The following speech was delivered by Victor J. Dzau, MD, President of the National Academy of Medicine (NAM), at the NAM Annual Meeting in October 2019.
Good morning! It is my honor to address you today as president of the National Academy of Medicine. Let me begin my address with a huge congratulations to Gregg Semenza and William Kaelin, Jr., two NAM members who are the recipients of the 2019 Nobel Prize in Medicine or Physiology. Their seminal work on how cells sense and react to oxygen significantly impacts the understanding and treatment of medical conditions, such as anemia, cancer, myocardial ischemia and stroke, and more. Congratulations!
Indeed, this is a very exciting time as we enter our 50th year of service to the nation – first as the Institute of Medicine, and now, for the past 4 years, as the National Academy of Medicine. We have amassed a great foundation of achievement on which to build in the years ahead. Because of our work together, countless people everywhere are living longer and healthier lives.
We live in an age of incredible progress in science and technology. Thanks to medical advances, many cancers that were once death sentences have become manageable or even curable. Developments in genomics are leading to new diagnostics and therapies that we could barely imagine a generation ago. Big data and artificial intelligence are rapidly reshaping how we live and work.
We also live in a very challenging time. We are witnessing profound changes in health and medicine and increasing social challenges and upheaval. With globalization, our increasing interconnectedness is giving rise to significant shifts in the global disease burden. While we’ve made huge gains in understanding, preventing, and treating many diseases, health inequities persist nationally and globally. Furthermore, new advances and technologies on the horizon offer great promise for improving human health, but they also raise complex ethical and societal issues, and, in fact, could even exacerbate inequities if they aren’t introduced thoughtfully and carefully.
All of this is happening during a time when science is being actively and purposely maligned by some, and discarded or ignored by others. As a result, the public is left confused and unsure of whom to trust.
These trends underscore just how important our work at the NAM will be in the coming years, both here in the U.S. and globally. But we can’t rely on “business as usual”. The NAM must itself be resilient and adaptive in this fast-moving global environment.
Last year, I began my presidential address with a quote: “The tragedy of life is often not in our failure, but rather in our complacency; not in our doing too much, but rather in our doing too little; not in our living above our ability, but rather in our living below our capacities.”
That quote – from Benjamin Mays, often called the father of the modern civil rights movement and mentor to Martin Luther King, Jr. – bears repeating. It is a call to action for all of us. As the premier health academy of the nation and the world, the NAM must be a leader. We cannot afford to be complacent.
Fortunately, two years ago, with the wisdom and guidance of our members and many others, the NAM created a multiyear strategic plan that serves as a long-term roadmap to tackle the most pressing challenges in health and medicine for years to come.
The tragedy of life is often not in our failure, but rather in our complacency; not in our doing too much, but rather in our doing too little; not in our living above our ability, but rather in our living below our capacities.
Benjamin Mays
NAM Strategic Plan
The strategic plan enables the NAM to be proactive as a leader to address critical issues today and in the future. The plan emphasizes 4 major areas:
- Ensuring that science continues to serve as the foundation for our Academy,
- Charting the course for the future of health and medicine in the U.S. and globally,
- Addressing the medical and societal implications of emerging science and technology, and
- Diversifying and activating our members and cultivating future health leaders.
First, science and evidence have been the foundation of our Academy since its inception nearly 50 years ago, and their fundamental importance serve as key tenets that underlie all that we do. As trusted advisors to the nation on issues of health and medicine, our Academy must never waver in our longstanding commitment to apply scientific rigor and objective evidence to generate solutions to complex human health challenges.
Science is advancing more rapidly than ever, and the NAM needs to be prepared to embrace new science. The future of health and medicine lies in research that transcends disciplines and coalesces around multiple lines of evidence to advance biomedical science and health. This is why we must practice convergence science, which was described in a 2016 report from MIT as “the Future of Health” that would integrate expertise from life sciences with physical, mathematical, and computational sciences as well as engineering.”
At the Academies, we strongly support this concept, but I believe the current definition of convergence science is too narrow. As I noted in a 2018 paper in the Lancet, “to improve population health outcomes, we have to expand this definition of convergence to include the social and behavioral, economic, and political sciences and the law, to name a few.”
Along with the NAS and NAE, the NAM has made a concerted effort to advance convergence science across the institution. Together we formed an advisory committee and convened a major workshop to help enhance this work. Indeed, NAM’s own work can be further amplified and strengthened through strong relationships with our fellow Academies and other scientific partners.
