Chris Silagy : One of the leading lights of evidence based medicine dies aged 41
Authors: Melissa Sweet
Journal: BMJ (2002)

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.

Silagy became involved in evidence based medicine 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 evidence based medicine: “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.

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.” 




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.

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 leaves a wife, Jane, and four sons.

At Silagy's request, the Cochrane 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 (www.cochrane.de/cochrane/silagy.htm) and Monash Institute of Health Services Research (http://203.94.147.62/memoriam/memoriam.html).

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, FRACGP, FAFPHM; died from non-Hodgkin's lymphoma on 13 December 2001.bmj.com/cgi/content/full/323/7326/DC1