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The sins of expertness and a proposal for redemption

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1283

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The cry of an intellectual

The provocation by David Sackett (BMJ 2000;320,1283), that with
respect and attention we have to grasp, deals with the methodology behind
producing knowledge. In Sackett's view there is probably ambiguity
concerning the conception of an expert. In fact, if an expert is someone
who has acquired special skill or knowledge in an area, by understanding
its properties and the way its contents relate, an expert is a skillful
and specialized technician. In such a context, David Sackett is
unquestionably an expert of evidence based medicine (and not only of
this). However, when he applied epidemiological approaches to clinical
practice he carried out a "trial" not as a skillful technician but as an
intellectual. The achievement that is evidence based medicine is the
result of the generalization of an intellectual process that faced
clinical problems in a new manner, a more comprehensive one and one that
is external to specialized and codified professional circuits. To affirm,
demonstrate and defend the supremacy of the evidences, Sackett intended to
(and succeded in) overcoming a few of the limits of contemporary medicine.

This is the work of an intellectual, not of an expert.
Now that theorems have been proven and rules defined, experts of evidence
based medicine grow (and, alas, inflate). They use their own jargon,
books, journals, web sites, databases, etc., and a few of them produce and
sustain their own power. But these are human weaknesses and are not
unusual in the era of globalization where the market needs more and more
of experts, and fewer intellectuals. The exhausting experience of roaming
the world, along with much writing and editing (often without the benefit
of criticism), is unfortunately the main activity of a lot of experts and
intellectuals in all fields of knowledge. However, if for an expert this
is a repetitive performance, for an intellectual it is a mission for
disseminating his knowledge, that has to be unceasingly discussed in order
to contribute to the progress of science (and, not less importantly, to be

The noise Sackett created by slamming the door should once again wake up
(at least a few) experts from their own field and drive them towards more
critical appraisals and as well as new problematic areas. This is
therefore not only a message but a need for scientists of all ages. Today,
the "Children of Sackett" sect is probably in ferment because the guru has
abandoned them, but he has done this to save them from the routine of
"evidence", and to urge all those interested in the improvement of
knowledge to be more scientists (intellectuals) and less experts.

Competing interests: No competing interests

17 May 2000
Maurizio Bonati
Head, Laboratory for Mother and Child Health
"Mario Negri" Research Institute, 20157 Milan, Italy