We also need to do a better job of supporting and capitalizing on basic science discoveries. Toward that end, the NAM formed a basic and translational science advisory committee, chaired by Keith Yamamoto, which is charged with identifying ways to enhance discovery science and speed the translation of basic research into human applications through the creation of a national innovation system.
An important responsibility of the NAM is to chart the course for the future of health and medicine.
The NAM must examine major issues related to health and health care, including coverage, access to quality care, and health equity for all. We must be prepared to take on priority topics like health care financing, cost of care, and value-based care. The NAM must also take a leadership role to address health inequities, social determinants of health, and population health. These issues are starkly reflected in some recent alarming trends in the nation: a decline in life expectancy, high rates of maternal mortality, and an increase in so-called “deaths of despair” from suicides or drug overdoses.
We feel so strongly about the importance of health equity underlying all of our work that we added it in 2017 to our mission statement.
NAM Programs
We’ve advanced our work in this area through our Culture of Health Program, a multi-year effort supported by the Robert Wood Johnson Foundation to identify strategies to create and sustain conditions that support equitable good health for all Americans. We’ve released 4 consensus studies in collaboration with our divisions on health and medicine and on behavioral and social sciences, and we have fostered cross-sector, multi-disciplinary dialogue, and have sparked collaboration and action among diverse stakeholders to promote health in local communities. Going forward, we will strive to advance an actionable health equity agenda as a central national priority, and we aim to structurally embed health equity into everything we do at the NAM and across the Academies.
A big part of advancing equitable good health is tackling the cost of health care and working toward a value-based health care system. The NAM’s Leadership Consortium for a Value & Science-Driven Health System, chaired by Mark McClellan, provides a trusted venue for national leaders in health and health care to work cooperatively to improve the nation’s health. The consortium developed the concept of a learning health system to deliver effective, innovative care that improves efficiency, reduces waste and provides value to patients.
With the 2020 election fast approaching, the NAM is also redoubling our efforts to inform national and state policy makers about the critical issues facing U.S. health and medicine. To do this, we are building upon our 2016 policy initiative, Vital Directions for Health and Health Care, chaired by myself and Mark McClellan, which produced 19 priority papers and was instrumental in informing Congress and the presidential administration during the 2017 national debate about health care reform and the repeal of the ACA. Next year, we will launch Vital Directions 2.0, which will update the important work we did in 2016, examine troubling trends that have emerged since that time, and identify important areas for policy action for the US administration in 2020.
Turning to our global reach, we are collaborating with our colleagues across the Academies to identify and tackle important issues of global concern that will impact health now and in the future. These include emerging infectious disease outbreaks, universal health coverage, climate change, migrant and refugee health, and aging, among others.
Climate change is one of the biggest threats of our lifetimes. Unfortunately, climate change science is being largely ignored in US policies. In response, I joined with my fellow presidents in June 2019 to issue a joint statement strongly affirming the scientific evidence behind climate change. The NAM has identified climate change and health as a high priority. Yesterday, an exploratory interest group focused on climate and health, organized by Charles Halpern and Dick Jackson, met for the first time to examine ways the NAM members can get more involved.
Climate Change and Health was also identified as a Campaign Strategic Initiative. In December, in collaboration with the Climate Communications Initiative at NASEM, and sponsored by Burroughs Welcome and the NAM, we will convene a preliminary meeting of experts to review the topic of climate change and health. This will be followed by a more formal NAM planning process to identify emerging research gaps and needs, catalyze action, and chart next steps. The findings will be used to inform the development of a new initiative at the NAM focused on developing solutions and actively communicating these areas of great concern to the health community and broader public.
Our nation and the world also face another significant challenge in the coming years – a rapidly aging population in an environment that is unprepared. Today, 8.5% of people worldwide are aged 65 and over. By 2050, this is projected to more than double, and the population of 80 and older is expected to more than triple. These demographic shifts have been described as a ‘silver tsunami’ and they pose countless economic, social, political and health care challenges for our global society.
Having recognized that an aging population is a defining challenge of the 21st century, the NAM has established the Healthy Longevity Global Grand Challenge as our inaugural grand challenge. This will be a multiyear international effort directed at improving the health, productivity, and quality of life for the world’s aging population.
The initiative will have two components. The Global Roadmap for Healthy Longevity will involve an International Commission, chaired by Linda Fried and John Wong, which will produce an evidence-based report with recommendations for societies worldwide to foster healthy longevity. The Healthy Longevity Global Competition, chaired by Tachi Yamada and Robert Horvitz, is a multiyear, multi-million-dollar international competition that will accelerate breakthroughs in healthy longevity through a series of awards and prizes. The competition is open to innovators of any background, including those in science, medicine, engineering, technology, and public policy.
