With a focus on evidence, ‘giant among giants’ influenced research and treatment across health care spectrum
A May 25, 2015 Globe and Mail article is entitled: “David Sackett: The father of evidence-based medicine.”
The subhead, at the online version of the article that I read, reads: ” ‘Giant among giants’ influenced research and treatment across health care spectrum, from pediatrics to geriatrics”
The opening paragraphs read:
In his final year of medical school, David Sackett was entrusted with the care of a teenager being treated for what is now call hepatitis A. At the time, the late 1950s, the standard treatment was months of bed rest, the belief being that until the liver receded to its normal size, activity would surely result in death.
As the weeks dragged on, the teenager grew ever more restless; spurred by daily confrontations with a patient begging to roam, the medical student began to wonder what the evidence was for strict immobility.
In the days before the Internet and PubMed, the soon-to-be Dr. Sackett turned to the U.S. Armed Forces Medical Library. There, he discovered an elegantly simple study that took two groups of soldiers with hepatitis and randomly assigned them to bed rest or regular activity and found that they had precisely the same outcomes. There was no evidence that bed rest was useful; the “conventional wisdom” that guided medical practice was bunk.
On that day, he read his first randomized clinical trial and discovered the power of evidence, an epiphany that changed his life and, eventually, the practice of medicine in the Western world. He also apologized to his patient and told him to walk around as much as he liked.
Additional quote, regarding “tradition and expert opinion”
For the lay public, the notion that medicine should be evidence-based may seem self-evident. In fact, medical practice was long rooted in tradition and expert opinion.
Dr. Sackett remained unpretentious to the end. Asked to explain his success, he again cited Kurt Vonnegut: “We are what we pretend to be.”
Comment: The version of this quote that I remember is one that Allen Garr shared with us, I think in one of his articles, when he was a writer (or maybe he was Editor at the time; I forget) at The Peak at Simon Fraser University in the late 1960s.
The quote was along the lines of “We become what we pretend to be, so be careful what you pretend to be.” It was a line at the front of one of Vonnegut’s books. The quote brings to mind in turn a line from William Blake, which runs approximately as (or these may be the exact words): “They became what they beheld.”
An underlying current of thought addressing the same theme, that I’ve often encountered over the years, is that wherever we put our attention, what we attend to take on a particular role in our lives. Another related theme is that, if there are two ways of expressing a thought, expressing it in positive terms is a good way to go – as in speaking in terms of “What we want” as opposed to speaking in terms of: “What we don’t want.”
Or: “We will do well to focus on the next steps to fix the issues that confront us, whatever that issues may be.”
The concept is further elaborated in posts addressing the evidence-based, field-tested WOOP – Wish | Outcome | Obstacle | Plan – concept:
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Predilection for marching to a different drummer
“David Lawrence Sackett – ‘Sack’ to his friends – was born on Nov. 17, 1934, in Chicago, the son of an artist-designer father, DeForest, and homemaker-bibliophile mother, Margaret (née Ross). A self-described “prototypical geek,” he was a tall, awkward child with poor eyesight and worse teeth (he wore braces before they were common), but was nevertheless happy-go-lucky. At 12, he suffered from polio and spent months in bed, becoming a voracious reader. As part of his recovery, he took up running and became a gregarious track star. He also developed a life-long love for music, barber shop-style singing in particular.
“While he excelled academically, his high school record was most notable for its abundance of misconduct slips, a result of what he described as a ‘predilection for marching to a different drummer.’ He followed his two brothers to Lawrence College in Appleton, Wis., where he discovered an interest in physiology, and was pointed toward medicine. He chose the University of Illinois because, at $500 a year, it was the only medical school he could afford.”
Eight distinct careers; no career should last more than 10 years, he believed
“In 1994, he moved to the University of Oxford in England to establish the International Centre for Evidence-Based Medicine. He retired five years later, at 65. He also gave his last lecture about evidence-based medicine; he firmly believed that “experts” were an impediment to progress and change, so no career should last more than 10 years. (In all, he had eight distinct careers.)”
“When word spread of his cancer diagnosis, Dr. Sackett was inundated with requests for interviews, which he rarely agreed to. Aware that there was great interest in his career, he invited questions and, with the help of his wife and his close friend Dr. Haynes, he essentially wrote an autobiography in question-and-answer format. He made his last contributions just days before he died. (The 103-page “interview” is available online.)”
The topic of how some key event at an early stage in a person’s career influences how that person’s career proceeds from that point on is also of salience. What is of interest as well is that David Sackett had eight distinct careers, not just one.
A Feb. 10, 2016 Guardian article is entitled: “Opinion vs facts: why do celebrities so often get it wrong? Celebrities often make wildly inaccurate claims and comments to millions of people. But the workings of our minds mean we’re all prone to such behaviour.”
A Feb. 22, 2016 New York Tims article is entitled: “For Mark Willenbring, Substance Abuse Treatment Begins With Research.”