Thoughts from the Dean

The World is Waiting

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November 14, 2014
The World is Waiting

'At Harvard we ask questions that will often mean the difference between life and death.'

On Nov. 13, 2014, Harvard Medical School officially launched a fundraising campaign that will empower its mission to alleviate human suffering caused by disease. The World is Waiting: The Campaign for Harvard Medicine is part of the larger Harvard Campaign that launched last fall.  

As Dean of the Faculty of Medicine at Harvard University, I had the privilege of addressing 350 guests at a gala celebration held in Boston to outline the need for support that will advance the HMS mission.  Below, I share with you my speech and the campaign video.  


 

Today, we'll mostly talk about the future during this third century of Harvard Medical School, but I start with something that happened decades ago, to a young diabetes researcher working down in Washington, at NIH.

At the time, his research group was baffled. They'd identified a desperately ill group of diabetic patients who didn't respond to any dose of insulin that doctors administered. Nobody could figure it out, but unless they did, these patients would likely die.

One day, the young researcher had an idea. He told his mentor, "Some of these patients have autoimmune symptoms. They produce unusual antibodies. Could one of their antibodies prevent insulin from acting by attaching to insulin receptors on their cells?"

He truly feared his boss might say, "Ridiculous." Instead, he said, "Wow. You’re the first to suggest that idea. Why don't you test it?"

The next night, after doing a quickly designed experiment, this researcher sat alone in a little room beside a gamma counter. He waited for it to spit out his data. He was both thrilled -- and terrified.

By now you've probably guessed. That young researcher was me.

I'd gone to med school planning to become a practicing doctor. But I had an amazing mentor named Solomon Berson. He was both a great doctor and a brilliant researcher. Working with him got me excited about research. In fact, in addition to learning from him, I dreamed of being his colleague for the rest of my life.

One day, he said to me: "You really should go to NIH to pursue research, and I know just who you should work with."  That's why, back in 1974, I was sitting in that room. No, I won't tell you if my research idea was right. At least not right now. Because what's really critical to understand about research is this: not every idea pans out. They don't. But every idea, every student, every project, might.

Especially at Harvard Med School, where we have some of the most brilliant scientists in the world, some of the most brilliant students, the greatest teachers, the greatest medical innovators, and the greatest leaders of HMS -- our deans, department chairs, the heads of our affiliates.

Here, ideas often do pan out.

I wish there was time for me to introduce every one of these leaders and talk about the contributions they've made, but there isn’t.

So, in the next few minutes, I want to tell all of you about why what we do here matters; about some exciting new things we will do, and why you all have the power not just to be part of that, but to be the power behind it.

Of course, you already know a lot about why what we do here matters. We see it in West Africa, where thousands of people sit home alone, waiting to die from hugging a child or wiping the face of a sick neighbor because something they cannot see has invaded their bodies.

We see it in India, where over 4,500 children younger than 5 will die today, mostly because they don't have clean water to drink.

We see it here in Massachusetts, where we have great hospitals and have pioneered health reform but still have many people with inadequate health care.

And we see it in this room. For, with all our resources, who hasn't had a family member or friend diagnosed with a tumor we can't treat? Or a child on the autism spectrum? Or a parent who can no longer recognize us when we walk through the door?

At Harvard we ask questions that will often mean the difference between life and death. We've been doing that for more than two centuries.

We did it in 1799, when people asked: could there really be a vaccine to prevent smallpox? Dr. Benjamin Waterhouse, one of this school's co-founders, carried out an experiment, including his own family members, to show Bostonians it could be done.

We did it in 1846, when surgery was virtually torture and surgeons were told what they needed most was to be "pitiless." People asked: wasn't there some way to make surgery painless? And in the MGH Ether Dome, we held the first public demonstration of anesthesia.

We continue to ask questions and find answers today. We do it first, through our med students. Sometimes people forget that. They focus on our research. I can't forget, because I'm the dean of Harvard Medical School. I am thrilled to watch our students progress -- from basic science, to clinical exposure, to the wonderful and sometimes bewildering moments when they need to decide what kind of doctors, researchers or leaders they’ll be.

