Oops!

My Generation to Yours

Graduates, Friends, Faculty and honored guests. Let me begin by offering my most heartfelt congratulations to the Harvard Medical School and Harvard School of Dental Medicine Class of 2008, on the first day of your medical and dental careers. I am honored to address you on this wonderful occasion.

When I sat down to ponder what comments I might make today, during your graduation ceremony, I realized that this joyful occasion holds a similar spirit of change for both of us. This is my first year as dean—an opportunity that I never imagined having during the 36 years since my own graduation in 1972. This new beginning for me resonates very strongly with your own impending entry into this extraordinary profession. I felt that this shared beginning, and lessons I have learned from the surprises of my own career might be a good  theme for  my remarks.

Bear with me as I take you back briefly to June 1972. America was at the tail end of the divisive Vietnam War, and in the middle of the Cold War. President Nixon made his famous trip to China to meet with Chairman Mao, and in June, the Watergate burglars were arrested, setting in motion the end of that administration. A first class stamp cost 8 cents, median household income was $9,000, and HMS tuition was $3,150! The first cable TV show was transmitted that year on the newly created HBO network and the first video game, PONG, was introduced by Atari. The Godfather was released as a hit movie, and Carole King’s “You’ve got a friend” was the Grammy “song of the year”....

My class was the first to graduate from a new medical school, The Mount Sinai School of Medicine. As the class speaker , I delivered a passionate, politically extreme speech that thrilled me, but irritated many people, and which only I now remember (at least I hope that’s the case).

I was ready upon graduation to be a clinician and teacher, and I couldn’t wait for the start of my medical internship, despite the hard work that I knew it would entail.

After a short-tracked residency, I delayed my expected pursuit of clinical medicine and began a stint as clinical associate at the National Institutes of Health, following a mentor’s suggestion to join an exciting lab doing diabetes research. Wonderful science was going on all around me, but, alas, my ambitions exceeded my nonexistent skills as an experimentalist. Between cell culture and pipetting, frustration born of repeated failure was about to send me back to my original destination as a clinician and teacher. One night, however, as I watched the data emerge from the gamma counter, I was overwhelmed by the exciting positive results of my experiment. That one moment of discovery, being able to understand a disease mechanism that no one ever had before, gave me an extraordinary thrill and inspired me to pursue a career as a physician-investigator.

This tale of unexpected discovery and its impact on my career is just one example of the many ups and downs and changes during the course of my life. I never knew precisely where I was heading and, certainly, I never expected the job that brings me here before you today.

Throughout it all, my family was a central element of my life, as I hope it will be for you. Mine is a dual medical career family, and I never imagined that my wife, in addition to raising with me two lovely daughters, would end up sharing a laboratory and the same research interest. The opportunity now afforded me as dean of HMS to use my experience as a physician, a scientist, an administrator, (not to mention a husband and a father) on behalf of this great school, is beyond anything I expected on the day that I delivered my first graduation speech, to my peers.

What lessons, then, can I draw for you on this wonderful occasion of your graduation from HMS?

The profession of medicine is an extraordinary calling. In every age, there are those who wish medicine to return to an idealized past or skip ahead to a utopian future . We have no shortage of such voices today. Yes, there are problems in the world of medicine, but problems notwithstanding, this is a wonderful time to enter this profession. The HMS education that led you here today has transmitted to you knowledge at the cutting edge of biological science and human health and has given you an understanding of disease more sophisticated than was available to any of your predecessors. But this scientific knowledge, however thrilling, is, for most of us, only one attraction to this profession. By combining medical science with the age-old privilege of physicians to serve as healers, confidants, and advocates to suffering patients (often at moments of great need), the profession assumes characteristics of a unique and extraordinary calling.

Sadly, amid the joys and successes of your developing careers may also come moments of failure and unexpected tragedy. The heartbreaking and untimely death of your classmate David Magoon brought a profound and disorienting grief to your lives. Most losses you will encounter as a physician will not be this personal. But medicine, like no other profession, squarely faces human suffering and the shock of terrible misfortune. The fusion of science and humanism is at the very heart of our profession. To have the opportunity to enter this vocation remains as much of a privilege today as it was thousands of years ago, when Hippocrates practiced and wrote on the physicians calling.

