegration, leading to the worldwide use of dental implants known to everydentist on the planet. His life was commemorated in the January/February issue of this Journal.
Far less known, but equally influential is the work of Prof David Sackett, who trained as a nephrologist and epidemiologist. He is widely recognized as the father of evidence-based medicine, a term coined by one of his students. Prof Sackett’s contribution is far subtler but arguably more pervasive in the dental profession than even dental implants. He felt that received wisdom and expert opinion were threats to the practice of medicine, and there was ample evidence that this traditional approach was costing lives. His dual training led to the notion that epidemiologic principles could be applied to clinical practice. The dental profession was also susceptible to the authority of tradition, as eloquent speakers and strong personalities presented a confusing array of conflicting solutions at dental convention and specialty meeting podiums. It was an opportune time to re-examine dentistry’s established convictions and strong anecdotal tradition—a somewhat humbling, if necessary, step forward in clinical scholarship.
In 1967, at the age of 32, Dr Sackett was invited to establish the first department of Clinical Epidemiology and Biostatistics in the Health Sciences program at McMaster University, where his approach helped reshape medical education. His Clinical Epidemiology: A Basic Science for Clinical Medicine is often described as the bible of evidence-based medicine. His approach used the strength of clinical evidence and critical appraisal of the literature to differentiate between strong and weak evidence. Needless to say, the opinion makers of the day perceived this as a threat. But the practice evolved even to use of a mobile cart with a computer to bring evidence- based decision making to the bedside—in the days before mobile computing. Thus the best available external evidence could be integrated with clinical expertise and patients’ values and preferences for optimal treatment.
The burgeoning influence of critical appraisal on medical practice attracted attention in clinical dentistry. In the early 1990s, a group of 10 midcareer and well-known senior academic prosthodontists went to McMaster for a week’s exploration of this new phenomenon. Participants and their sponsors were understandably reluctant, as these individuals had achieved their positions through a solid understanding of the dental literature. However, they became so convinced of the power of critical appraisal that they returned a year later to consolidate their understanding, and in following years provided workshops for graduate program directors from dental schools across North America. Dental graduate programs around the world show the fingerprints of Prof Sackett to this day. By extension, a new level of quality is present in the dental literature and in the rigor of the clinical research design often conducted in those graduate programs. The graduates of these programs are now the speakers at quality dental conventions and specialty meetings. They present stronger evidence and ways for the practitioner to assess it, and they perist in their efforts despite a regrettable misappropriation of the term evidence-based and growing vested interests and biases.
David Sackett received numerous honorary degrees and high awards and was recognized both inside medicine and in civic society for his contribution to the full spectrum of medicine. He once wrote that experts needed to retire, lest their reputations and lingering biases eclipse new ideas. He was a buoyant personality who, as a teacher, believed strongly in mentorship and serving students—and getting out of their way. His example inspires the best of today’s clinical teachers in dental programs around the world.