Whatever career choices our remarkable students make, their ability to enhance health care will depend heavily on the questions our researchers ask.

One such research question involved Alzheimer's disease. We know about beta amyloid plaques that most people believe cause this terrible disease. We also know that some people with those plaques show no cognitive decline. How could that be? This year our faculty member, Bruce Yankner, led a study that found one gene -- the aptly named REST gene -- may provide an answer. The REST gene is useful early in life. For some, it switches on again during the rest of life. When it does, the REST gene protects the brain.

Bruce was the first person to identify the damage done by beta amyloid. He's eager to discover more about how this gene wards off that damage. And so are those whose support made this possible: NIH, and the foundation begun 50 years ago by Paul Glenn. Paul's field is investment. His passion is investing in health. The question he helped answer in Bruce's lab has suddenly opened an entirely new approach to a frightening disease.

We applaud Bruce and Paul Glenn.

Another question revolved around a critical global health issue that reminded us that NOT everything happens in labs.

Take Rwanda. After the 1994 genocide, Rwanda was in chaos. How could health care be provided to the millions who needed help? People came to Paul Farmer:  HMS graduate, rock star medical anthropologist, and physician on our faculty. Paul and his team found answers. They designed programs and they saved lives. The probability of a Rwandan child dying by age 5 dropped 70 percent from 2000 to 2012. Now Paul is helping to map out the world's response to Ebola. 

We do great things here every day.

But there's another challenge we face. Even at Harvard, this pulsing ecosystem of energized people able to educate, innovate, and discover. Yes, even at Harvard we cannot fund everything we should -- and must.

Fifteen years ago, NIH provided a steady stream of dollars for worthwhile ideas, but not since 2003. In real dollars, NIH funding has gone down every year.

There isn't a day when I don't see a proposal on my desk that promises to illuminate our understanding or save lives. Except for one thing: It probably won't get funded.

Let me tell you one story about how we've handled that at Harvard. We see two roads to discovery. One belongs to those looking for cures. These faculty might ask: Can we develop a vaccine to prevent Ebola?

This is vital, necessary work. But there's also a second road. Fundamental science. These faculty ask: "How does a cell divide, or signal to another cell, or die? Sometimes people call this "curiosity-driven" science. For all the differences between these two approaches, both are essential.

Now, if you ask me which -- in the long run -- will bring more cures, I think fundamental science will. But these scientists could do a better job of envisioning and then demonstrating the practical applications of their work. And that’s why, a few years back, we asked: What about creating a lab that did both? A lab that focuses on the therapeutic possibilities of fundamental research? We were very excited about that. But we needed start-up money. For a while, we couldn't find it. It looked like we might have to give up.

Then, we talked to the wonderful family of a man named Giovanni Armenise. He had come from Italy to Harvard hospitals hoping we could help his ailing wife. Eventually, she couldn't be saved, but he was grateful to the Harvard doctors who had treated her, and to the medical school of which they were proud to be faculty. He gave us one of the largest gifts in the School's history. What made the gift extraordinarily insightful, as well as generous, is that he directed the funds to support basic biomedical research.

That was nearly two decades ago, and Count Armenise passed away last year. This year, I asked his son, Giampero, whether he would support this new program. He listened. He asked questions. And then he said ... yes.

You know that first building on the left when you face the Quad? The Armenise Building. That's where you'll find what we call the Harvard Program in Therapeutic Science.

I only wish we had Count Armenise -- Nino as I came to know him -- here today to tell him personally what we all feel: gratitude. For this would not have happened except for the generosity of a family who, after losing the life of one they loved, made possible a project that will someday give life to others.

But now let me tell another story about a gathering crisis in American medicine. Primary Care. I spoke earlier about the pressures on young clinicians to choose a specialty. Too few young trainees choose primary care. Primary care docs play a critical role on the front line of health care. But within 10 years, the U.S. will be short 45,000  primary care doctors.

We need to produce more. We need to train them better. We need to excite them about being on those front lines.

