Evidence-Based Medicine: Sackett and Guyatt — The Schism at the Outset

This paper delineates the genesis of the evidence-based medicine (EBM) framework at McMaster University and examines the latent conflict between its foundational pioneers, David Sackett and Gordon Guyatt. It uncovers the historical precursors of EBM alongside the behind-the-scenes academic drama that enveloped the birth of the term itself. The analy­sis highlights a profound methodological rift between the two leaders: while Sackett championed a clinical humanism — positing that statistics ought to serve merely as a flexible instrument in the hands of a discerning practitioner, and that a clinician’s experience and intuition carry equal weight with trial data — Guyatt pivoted toward technocratic utilitarianism, advocating for total mathematization, the subordination of the physician to systemic algorithms, and the eradication of «subjective expertise». The contemporary crisis and subsequent dehumanization of «protocol-driven medicine» are direct corollaries of the triumph of Guyatt’s standardization over Sackett’s pluralistic and adaptable approach. By expunging both the physician’s agency and the patient’s unique clinical presentation from the medical equation, the system has reached an impasse — a reality that Guyatt himself conceded in the twilight of his career during the 2010s and 2020s, noting the corporate hijacking of EBM and the proliferation of biased, industry-driven trials.