We have raised over $30M USD, and nearly 50 countries and regions have joined this global movement. I am pleased that today the New England Journal of Medicine published a viewpoint on our grand challenge, coauthored by myself, Sharon Inouye, Jack Rowe, Tachi Yamada, and Liz Finkelman. In fact, we will formally launch the global competition following today’s symposium, at 6:00 pm in the Great Hall. I hope you will stay for the reception and celebrate with us.
Next I would like to address the medical and societal implications of emerging science and technology. As you all know, scientific and technological breakthroughs are transforming health and medicine as we know it. I have no doubt that these new developments will lead to tremendous progress for the care and treatment of patients here in the U.S. and around the world. But these breakthroughs also carry many risks and have important societal implications, including the impact on health care costs, the potential to aggravate inequities, and potential negative effects on social norms and ethics.
Human Gene Editing and Artificial Intelligence
Two recent and extremely important examples of scientific development are: human gene editing and Artificial Intelligence. The NAM has been at the forefront of addressing both issues. Along with the NAS, we have initiated an important, ongoing global discussion about the future of gene editing technologies and their responsible use. You’ll recall that we held two international summits on human gene editing in 2015 and 2018, and issued a 2017 National Academies report.
With the shocking development of the twins born as a result of embryo editing in China, there is an urgent need to clarify the condition and achieve international consensus around acceptable use of human germline genome editing technologies.
With the participation of 27 science and medical academies around the world, the NAM, the NAS, and the Royal Society of the UK have convened an international commission. This commission is chaired by Kay Davies and Rick Lifton. The commission, which includes representatives from 10 nations, is tasked with developing an internationally agreed upon framework for scientists, clinicians, and regulatory authorities to consider when assessing potential clinical applications of human germline genome editing — that is if society concludes that this application is acceptable. The report is due out next spring, and we will be closely coordinating our work with the World Health Organization’s expert advisory committee, co-chaired by our own foreign secretary, Peggy Hamburg.
AI and machine learning are new technologies that have already begun to revolutionize health and medicine. The National Academies are leading in this arena too. We’ve initiated several activities to explore and shape how AI technologies are developed so that they can be utilized for improving the population’s health and well-being, while mitigating unintended consequences, such as exacerbating inequities in health when using racial- or gender-biased data. You’ll hear more about some of these issues during today’s scientific program.
While these technologies have incredible possibilities, they raise many issues that require further consideration across multiple domains — ethics, law, equity, workforce, biosecurity, national economic competitiveness, and more. Given that most emerging technologies affect multiple sectors, it is imperative that their impact be considered together. There is a need for a multi-sectoral governance framework to guide assessment of societal implications, governance and policy of new technologies. At the President’s Forum today, we plan to examine this need and discuss the creation of a new NAM Committee on Emerging Science, Technology, and Innovation in Health and Medicine to focus on these issues.
Finally, I want to talk about the importance of diversifying, activating, and cultivating NAM members and future leaders. For all of the important work the NAM is doing now and in the future, we rely on our greatest source of strength – our members. You are essential to all of the work we do here at the NAM and across the Academies. Our work is based on bringing a diverse group of stakeholders to the table to address some of the most complex and nuanced issues of the day. Therefore, it is critically important that our membership reflects the diversity of our society at large.
With this aim in mind, we have established a permanent diversity committee at the NAM, which is continuing to develop policies and strategies to ensure that we nominate and elect outstanding members from a wide range of specialties and regions, and who are diverse in terms of gender, race and ethnicity. Our past and continuing efforts are making an impact. This year, in 2019, we elected 100 members – the largest class in the NAM or IOM’s history. Women make up 44 percent of the class. A quarter of our newly elected members are from underrepresented ethnic and racial groups, and 22 percent are under age 50.
Another activity that has involved significant member engagement is the new NAM Code of Conduct and policies that was developed and ratified last year. This new Code of Conduct underscores the expectation and importance of professionalism and integrity among our members. And our Council and staff are now planning a new Membership Election Task Force to consider improvements and modernization of the member election process. This was discussed with membership at the business meeting yesterday, with unanimous support. Moving forward, we will be putting together a task force to evaluate this complex issue. We’ll be looking for volunteers.
