In May 2017, National Academy of Medicine President Victor J. Dzau delivered commencement addresses to medical school graduates at the University of South Florida and Case Western Reserve University. On both occasions, he emphasized the importance of science and evidence in health and medicine, of speaking up for science and truth, and of doing what is right. Below are excerpts from his remarks.
On the pace of scientific progress:
Because of the contributions of scientists and physicians like you who have been trained at U.S. research universities, modern medicine has seen some remarkable progress. In just the past few decades, we’ve made major strides toward making precision medicine a reality. We’ve also developed new lifesaving medicines for diabetes, heart disease, and other chronic illnesses. We’ve improved treatments for many types of cancer and increased survival rates. We’ve also made huge leaps in understanding the causes of diseases, and how to prevent them from occurring in the first place.
We must never underestimate the value of scientific research and evidence. It is the core upon which all this amazing progress is built.
On the imperative to defend the role of science and evidence:
Every day as I enter my office building, I walk by a quote from Albert Einstein inscribed on the wall. It reads: “The right to search for truth also implies a duty; one must not conceal any part of what one has recognized to be true.”
Science, as Einstein put it so aptly, is the search for the truth. Boundless curiosity, a drive to better understand our world, is central to our shared humanity and is responsible for every technological advancement we enjoy today. I believe this is why Einstein refers to the pursuit of knowledge as a right.
Science cures diseases. It lifts nations out of poverty. It breaks down false and harmful barriers between us. Science protects our families’ health, our increasingly interconnected global populations, and our complex and fragile ecosystems. In short, science helps us reach our full potential, both as individuals and in the long trajectory of human progress. Therefore, we must understand science, and defend it, as a right.
Today, I’m afraid to say that science and all the progress it brings is being threatened. Evidence is often being ignored and, in some cases, even falsely maligned. What’s more, the benefits of strong science and evidence are not reaching the most vulnerable, including many people and communities right here in the United States. That is unacceptable.
A charge to the graduates:
You are the future leaders we need right now to help tackle big challenges. We need you to do the research and to make those great leaps forward. We need you to provide your patients with the best available evidence-based care. And now, more than ever, we need you to share that evidence — and yes, to defend it — beyond the walls of the clinic or the laboratory. We need you to make sure that research and medical advances are benefiting not just some of us, but all of us.
Einstein contended that, as scientists, we not only have a right, but also a duty. At times, in the search for truth, we reach conclusions that run counter to a treasured hypothesis or political priority. In these cases, more than any other, we must be entirely open and transparent.
Science is in danger when it becomes the instrument of an agenda. In other words, to preserve our right to scientific inquiry, we must protect its integrity. That principle — that science is both a right and a duty — is at the heart of our mission at the National Academy of Medicine. Today, I am asking you to make it a guiding principle in your work, as well.
That’s why it’s your responsibility — your duty — to not only put scientific evidence into practice, but also educate others about it whenever possible. It’s going to take not just one conversation, but many. You need to be visible, active participants in your communities. You need to be heard. As physicians, it’s your duty to speak up for the truth, even when some people don’t like what you say. By doing so, you are putting your patients first — all of your patients, as well as their families, friends, and communities. And you are honoring the Hippocratic oath.
It is not always going to be easy. But scientific evidence will not fail you. It will make you a better doctor and a better citizen. I’ve seen it over and over again in my work. The beautiful thing about scientific evidence is that it has no political affiliation. Scientific evidence has a way of reminding people of what our priorities should be. We just have to be willing to listen and to speak the truth.
On the worrying example of a U.S. measles outbreak in 2017:
If you ask most health care leaders to name the most important medical breakthroughs of the 20th century, vaccines would be near the top of just about everybody’s list. If you want to know why, ask your grandparents about the polio epidemic. In 1952, at its peak, nearly 60,000 Americans had polio. That year, 3,000 people died of it, and more than 20,000 were paralyzed. But by the early 1960s, polio had largely been eradicated in the U.S., thanks to the polio vaccine and a far reaching immunization program.
Measles used to be one of the world’s leading killers of children, accounting for millions of deaths each year. Now, because of the measles vaccine, less than 100,000 worldwide die annually. In fact, global campaigns for vaccination against polio, diphtheria, pertussis, tetanus, and tuberculosis have saved millions of lives. We’ve achieved a huge accomplishment in public health.
However, a small but growing anti-vaccine movement here in the U.S. is threatening to undo some of the progress we’ve made. Fueled by junk science, some parents mistakenly believe that vaccines cause autism or might otherwise somehow harm their children, even though we at the National Academy of Medicine and many other medical organizations have repeatedly debunked these beliefs based on undisputed scientific evidence. As a result, some parents and guardians — many of whom are well off and well educated — are opting out of vaccinating their children because of nonmedical “personal beliefs” or “conscientious” reasons.
