Chris Silagy (1960 - 2001)
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Chris Silagy, one of the leading lights of evidence based medicine, died from non-Hodkin?s lymphoma on 13 December aged 41
The night before his final admission to hospital, Professor Chris Silagy hosted a Christmas dinner at his home for more than 30 of his staff. That day, he had made a presentation to them about his vision for the future of the Monash Institute of Health Services Research in Melbourne, Australia, which he headed.
It was typical of Silagy, one of the leading lights of the Cochrane Collaboration, that he continued working until the last possible moment, despite feeling terribly unwell. Silagy, 41, died on 13 December. He had been diagnosed with non-Hodgkin?s lymphoma more than four years ago.
His communication skills, affability, enthusiasm, energy, vision, courage, and hard work are widely lauded as having been crucial for the progress of evidence based medicine (EBM).
Silagy became involved in EBM as the Sir Robert Menzies scholar in medicine at Oxford University?s department of public health in the early 1990s, where he met Iain Chalmers, who was then setting up the first Cochrane Centre.
Silagy?s systematic review of nicotine replacement therapy was published by the centre as a guide to other reviewers, and he attended the 1993 meeting that formalised the international Cochrane Collaboration, and joined its steering group.
After returning to Australia in 1993, to take up the foundation chair of general practice at Flinders University, he established the Australasian Cochrane Centre, and from 1996 to 1998 chaired the international collaboration?s steering group.
Silagy was open about his illness and the personal perspective it brought to his work. He said he felt a strange sense of familiarity with the hero he never met, Archie Cochrane, who also had a life threatening condition, porphyria, and found it a profound influence on his thinking.
Not long after his diagnosis, Silagy spoke publicly of his frustration at discovering how little reliable evidence was available to guide his treatment decisions, and of the need for research relevant to patients? needs rather than researchers? "intellectual interests."
He felt "increasingly irate" at some of the debate about the merits of EBM: "When I am faced with a life threatening decision, I want the best evidence about whether it will increase my chances, what the side effects are."
He also spoke about how being a doctor could be a disadvantage, when carers wrongly assumed he would know what to do about side effects, and about simple practical things, like how to take off his drip without ripping his hairy arm.
Silagy showed a remarkable determination to work on through his illness and the debilitating side effects of treatment. But it would be wrong to assume that an awareness of mortality was the key factor?from all accounts, he was always driven.
Michael Kidd, professor of general practice at the University of Sydney, knew Silagy since medical school. "We were both general practice registrars at Monash at the same time, and I just found it exhausting trying to keep up with him, and eventually gave up," Kidd once said.
Other colleagues said that a typical scenario was attending a work function with Silagy that ended near midnight. When everyone else went home to bed, Silagy would spend another two hours working on a paper.
When asked a few years ago about what drove her husband, Jane Silagy (who works as a general practitioner under her maiden name of Russell) said his determination to keep working through illness was both denial and a way of coping. It was also because "he just loves working" and is "extremely ambitious."
Hilda Bastian, convenor of Cochrane?s consumer network, says the network?s development owes much to Silagy?s support and care. She says Silagy was remarkable, not just for what he achieved, but how he did it. She recalls when Silagy once addressed a workshop for consumers, they were stunned to discover late in the day that he was a doctor.
"It was the personal impact he had on people," she says. "He changed things and he changed other people; he always challenged people."
Bastian adds that Silagy had a rare ability to understand the viewpoint of others, to change his thinking, and to take risks if he believed in a cause.
"It was a short life but it was amazing and he just packed so much into it," she said.
When Silagy and the Australasian Cochrane Centre moved to Monash University in 1999, the dean of medicine, Professor Nick Saunders, predicted it would be fantastic for the university: "A month of Chris Silagy is probably worth a lifetime of some people."
In 2000, Silagy was appointed to chair the board of the new National Institute of Clinical Studies. Apart from his many professional commitments, he was actively involved in scouting for almost 20 years, including time as branch commissioner for Scouts in Victoria and National Commissioner for Youth Program.
He was proud when his achievements were recognised in the 2000 Queen?s Birthday honours list, when he was made an Officer in the Order of Australia for services to medicine.
Although Silagy always spoke to colleagues as if he would be part of their future, towards the end he began to acknowledge the inevitable, and prepared his own obituary.
"He set this place up to run incredibly well without him but it doesn?t diminish the fact that we feel desperately sad he isn?t here because he was such an incredible leader," said the institute?s public relations manager, Meredith Cameron.
The institute?s chief operating officer, Gavin Horrigan, described Silagy as "one of the most extraordinary people I?ve ever met in my life." He said: "Although people are very low here, there?s a very strong will and determination to make this institute into something that?s a constant tribute and memorial to Chris?s memory."
Silagy is survived by his wife, Jane, and sons, Andrew, 11, Michael, 9, Nicholas, 8, and Benjamin, 6.
A memorial service will be held in the New Year. The family has requested no flowers.
Instead, and at Silagy?s request, the collaboration's steering group will discuss
with Jane Silagy and staff of the Australasian Centre the establishment of a commemorative
scholarship fund. Further details will become available at the websites of the Cochrane Collaboration and Monash Institute of Health Services Research.
Chris Silagy, professor of public health and foundation director of the Monash Institute of Health Services Research Melbourne; b Melbourne 1960; q Melbourne 1983; AO, PhD (epidemiology) Monash University 1992, FRACGP, FAFPHM; died from non-Hodgkin?s lymphoma on 13 December 2001.
Melissa Sweet is an Australian health journalist who writes for The Bulletin and Australian Doctor magazines. This obituary is partly based on a personal profile of Silagy that appeared in Australian Doctor in 1999.
Professor of public health and foundation director of the Monash Institute of Health Services Research Melbourne (b Melbourne 1960; q Melbourne 1983; AO, PhD (epidemiology) Monash University 1992, FRACGP, FAFPHM), died from non-Hodgkin?s lymphoma on 13 December 2001.
He spent two years in Oxford as the Sir Robert Menzies scholar in medicine before returning to Australia in 1993 to take up the foundation chair of general practice at Flinders University at the age of 33. He was actively involved in supporting the development of the Cochrane Collaboration both in Australia (where he was director of the Australasian Cochrane Centre from 1994 to 2001) and internationally (where he was chair of the international steering group from 1996 to 1998).
In February 1999 he moved to Melbourne to take up the position of professor of public health and foundation director of the Monash Institute of Health Services Research. He was passionate in his belief of the need for an evidence based approach to health care and the important role that consumers have within that process. He advocated strongly in public for such changes and that was accentuated further by his personal need for reliable information following his diagnosis with a non-Hodgkin?s lymphoma in 1997.
He spent the last few years of his all too short life cramming as much in as he always did. He was fully involved with his national and international committee work, speaking engagements, and research activities. In 2000 he was appointed to chair the board of the newly established National Institute of Clinical Studies. He also found time to serve the community. For almost 20 years he was actively involved in scouting, holding posts of branch commissioner for Scouts in Victoria and National Commissioner for Youth Program.
He managed to combine all these activities with a strong and devoted commitment to his family. He was immensely proud of the achievements of his wife (Jane) and his sons (Andrew, Michael, Nicholas, and Benjamin). In the 2000 Queen?s Birthday honours list he was made an Officer in the Order of Australia for services to medicine, an award of which he was immensely proud. In the end, his battle with lymphoma was lost, but his vision and legacy will hopefully live on in so many ways.