McMaster breakthrough ranks as a top medical milestone

By Suzanne Morrison, January 9, 2007

    Dr. Gordon Guyatt, a professor of medicine and clinical epidemiology and biostatistics, is credited for creating the term evidence-based medicine. Below, Dr. Brian Haynes, chair of the department of clinical epidemiology and biostatistics at McMaster's Michael G. DeGroote School of Medicine. Photos courtesy of FHS.
The prestigious British Medical Journal is hailing the development of evidence-based medicine by researchers at McMaster University as one of the 15 greatest medical breakthroughs of the last 166 years.

The phrase and the approach -- which makes conscientious, explicit and judicious use of current best evidence for patient care -- is in the running with other medical milestones such as the development of anesthesia, antibiotics, the Pill, vaccines and the risks associated with smoking.

The pre-eminent medical journal, which publishes weekly in the United Kingdom, is relaunching its print and online versions this year by looking back at the most important medical milestones since it was first published in 1840. Readers nominated milestones, then a panel of editors and advisers narrowed the field to 15 from an initial 70.

International experts argued the case for each milestone. You can read what the experts had to say -- either in summary or in full -- by going to the BMJ website. At the same time, you can vote. The winner will be announced on Thursday, Jan. 18 on the BMJ's new website.

Experts at Johns Hopkins University, the University of Calgary and the University of California argued in support of evidence-based medicine as the top milestone. They said without this advance from McMaster University the health of many would have suffered.

For example: Most women with early breast cancer would still be undergoing mastectomy instead of lumpectomy and radiation; many babies born prematurely would still be dying from respiratory distress syndrome, not having the advantage of a mother who took corticosteroids or of being given surfactant themselves; and the choice of a drug to help prevent a second fracture in an elderly woman might be made on the basis of television advertisements instead of good science.

"Evidence-based medicine is one of our most important medical milestones because, without it, the other 14 of the BMJ's milestones would not have been implemented," the international experts said.

The other medical advances being voted on are:

  • Anaesthesia
  • Antibiotics
  • Chlorpromazine
  • Computers
  • Discovery of DNA structure
  • Germ theory
  • Immunology
  • Medical imaging (x-rays etc)
  • Oral contraceptive pill
  • Oral rehydration therapy
  • Risks of smoking
  • Sanitation (clean water and sewage disposal)
  • Tissue culture
  • Vaccines

    Dr. Gordon Guyatt, a professor of medicine and clinical epidemiology and biostatistics, who is credited for creating the term, told the Toronto Star he is "delighted we're even in the running.

    "When you look down the list of the other developments, things like the development of anesthesia that transformed medicine in fundamental ways, the fact that the concept of evidence-based medicine is included is very gratifying."

    Dr. Guyatt paid tribute to Dr. David Sackett, a pioneer of evidence-based medicine who founded Canada's first department of clinical epidemiology at McMaster in 1967. His work was cited when he was named to the Canadian Medical Hall of Fame in 2000.

    Dr. Sackett's work was fostered and encouraged by Dr. John Evans, the first dean of McMaster's faculty of medicine.

    "The role he played was in recognizing David Sackett's vision, recruiting David Sackett as the first chair of the department of clinical epidemiology, and subsequently providing a high level of support for Dr. Sackett and the department's activities," Dr. Guyatt said.

    Dr. Brian Haynes, chair of the department of clinical epidemiology and biostatistics at McMaster's Michael G. DeGroote School of Medicine, said the worldwide investment in health research is $100 billion annually, and evidence-based medicine's role is to try to evaluate, clarify, communicate and transfer the mature findings from this research effort into health care.

    Until the development of evidence-based medicine, many physicians relied on past practice and consensus.