200 Congregation booklet_1701_Final

14 What's more, advances in technology combined with the growing availability of data will allow patients to take charge of their health and make more informed choices than ever before. In summary as future health professionals, you will be able to do many things for your patients that my generation was incapable of. Your career should promise to be very exciting. Indeed, your generation should be filled with hope for the future. Our healthcare system is changing rapidly and you will be the ones in the thick of things, steering the system in the right direction. So today, it is with great optimism that we celebrate your milestone achievement. But as incredible as all these advances sound, they also raise a lot of questions, too. For instance, will robots equipped with AI ever be better than we humans are at connecting with patients, and what precious relationship might we lose? How valuable is a new immunotherapy drug if a patient that really needs it doesn't have access to it? How will “big data” help a patient who lacks the social support, knowledge, or resources she need to make positive changes in her life? New advances simply don't get adopted in a vacuum. There is a whole set of implications and consequences that must be considered first – for patients, for the health profession, and indeed, for all of society. Our role as health professionals is to understand these advances, embrace change, apply them appropriately, and look out for unintended consequences. So, I want to talk to you about the social responsibilities of being a health care provider. I sincerely believe that many of the advances in science and health that are on the horizon will revolutionize health and medicine, as well as patient care. However, we must not be mesmerized with science and technology for technology's sake. We must put them to use to advance the well-being of the people we serve. Importantly, we must not forget the less fortunate. We must ask: will every patient who needs a new medicine or technology have access to it? Will these innovations make health care more equitable, especially at a time when there are already such stark health inequities? For every new innovation or technology in health, we must not only raise important questions of efficacy and safety, but also the larger issues of affordability, access and equity. Despite all the progress we've made on so many fronts, many people who most need the benefits of science and technology clearly are not receiving them today. This is just as true in the United States as in Hong Kong. Right now, in 2018, your health status is far more likely to be determined by your social status, by your income or by the neighborhood where you live and/or grew up, than by any other factor. Health disparities are growing wider between the rich and the poor, the well-educated and less educated, and urban and rural areas. This has to change. We have to ensure that all have access to these innovations. We have to consider all of the factors – individual, cultural, societal – that are essential to good health and have to be aware of all of the consequences of our decisions. In addition to access and affordability, new technologies may also challenge belief systems and cultural norms. As promising as it is, gene editing does just that. Many find the possibility of gene editing in human embryos or gametes to treat diseases controversial. And there are more potentially thorny ethical issues this incredible new tool raises. For instance, the use of gene editing in embryos to prevent disease has implications that extend far beyond one individual. It produces a genetic alteration that will be passed on to all subsequent generations, permanently affecting the human genetic makeup. Someday genome editing technology might even be considered for human enhancement – even to create “designer babies” – or babies with superhuman features such as high IQ or superior athletic ability. This raises important questions about the proper conduct of research, clinical application, and societal norms and acceptance. In 2017, a National Academies consensus report noted that gene editing for reproductive purposes might be considered in the future but only when there is compelling medical need, with clear understanding of risks and benefits, public dialogue, and more. Not following these guidelines would be an irresponsible act. Even then, germline editing should only be permitted under strict oversight. In addition, gene editing technology raises concerns about exacerbating existing social inequities or creating pressure for individuals to use technologies they would not otherwise choose. What if access to gene editing is not available to all segments of society, or all nations? It's essential for our society to have many open, honest discussions on all of these issues. Two days ago, the NAM, along with the Royal Society of UK and the Academy of Sciences of Hong Kong convened an international summit to explore the many questions surrounding the use of gene editing tools in humans. As you know, on the eve of the summit, a Chinese scientist announced that he used CRISPR-Cas9 to alter germline DNA that resulted in the birth of twin babies born recently for the purpose of conferring resistance to HIV. This work was widely condemned by the scientific community. The Chinese government has halted his work and announced that they would be investigating the matter. · This development underscores the importance of responsible scientific conduct, and the urgent need for international consensus on the limits and conditions under which germline editing should take place. Indeed, our summit brought together a broad range of world experts and stakeholders — including researchers, ethicists, policy makers, patient groups, and representatives from science and medical academies and organizations worldwide to engage in spirited discussions and debate on these issues. These types of frank exchanges are exactly what is needed so that all of us can make informed decisions.