One donor stepped forward to help make primary care a strategic priority at HMS, and he didn’t just give us the resources. He's involved.  We give him regular reports. We meet with him. He just doesn't want anyone to know his name. But he's the one responsible for the new Harvard Medical School Center for Primary Care.

We have great directors and a dynamic team. They're inspiring and training future leaders in primary care and pioneering new ways to design health systems.

Last year, one student talked about why she's so thrilled with the Center. Helen D'Couto wanted to work with people who need care most and get it least. But sometimes students take a long time to find the program they want. We set up an event, a little like speed dating. Students could go from one distinguished faculty member to the next, looking for a mentor. After one session, Helen had a match. The Center was designing a home for asthmatic kids. She went on home visits. Shadowed her mentor. Wrote papers.

"One of the best experiences I've ever had!" she said. 

Helen is grateful to many people. One is our donor. She doesn't know his name. But she knows firsthand the way he has influenced her life -- and the lives of our patients.  

Now, let me be quick to say: most great discoveries don't come from scientists who work by themselves, what historians call the "Myth of the Lone Inventor." To paraphrase Isaac Newton, "We stand on the shoulders of others.”

Let me also be quick to say that we don't see results overnight. After all, tomorrow is the 348th anniversary of the world's first successful blood transfusion. That's right. Nov. 14, 1666, and we're still working on doing that better.

Let me also be quick to say that, unfortunately, research doesn't always succeed. Even when our insights into a puzzle are right, they don't always result directly in a therapy. Why? Because we're missing another part of the puzzle.

Take an area of my own research: Obesity. We know infinitely more today about the causes of obesity than when I was a student. But now, three times more Americans are obese. It turns out that despite our insights, obesity is more complex than we imagined.

So we need to continue our efforts, and to understand more. We need to be patient, too. We don't succeed right away. Usually.

But now, let me go back for a moment to that night when I sat, waiting for my data. The sheets slid out. I looked -- and was sure I'd gotten it wrong. No, the data didn't look wrong. It looked good. Too good.

I took the sheets home. I thought I'd see some mistake when I woke up the next day. But that morning, when I took the data to my NIH mentor, he looked. Listened. Asked some questions. And then he said, "Jeff ... I think you found the answer."

Sometimes we get lucky. Dr. Sol Berson, my first medical school mentor, had set me on the most intoxicating road I could possibly imagine.

Sadly, the lifetime of friendship and counsel I'd hoped for wasn't to be. He, who had helped so many, died too young. But he did leave a legacy. That legacy includes what happened to me that magical night.

Today, our distinguished faculty are privileged to leave a legacy too. They train hundreds of young people who are working and hoping for the same kind of magical moment. We ask you to share that privilege with us. We ask you -- our faculty, our funders, and people we hope will become our funders -- to leave your own legacy.

It might be understanding the causes of Alzheimer's disease, cancer or diabetes. It might be helping solve the crisis in primary care. It might be restoring the health care systems in West Africa or our own country.

Be part of our team.  Just like the Patriots, the Celtics, the Bruins, or the Sox ... every player counts. I ask you to become a player.

Today, in every building, down every hallway, in every lab, I see young medical and research students dreaming what I dreamed.

In many cases, all they need is one person with the resources to help. You can be that person.

You can help a researcher with an idea about enhancing medical care around the world, or around the corner.

You can be the person whose resources permit someone in a lab here to answer the question: why do nerve cells, or cancer cells die?

You can be the person to help a student like Helen D'Couto treat a vulnerable, asthmatic kid and discover what she wants to do with her life.

You can be a person like Giovanni Armenise with the means to create a building where people unlock the mysteries of a cell. Find cures for those who are sick. Give life to those who would die.

Join us and become part of our team.

There isn't a day that I don't cherish the gift Dr. Berson gave me. You will discover that gift, by a gift you present to our students.

Offer your hand. Offer your help. So we can enter this third century of Harvard Medical School poised to contribute not just discoveries, but doctors. Not just health, but hope … to a world waiting, indeed hungering, for what our partnership can provide.

 

 

The World

Is Waiting

 

 

The Campaign for Harvard Medicine

Through this campaign, we will address the greatest health care challenges of our time to help people live longer, healthier lives.