Members of the faculty, distinguished guests,
family members, and friends of the graduates,
and especially you, the graduating class of 2017.
It is truly a personal pleasure and an honor
to be your commencement speaker here today.
As I was putting my thoughts
together in preparation for addressing
you I could not help but reflect back to
my own graduation from medical school
when I was sitting in a very similar
setting to where you are right now.
And in this regard I thought about what has
since transpired in my own career in my
own life and what broader insights may
have emerged from these experiences and
what applicability these insights might
have to you at this very pivotal stage in your careers.
Now the first thing that comes to my mind is the extraordinary
dynamic nature of our profession, even
though medicine and it's related
disciplines are based on fundamental
principles that are unmutable, I certainly
did not fully appreciate at that time
how dramatically the biological sciences in general
and my own chosen field of medicine would change.
What I can see now,
looking back over decades, is that
certain things have indeed undergone
extraordinary change whereas other things
have not and in fact should not have changed.
And so similar to my
experience you will have one foot in the
medical past as you take gigantic leaps
into the medical future. It is in this
context that I'd like to share some
brief thoughts with you as you leave
here today armed with your newly
developed professional skills.
One thing for certain is that you will
bare witness to a constant and at times
seemingly overwhelming evolution
of scientific and technological advances.
You will feel, believe it or not,
as I still do up to this day
both exhilarated and a little bit intimidated
For the physicians in the group
you will be learning the art of
practicing medicine at the same time
that you are trying to keep up with the
science that will be advancing at a breathtaking pace.
For the PhDs in the group, the experience will be quite
similar the evolution of medicine and
the biological sciences will be beyond
your control but you will be part of it
hanging on seemingly for dear life to
keep up with it. Rest assured that being
bored will not be a problem for you.
Let me give you an example of the kinds of
dramatic evolutions and changes that can
occur totally beyond one's control and
that can profoundly impact your career.
It is a story I often tell since it is
so demonstrable of the point that I will
make, in 1968 I finished my residency in
internal medicine at the New York
Hospital Cornell Medical Center that
very same year noted public health
scholars were opining and even
testifying before the United States
Congress that since the advent of
antibiotics vaccines and public health
measures over the previous decades and I
give you a quote the war against
infectious diseases had essentially been
won and we should focus our efforts on
other areas of research and public health.
Now as fate would have it at that
time I was on my way to begin of all things
an Infectious Diseases fellowship at NIH.
I remember reflecting as I drove from
New York City through the Lincoln Tunnel
down Route 95 to Bethesda Maryland
as the words of the seemingly wise
pundits resonated in my mind I felt
somewhat anxious and even ambivalent
about my career choice to say the least.
Was I entering into a disappearing sub-specialty?
Well apparently not,
for within a few years the first cases of
what would be known as aids were
reported in California and New York City
and with that my professional career and
in fact my entire life was transformed.
However it did not stop with hiv/aids
for my field of infectious disease had
witnessed the continual threat of
emerging and re-emerging pathogens such
as SARS, West Nile virus, extensively
drug-resistant tuberculosis, hospital
outbreaks of drug-resistant gram
negative organisms, dengue in Puerto Rico
and southern Florida, Chikungunya in the
Caribbean, the 2009 h1n1 pandemic,
and MERS Coronavirus in the Middle East.
Now if that were not enough then came
the devastating Ebola outbreak that
infected 28,000 people and killed 11,000
in West Africa while frightening about
300 million people in the United States
and consuming much of my time and energy
in 2014 and 2015 and just this past year
and even spilling over into this year
we've had the terrible on sort of Zika
virus in South America and the Caribbean
spilling over into southern Florida.
A relatively mild disease yet with
potentially devastating consequences in
pregnant women.
The first ever mosquito-borne virus that
results in congenital abnormalities in
infected pregnant women and one that is
also sexually transmitted. You could not
have made this stuff up even for a
science fiction movie. Finally we have
yellow fever outbreaks threatening the
highly populated areas of Brazil all of
these issues were completely off my
radar screen at the time that I was
sitting where you are graduating from
medical school. But unfortunately they
are now part of all of our daily lives
and occupy much of my professional life.
Now obviously to be realistic not every
change evolution or advance in medicine
or the biomedical sciences will be as
dramatic or as draconian as a
frightening infectious diseases outbreak.
However, please believe me that the same
unpredictable elements in the evolution
of public health medicine and biomedical
science are going to confront each and
every one of you regardless of what
specialty or subspecialty of medicine
you pursue or what particular area of
biomedical science you enter.
The exciting part of all of this which still
grips me after all these years is that
you will be part of that evolution and
continual learning is integral to what
we do. There is nothing static about the
discipline of which all of us are a part
and what does all of this have to do
with what is happening here today at
your commencement? It relates to the
issue of what I call the paradox of
graduation, when you are dealing
with medicine and science.
It is understandable that on this day you feel
that you no longer are really a student
well let me tell you that this is just
an illusion.
