Experts: off with their heads

Dave Sackett, the father of evidence based medicine, announces on p 1283 that he will “never again lecture, write, or referee anything to do with evidence based clinical practice.” And so an era ends.

Sackett is not doing this because he has ceased to believe in evidence based clinical practice but because he is worried about the power of experts. In characteristically provocative style he proposes that “the retirement of experts be made compulsory at the point of their academic promotion and tenure.” There are two problems with experts. Firstly, their opinions are given more weight than they deserve on scientific grounds and so impede progress. Secondly, experts are likely to review grant applications and manuscripts in terms of how much they agree with the expert view. They are thus biased against new ideas.

This is Sackett's second retirement from being an expert. In 1983 he renounced his expertness on compliance with treatment and received a flood of enthusiastic mail from young investigators—but almost none from experts. Perhaps this time more experts will follow Sackett—not into retirement but into a new branch of study. This is, of course, a third argument for stepping down from being an expert: people who had the ability to become experts in one subject can now bring the power of their thinking to a new subject. Innovation often comes from combining ideas from different disciplines. Evidence based medicine came from applying epidemiological ideas to clinical practice.

The BMJ challenges its many expert readers either to renounce their expertness or to produce compelling arguments, preferably evidence based, in favour of experts.

Sackett's historic declaration comes in an issue that contains other material marking historically important events. We publish 10 letters in response to the case of Harold Shipman, the general practitioner convicted of murdering 15 patients. This was an extraordinary case and as such might not have been expected to influence broad policy. In fact the case seems to be having a strong influence and is often linked with the deaths of babies from cardiac surgery in Bristol—even though it is completely different. One debate prompted by the Shipman case concerns the detection of homicide. John Havard, a former secretary of the BMA, resists the temptation in his letter to say “I told you so” to the Home Office, but he and the BMA argued for years that systems needed to be improved to detect secret murders (p 1271 They were ignored.

The final historic moment is next week's vote by junior doctors on a new pay deal. Fiona Moss argues that the vote will be important not just for doctors' pay but also for patients' health and safety (p 1224).