We are also working hard to identify, engage and cultivate the next generation of health leaders through our Emerging Leaders in Health and Medicine program. Launched three years ago, the program is designed to facilitate opportunities for mentorship, collaboration, and innovation between exceptional early- and mid-career professionals and thought leaders – including NAM members. The program has two components: the Emerging Leaders Scholars and the Emerging Leaders Forum.
We currently have 30 diverse emerging leaders scholars. While continuing to work at their primary institution, the Scholars attend meetings with NAM leadership, engage in Academies activities, and participate in a mentoring program with NAM members. The scholars also plan and design the Emerging Leaders Forum. This past July, the inaugural forum brought together 70 emerging leaders and over 30 NAM members to examine some of the most pressing challenges, encourage collaborations and networking, and seek advice about career paths. It was a very successful meeting and the next event is planned for spring of 2020.
Finally, as an indication of the caliber of these emerging leaders, I’m pleased to announce that 3 of the initial cohort of emerging leaders were elected to NAM this year as part of the class of 2019. I would like to congratulate them!
We have come a long way in the few short years since we became the National Academy of Medicine. We have learned to lead and collaborate; to be bold and flexible; to communicate effectively with stakeholders and the public; and to actively engage with our members to shape our future. I’d like to go over four guiding principles for our work.
First, the importance of leadership and collaboration across the Academies. The reorganization from IOM to NAM was not simply a name change but, in effect, the creation of a new organization for which we had to establish new bylaws and policies, as well as develop new financial and operational structures. Now that we are the NAM, we are positioned to provide leadership across the Academies on issues related to health and medicine.
We understand that we are stronger when we join forces with our fellow Academies of Sciences and Engineering, and across the divisions of the NRC, to develop and amplify activities that impact health. We strive to be transparent and collaborative with the NRC divisions, especially the Health & Medicine Division, to avoid the misperception of competition.
At the leadership level, I have been working closely with NAS President Marcia McNutt and NAE President John Anderson to oversee the governance and operations of the Academies. As Presidents, we are committed to the successful implementation of the NRC transformation which was undertaken in response to an independent review of our products and services. The goal of the transformation is to be more efficient and effective so that we can be more timely and relevant in a rapidly changing environment. As another important step, I have just been tasked by the NRC Governing board and my co-presidents with leading a strategic planning process for the NRC, which we all believe will be vital to guide its future.
Next, I’d like to talk about the second guiding principle. The NAM has a responsibility to lead on critical issues in health and medicine. To that end, it is as important as ever for the NAM to be bold, proactive, flexible and innovative in our programmatic approach, while maintaining the highest standards of independence and rigor. Over the past five years, I have seen countless examples of our work’s impact, especially when we are bold enough to take on challenging subjects that others are either unable or unwilling to tackle.
Two major examples of innovative programmatic models initiated by the NAM are the action collaborative and the international commission. Through the action collaborative model, we use our convening power to bring stakeholders together to advance progress across priority areas through collaboration, coordination, communication, and collective actions.
For example, the NAM has taken leadership on the very real problem of clinician burnout. It is well recognized that no single entity can solve this problem. Therefore, our action collaborative on clinician well-being and resilience is a national network of more than 200 organizations committed to reversing the alarming trend and advancing evidence-based, multidisciplinary solutions.
Similarly, we created an action collaborative on countering the nation’s devastating opioid epidemic. More than 100 organizations have joined this effort — a one-of-a-kind public-private partnership comprised of government, communities, health systems and providers, payers, and more – all committed to advancing effective solutions, including changes to education, developing prescription guidelines, and improving prevention, treatment, and recovery activities.
In fact, our action collaborative model has been so successful that now all three Academies have together launched an action collaborative to combat sexual harassment in academic science, engineering, and medicine. Sixty universities and research institutions have committed to sharing best practices and policies to stop sexual harassment.
To tackle complex global challenges that demand international collaboration rather than U.S.-centric approaches, the NAM has designed a model whereby a study is conducted by an international commission, with NAM serving as secretariat. The commission follows all of the rigorous procedures and meets the same high quality standards expected of every National Academies product. This model was first piloted in our 2016 report on building a “Global Health Risk Framework”, in response to the West African Ebola crisis. We are currently using this approach for our International Commission on Clinical Use of Heritable Human Genome Editing and the Global Roadmap for Healthy Longevity.
Now, I want to talk about the importance of communicating, speaking up for science, and building relationships. The NAM and the National Academies must strengthen and modernize our communications strategy, capacity, and effectiveness in order to communicate in a clear and compelling way to our members, Congress, the US administration, and the public.