In my own career it became painfully
apparent very shortly after graduation
for medical school that my student days
had actually just begun. For in the field
of medicine and the biological sciences
we are all perpetual students. We may
graduate from whatever institution of
learning that we attended but that is
not the endgame the scope of what we
have learned and what we still need to
learn is like a giant mosaic and this
mosaic of our knowledge and experiences
is eternally unfinished, as well it should be.
Now there's good news and bad news about this.
The good news is that it
will as I just mentioned be very
difficult to get bored and the level of
self fulfillment will be very high.
The bad news or maybe I should say sobering
news is that you will likely develop a
sense of low-grade anxiety and a nagging
feeling of inadequacy as if we all do
not have enough of that anyway as we
prepare to enter our house staff or
other postdoctoral or advanced degree
training. That certainly was the case
with me. That somewhat paradoxical mix of
confidence and insecurity this feeling
however is not all necessarily bad since
it can be transformed into something
quite productive and positive because
when you realize and finally admit to
yourself that you will never know as
much as you want to or need to know, this
is a consistent feeling that I still
have, and that you are participating in a
dynamic process with a steep learning
curve you have to strike a delicate balance.
On the one hand you can't be
immobilized by this potentially
disturbing concept and you should
certainly experience fully the joys of
life. In other words don't
forget to have some fun. On the other
hand it should create a healthy positive
and productive tension whereby you never
feel completely comfortable. It is this
tension that can actually serve as a
catalyst to consistently improve
yourself and fulfill what we know is
your enormous potential. To this very day
I still feel such a productive tension,
whether it's in my lab, running a large
biomedical institute, or seeing my
patients, it has become a part of me and
I truly believe that it has helped me
greatly rather than hurt me in any way.
Now given what is happening in our world
today and in the context of your chosen
profession I want to turn for just a
moment to the issue of global leadership
in medicine. For the physicians in the
group most of you will be concerned with
matters that seemingly apply only to
this country however be assured that in
the broad sense what you all will be
doing is linked directly and indirectly
to the health of all the citizens of the
world. It is so apparent now as we come
to the end of the second decade of the
21st century that we live in a global
community and linkages exist between
what happens here in the United States
and throughout the world be it with
regard to the environment security
finance and indeed health. In this
context the United States is clearly the
world's leader in the field of medicine
and the biomedical sciences. As such your
generation as a whole and even some of
you as individuals will be setting the
example and the world will be looking to
you for leadership. Be it in clinical
medicine, teaching research
administration, or public health your
generation of physicians
and biomedical scientists will serve as
the gold standard for the rest of the world.
We cannot relinquish this leadership role.
Health and biomedical research is by definition global
we are not alone. I appreciate that it is
difficult for you to think of yourselves
in this context at this early stage in
your career, however, it's unquestionably the case.
You have been trained at a very
fine institution and as such those of
you who choose such a path you will be
ready to assume this type of leadership
and remember don't for a moment believe
that you are too young or too
inexperienced to begin to assume
leadership roles. You do not need to wait
you are ready to lead and society is
ready for you and actually needs you
very much. Remember leadership is a
gradual process that you have already
begun when you enrolled here in Boston
University School of Medicine an
institution for leaders in medicine and
biomedical research. And let me point out
that I speak not necessarily of
officially designated leadership
positions because leadership takes many
forms including the quiet leadership of example.
Finally we have been considering
over the past few minutes the changes
that we can expect in our profession
over the coming years, but what about
those aspects of medicine that hopefully
will never change. In what way do we
actually want to be stuck in the past?
I refer to the fundamental principles that
have guided past generations of
physicians principles that are sometimes
forgotten and neglected in the current
technological world of modern medicine
and unfortunately may be difficult to
execute properly in the restrictions
of a managed care setting.
These are principles that are the foundation of
the joy in the beauty of our chosen
profession, integrity, unselfishness
perseverance, inquisitive, and a
compelling thirst for knowledge with the
patience as the focus and the
beneficiary of all that you do professionally.
If you are physician or
the health care providers you must have
nothing less than complete commitment
towards your patient and establish a
relationship based on sensitivity,
comfort, compassion, reassurance, and respect.
In my role as an editor of
Harrisons principles of internal
medicine for the past 34 years I have
included in the first chapter which is
entitled the practice of medicine a
quote from the legendary American
physician Francis W. Peabody who lived
from 1881 to 1927 right here in Boston,
and he was actually born just blocks
from where we are right now. He said it
so well and I quote, "one of the essential
qualities of the clinician is interest
in humanity for the secret of the care
of the patient is in caring for the
patient. Likewise, if you are a basic
scientist your integrity your
scholarship and your commitment should
match the importance of your task which
is the advancement of knowledge for the
good of mankind." And so my colleagues you
will leave here today as professionals
in a most noble field you and I have
been privileged and with this privilege
comes responsibilities may you carry
these responsibilities with pride and
conviction and I strongly hope that you
will experience the great joy and
satisfaction in our shared profession.
Congratulations to you, to your families,
and your loved ones.
Good luck and God bless you.