The physician David Sackett, who has died aged 80, was a leading advocate of evidence-based medicine. Born in the US, he spent much of his life in Canada; there and in Britain he promoted a radical way of thinking about diagnosis and treatment that was based on a rigorous assessment of the relevant evidence from a patient’s symptoms and clinical signs, and from results of tests and published trials. This challenged the medical profession’s long-held reliance on subjective judgment, tradition and authority.
In putting the patient at the centre of every discussion about diagnosis and treatment, Sackett followed the lead of another pioneer of clinical epidemiology, Alvan Feinstein of Yale Uiversity. Evidence-based medicine, first termed as such by Sackett’s Canadian colleague Gordon Guyatt in 1990, depends on a belief in the value of systematic reviews of literature and critical assessment of the worth of diagnostic tests and treatments, allied to a consideration of the trade-offs of risks, benefits and costs, and, above all, the patient’s preferences.
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