As president of this prestigious Academy, I am using my voice to speak up about controversial issues and counter misinformation in a neutral and non-partisan fashion, particularly when the NAM or the Academies have a broad evidence base to draw upon. It’s true that the NAM should not engage in political discourse or advocate for a particular political point of view. But as the preeminent advisor to the nation on matters of health and medicine, we do have a responsibility to share and defend the scientific evidence on contentious issues.
For example, we have spoken up on vaccines and our three academies joined to launch a communications campaign. More recently, we issued a statement to support the cumulative scientific evidence for climate change. Both of these efforts are tied to a new public outreach platform that we’ve created through a pilot program with Google called Based on Science.
Last year, we also issued a statement asking the federal government to immediately halt its policy of separating migrant children from their families at the border and detailed evidence from many National Academies reports about how harmful family separations are to the health and development of children. And in response to so many tragic mass shootings in the U.S. I worked with Alan Leshner and Mark Rosenberg to write editorials in support of federally funded research. I’m proud to say that, for the first time in many years, the House passed a bill that proposed designating $50 million for gun violence research – although the Senate has yet to take action.
Science Communication
Engendering trust in science also requires an all-out effort to develop and safeguard the integrity of scientific work as well as more effective ways of communicating with the public. If researchers want the public’s trust, we have to earn it. Toward that end, the National Academies have developed a communications strategy to improve public trust in science. Recently, we issued a number of studies on how to improve integrity in science and address issues such as reproducibility and replicability. We are committed to doing a better job to communicate science more effectively to the public going forward. Comprehensive efforts are underway at the National Academies to strengthen its communication of science and medicine to the public.
In an effort to reach an even broader public audience, the National Academies has been experimenting with a more accessible and lay friendly social media approach. While this has resulted in significant public engagement, we have also experienced a couple of hiccups recently. We are learning from these experiences and will work to get it right and to gain the trust of the public.
And finally, I would like to talk about the importance of engaging with members to shape the future of the NAM. As the leader of a member-driven organization, I am constantly reminded just how important it is to engage all of you – our members – in all of our work and to shape the future of the organization. Recently, NAM members have led the development of the strategic plan, campaign themes, and code of conduct. Going forward, we want your input on the modernization of membership election processes, 50th anniversary, the NAM campaign and many more areas.
I can never say enough how grateful I am for your involvement in and support of the NAM. Without you, we wouldn’t have achieved all that we have. And without you, we wouldn’t have such a strong strategy for the future.
50th Anniversary
Throughout the next year, we will be celebrating the 50th anniversary of the founding of the Institute of Medicine in 1970. I want to share with you the tagline we have chosen for this important milestone — “Celebrating a legacy of impact. Forging a healthier future.” Indeed, our anniversary presents an important opportunity to communicate about the critical role and unique influence of the IOM, NAM, and the National Academies to as broad an audience as possible.
Our 50th anniversary will be a focal point to increase philanthropic support of the NAM and the important work we do. We have undertaken a major campaign to raise $100 million over the next 7 years, and we must capitalize on the 50th Anniversary. Our goal of $100 million is an ambitious goal, to be sure, but it’s entirely within the realm of the possible. And it’s really necessary if we want to continue our strong leadership in health and medicine.
Our anniversary celebration will also include three regional symposia and culminate in the 2020 Annual meeting. All four events will examine our impact on science and medicine in the past 50 years and where we see the biggest promise for advances in the next 50 years. We have also commissioned a book on the history of our organization, and the major contributions we have made in health. A second publication will be an illustrated coffee table book focusing on the most significant breakthroughs since our founding in 1970, and trace how our institution contributed to them.
No doubt, we have much to do. But because of you, I am more optimistic than ever about our future. Your commitment and dedication to the NAM – and to improving the health and well-being of people everywhere – inspires me and my staff every day. Our members always have and always will be the life-force of the National Academy of Medicine. In closing, I’d like to share with you one quote among many, many similar quotes from our members responding to a survey we did for our 50th anniversary in which we ask what it means to be an NAM member.
The National Academy of Medicine has saved lives as our nation’s beacon for science-driven medicine and compassionate care. Its north star continues to be improving the health of our nation above all else. I am proud to be a member.
We should all be incredibly proud of all that we have accomplished together. I am honored to serve such talented, committed, and dedicated members and staff, and I’m really excited to see what we’ll do in the years ahead. I have no doubt that together, we will shape a better future in health and medicine for the nation and the world.
Thank you.
