Professor Victor J Dzau
President of the National Academy of Medicine, The United States
Professor Sophia Chan, Professor Ian Holliday, Professor Gabriel Leung, students, families, distinguished faculty guests, and friends,
I am deeply honored to be your commencement speaker today.
Class of 2018, today is great day. It is your day of celebration. Let me be among the first to welcome you to the health profession. You worked hard to reach this important moment. My sincere congratulations to you, to your parents, and to your loved ones who have given their unwavering support, encouragement, and guidance to help you get here. Let’s have a round of applause for all of you!
You have worked hard to reach this important milestone. This is a big undertaking and you should be proud of all that you have accomplished. I know how difficult it must have been for many of you to be working constantly with little rest, studying many complex scientific subjects, and, for many of you, being on night call and staying up without sleep. These demands probably seemed never ending. But you survived. In fact, you thrived and have reached this important moment of graduation. From these experiences, you have learned the importance of being adaptable and resilient as a health professional.
Graduating from the Faculty of Medicine is quite an accomplishment. Some of you will go on to pursue further study. And many of you, at last, are ready to launch your career! After all of the studying and late nights, after all of the work you’ve done in clinical rounds, you’re finally finished.
But I have some news for you. You’re not done learning yet. Not by a long shot!
As long as you’re in the health profession, you will never be done learning, throughout your career, you will be asked to master new knowledge, new technologies, and new systems.
You’re very lucky to be graduating at a tremendously exciting time in health and medicine. It’s really quite remarkable how much knowledge we’ve gained and how much progress we’ve made in just a few generations.
Think about it. Over the last century, we almost doubled life expectancy. We made those gains through the development of vaccines and antibiotics, greater access to safe drinking water, clean air and better nutrition. In your parents’ lifetimes, we cut the rate of deaths from cardiovascular disease in half, and many types of cancers that were once considered a death sentence are now treatable and even curable. And we’ve made tremendous public health gains in terms of getting people to wear seatbelts, quit tobacco, and take charge of their health.
We now know that social and economic factors such as jobs, education, strong relationships, and a sense of meaning in our lives are essential to individual and community health. We’re learning better ways of working in our neighborhoods to truly understand what health actually means to different people. This expanded perspective of health will enable us to develop health care that is truly for the people and by the people.
What advances will we see in your lifetime? I am certain that science and innovation will bring breakthroughs and transformations during your career that were unimaginable to previous generations. In the past decade alone, we have made major strides towards making precision medicine a reality. It is now possible to sequence your entire genome for less than $1000. Cancers can be individually sequenced to identify specific gene mutations that can lead to more rational and targeted drug treatment. Furthermore, new immunotherapies are helping patients harness their own immune systems to fight their own cancers. We’re also seeing new lifesaving medicines for many serious and chronic disease such as diabetes, high cholesterol and heart failure.
But that is just the beginning.
Through an exciting new field called regenerative medicine, I believe that sometime during your career, we will be able to use a patient’s own stem cells to help repair his or her damaged heart or brain or even create new organs outside the body for transplant.
Our expanded knowledge of the human genome – combined with the new genome editing technologies– means that in the future, you will be treating, curing, or even completely eliminating devastating genetic diseases that have preyed upon individuals and families for generations– diseases such as Huntington’s, sickle cell anemia, or Duchenne muscular dystrophy.
I know that to many of you, this almost sounds like science fiction: a Steven Spielberg movie. But it’s very real, and the research is moving forward quickly.
Besides these amazing medical breakthroughs, we are witnessing the emergence of digital technology and other sophisticated new tools that can monitor patients remotely, help people stay on track and healthy, and future robots may provide assistance and care.
How many of you wear a Fitbit to track your steps and activities every day? It’s basically a wearable sensor that is collecting all kinds of personal data – your heart rate, your activity level, your sleep patterns, and more. It’s a small example of the vast amounts of data – on patient behavior, clinical encounters, or the environment — that we increasingly are able to capture in real time. I believe that one day you will be basing your clinical decisions on a wealth of “big data” that identifies what works and what doesn’t – more accurately and precisely than ever before.
Indeed, artificial intelligence is likely to transform all areas of health and medicine – from image interpretation to drug development to clinical decision support to public health surveillance.
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, permenantly 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.
But what does all of this mean to you? These open-ended, societal questions may not be top of mind for you as you go about your daily responsibilities in the laboratory or the clinic or the hospital. But I urge you to give these issues some serious thought. The best clinicians, researchers, and public health professionals take an expansive view of their role. They reach out to others and work together within and beyond their own professions. They use their resources, their position, and their influence to ensure more equity and justice in our world.
Their care for their patients should help ensure not only their physical well-being, but also their mental, emotional, and societal well-being.
In the end, we must remember that these advances and new technologies are tools for all health professionals to employ. They can aid you greatly, but they cannot substitute for the compassionate you. Only you can provide your patients with wise counsel based on evidence, knowledge, and experience. Only you can give your patients the attention, care, and commitment they need and deserve.
As the late, pioneering brain surgeon Harvey Cushing once said, “A physician is obligated to consider more than a diseased organ, more even than the whole man – he must view the man in his world.”
As you embark on a career in the health and biomedical field, you need not only a lot of education, skill, and experience, you also need to develop a strong social consciousness. You need to do everything possible to make sure that everybody can attain their best health and has access to the best available treatments. And you need to guard against those who would put profit and convenience before people’s well-being.
It’s a tall order, I know. And it won’t be easy. But, your informed voice on these issues is essential. With your actions and words, you will be shaping the future – not only of health and medicine, but of our society. Besides that famous oath, Hippocrates also has some other pretty wise words for you: “Wherever the art of medicine is loved, there is also the love for humanity.”
Let us never let our love of progress in science and technology outweigh our love of humanity. Indeed, helping our patients and our society should always be the most important measure of progress in the first place. Let that be your guide, and you will surely help steer health and medicine toward the right side of history.
So once again, let me congratulate you and welcome you to this wonderful career you have chosen. I know your future patients will be in good hands. And I’m confident that, because of you, our society will be, too.
Thank you!
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