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Back To Vidyya BMJ Gives A Thumbs Down To Experts

Dave Sackett Renounces His "Expertise" In The Field Of Evidence-Based Medicine

In the 60s and 70s, Dr. Dave Sackett, current director of the Trout Research and Education Centre at Irish Lake, Markdale, Ontario, Canada, enjoyed life as an expert on the subject of compliance with therapeutic regimens. He enjoyed the topic, lectured internationally on it, and his opinion was sought by other researchers and research institutes. He and his colleagues ran several international compliance symposiums and wrote two books, chapters for several others, and dozens of papers about the subject of compliance. For years, Dr. Sackett enjoyed the last word on the subject of therpeutic compliance. Then he retired from his expert status feeling that there were more experts around than was healthy for the advancement of the field.

According to Sackett, experts commit two sins that retard the advance of science and harm the young. Firstly, by adding prestige to opinions, those opinions receive far greater leverage than they deserve on scientific grounds alone. Through deference, fear, or respect, others tend not to challenge them, and progress towards the truth is impaired. The second sin of expertness is committed on grant applications and manuscripts that challenge the current expert consensus. Reviewers face the unavoidable temptation to accept or reject new evidence and ideas, not on the basis of their scientific merit, but on the extent to which they agree or disagree with the public positions taken by experts. At other times, the expert bias against new ideas is unconscious. The result is the same: experts thwart new ideas and new investigators, and progress toward truth is slowed.

At the time of his retirement in 1983, Sackett wrote a paper calling for the compulsory retirement of experts and never again lectured, wrote, or refereed anything to do with therapeutic compliance. Sackett repeated his training in inpatient internal medicine and spent much more time in clinical practice.

Sackett applied his skills to a new set of challenges in appraising and applying evidence at the bedside and again became an expert in an old field with a new name: evidence based medicine. Because interest in these ideas was so great, especially among young clinicians around the world, his writing and editing was published in several languages, and when not running a clinical service, he was out of town demonstrating evidence based medicine at the bedside and lecturing about it.

Once again, Sackett felt his conclusions came to be given too much credence and his opinions too much weight. Two clinical signs confirmed that he was once again considered an expert. The first was the reception of an honorary degree and the second was the birth of "Sackettisation," or the artificial linkage of a publication to the evidence-based medicine movement in order to improve sales.

So, Sackett has decided to get out of the way of young people entering this evidence-based field and will never again lecture, write, or referee anything to do with evidence based clinical practice. Instead, Sackett will devote his energies to thinking, teaching, and writing about randomized trials.

Sackett feels that more people could retire from their fields and use their intelligence to new problem areas where, having shed most of their prestige and with no prior personal pronouncements to defend, they could enjoy the liberty to argue new evidence and ideas on the latter's merits. He also calls retirement of "expert status" to be compulsory at the time an expert achieves academic promotion and tenure.

For more information on Sackett's views, visit the BMJ Web site at www.bmj.com. The journal is asking for readers to write their opinions on Dr. Sacketts retirement from evidence-based medicine.



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Editor: Susan K. Boyer, RN
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