From the age of Hippocrates, medicine has not continuously moved forward in an arc of progress. However,  it is difficult to deny that medicine and medical science have advanced at an astonishing rate in recent decades. Certainly, progress in many areas has not been as fast as we would like or even expect. There are periodic missteps and even reversals. There are devastating diseases for which we currently have no answers. But few can question that medical science is moving forward at an accelerating rate or that your capacity as physicians to understand, to predict, and to treat disease, including common disorders, will be unrecognizably better when you are 36 years from your graduation day, as I am today.

Still we should keep in mind the words of  a former leader of HMS, Dr. C. Sidney Burwell, who was dean from 1935 to ’49. At an HMS graduation in the late 1940s, he said “…Half of what we have taught you is wrong. Unfortunately, we don’t know which half.” Though this quip may cause us to laugh, it is surely still true today. This comment also reminds me of the 1973 Woody Allen movie Sleeper. In that movie, which I saw while an intern, Miles Monroe, owner of The Happy Carrot health food store (and played by Woody Allen) is hospitalized in Manhattan for an ulcer operation, but ends up in an immortality institution's liquid nitrogen tank. He is revived 200 years later, in the year 2173, by a subversive organization, the only member of the human race without a biometric identity.

This early Woody Allen movie introduces concepts like orgasmatron booths, intoxication orbs, confessional robots, and the cloning of organs, for which we will likely not have to wait until 2173. Many things that were considered unhealthy in 1973, including junk food, had been shown by scientists to actually be good for you.

Indeed, as dramatized by Woody Allen in Sleeper, the advance of human knowledge will require that some of today’s teachings be discarded, including some that we may be quite attached to. While remaining skeptical of new claims, we must be open to new discovery, and the periodic upending of existing wisdom. Indeed, if we have done our job well, many of you graduating today will make the discoveries and change the basic- and social-science paradigms that will represent our next generation of progress.

One thing I do know for certain is that the technology at your disposal will have unprecedented power. From DNA microarrays and extremely low-cost gene sequencing, to new imaging tools, to novel algorithms for working mountains of data into manageable landscapes, the techniques you apply will have an increasing impact on human health. And hopefully, it will not just be the health of people in this country. Harvard Medical School now officially has a global focus with the renaming of the Social Medicine Department as the Department of Global Health and Social Medicine. This change reflects both our recognition of the need for high-quality health care in every corner of the world as well as our intention to reach out effectively to suffering populations and train the next generation of global health leaders. Many of you have helped drive this change.

Closer to home, the Medical School recently received funding for a paradigm-shifting Clinical and Translational Science Center from the National Institutes of Health. The Harvard CTSC will integrate clinical and translational research across Harvard and the HMS-affiliated hospitals. For the first time, the independent hospital-based clinical research centers will be integrated.  This will accelerate research through automated information exchange, simplified regulation, shared core technologies, and grants to support innovation. Many of you will take part in these efforts, as surely many will benefit from them in your careers as health care providers.

Just as this new grant was difficult to envision several years ago, be prepared for many other, even more remarkable transformations in medicine and medical science. As Harvard medical and dental graduates, your intelligence, your skepticism of received wisdom and your desire to have a positive impact on the world positions you extremely well as critical agents for future change.

In addition to medicine evolving as we replace old paradigms with new ones, your individual careers may also change over time, in unpredictable ways, as did mine. Some of you will travel a clear path to a well-imagined goal within medicine, and you will stay on that path with great satisfaction through your entire career. I know of many such physicians, and their careers and successes are wonderful to behold. Others of you will start down one road and then change directions, perhaps because of new opportunities, a change of mind, adversity, or sudden inspiration. Such career changes have the opportunity to be wonderful and will create lives, and successes, unimaginable to you today. And as your dean, watching your careers evolve will be one of my great joys, and this will surely be among the pleasures of your families, your classmates, and our faculty.

Whether or not you feel certain today where your degree will take you, keep yourselves open to the many opportunities that are likely to present themselves. In making your decisions, consult your mentors, rely on your families, be prepared to take some risks, and most importantly, be confident in your own inner voice.

Finally, as you get ready to leave today as physicians, remember to keep your passion and idealism. But bear in mind, as I do now looking back at the world of 1972 and the soapbox I stood on at my own graduation, that passion and idealism alone do not change the world. Rather, it is what you will do as physicians, scientists, policymakers, academic leaders, entrepreneurs, writers, or even artists that will have the greatest impact on the world.

Whether you end up where you always wanted to go, or someplace entirely unexpected, I wish every one of you well in your journey.