As you know, the problem with opting out is that vaccines are only effective at protecting a community when there is “herd immunity” — in other words, when a critical mass is immunized. For the measles vaccine to work, for example, 92 percent to 95 percent of a population needs to be vaccinated to ensure the whole area is protected. In a small community, that means a few households that opt out of the vaccine could be putting their neighbors at risk.
That is exactly what is happening now in Minnesota, and the results are devastating. According to recent news reports, a specific community there is experiencing a measles outbreak that has sickened more than 50 people so far. The outbreak has affected mostly children who weren’t vaccinated. In fact, about a quarter of them had to be hospitalized. How is this occurring in 2017?
It turns out that for a few years prior to this outbreak, anti-vaccine groups that tout the false link between vaccines and autism preyed on parents’ fears by repeatedly handing out literature and speaking at community health meetings. As a result, the vaccination rate in this community in Minnesota dropped dramatically: from 92 percent in 2004 to just 42 percent in 2014.
And this specific community is by no means the only one facing this problem in the U.S. In 2015, a large outbreak of measles that originated in California spread to several states, including the state of Washington, where an immune-compromised woman died of the disease. That was the first measles death in the U.S. in 60 years. Many states and counties are now bracing for another potentially large, multistate outbreak.
As doctors, this is especially frustrating because we know without a doubt that this is entirely preventable. We can’t afford to go backward. The evidence is clear that vaccines are safe and effective.
On access to health care and other pressing health challenges for the United States:
Speaking the truth isn’t always easy in today’s highly charged political climate. Take the debate over health care reform and repeal of the Affordable Care Act. It has become so politically polarized that it’s hard to know the facts.
Consider a recent remark by a member of Congress, who said at a town hall meeting, and I quote, “Nobody dies because they don’t have access to health care.” This claim has been widely condemned, and for good reason — because the evidence says just the opposite. People do die when they don’t have health coverage. A 2002 report from the National Academies, for example, found that approximately 18,000 Americans die each year because of lack of health insurance. Newer data suggest that number may be as high as 45,000. What’s more, uninsured adults are more likely to suffer extremely poor health outcomes, including death, if they are diagnosed with cancer, diabetes, heart disease, stroke, or other serious conditions. That is unacceptable.”
Speaking on the debate on healthcare reform, he stated: “Whatever reforms Congress makes to health care insurance, we must ensure that every American has access to healthcare. Nobody should be denied coverage. Importantly, the care we deliver must improve outcomes for everyone and must be affordable.
What’s more, although discussions about best ways to provide coverage are important, Americans are facing challenges in health care that go beyond coverage. For coverage to have value, our health care system has to work towards attaining its fullest potential. With all of the polarized debate on insurance provisions, critical and necessary changes to healthcare are being overlooked. Our nation is spending $3 trillion on health care, and yet we are failing to achieve better health outcomes, ranking lower than most other developed countries in access, efficiency, and equity. Therefore, in the midst of political debates, we can’t afford to lose focus on the ultimate goal of achieving better health for all through an effective health care system — one that not only helps people prevent and treat their ailments but also helps every American reach their best health and well-being. We need to ensure that good health is attainable to everybody — regardless of our race, our income, or our zip code.
Martin Luther King once said, “Of all forms of discrimination and inequalities, injustice in health is the most shocking and inhuman.” I couldn’t agree more. I grew up in post-war China, where I saw tremendous poverty firsthand. Many people died from lack of access to health care. My grandparents and parents were infected with tuberculosis. My relatives died from stroke. It was heartbreaking to see people suffer and die from preventable or curable diseases –primarily because they were poor.
Decades after Dr. King uttered those words, I still take them very personally. Speaking as a grateful immigrant who is proud to be a U.S. citizen, I find it unacceptable that, while Americans in higher income brackets can expect to live into their 80s or 90s, those earning lower incomes have a much lower life expectancy.
It’s unacceptable that hundreds of people are dying every day from a devastating opioid epidemic that is hitting especially hard in rural areas, where there are not enough doctors or health care workers. It’s unacceptable that in 2017, U.S. cities like Flint, Michigan, are still experiencing the medical fallout from lead-contaminated drinking water.
The truth is, we simply can’t afford to leave anybody behind. Health care disparities of the sickest and poorest Americans increase the direct costs to our health care system. Furthermore, by not taking care of all of our citizens, we are losing out on increasing economic productivity and developing a vibrant community. However, to tackle health inequities, we must address the root causes — social factors such as unemployment, lack of education, and inadequate housing.
A closing call to action:
These aren’t the only challenges you’ll be faced with in your careers. How are we as medical professionals going to meet the increasing demands of an aging population? How can we deliver better, less fragmented health care to patients with chronic conditions such as diabetes or heart disease?
Also, you can be sure to expect the unexpected — outbreaks of new diseases such as Zika. Or natural disasters such as such as Hurricane Katrina — nobody knows where or when the next one will occur, but we can be sure it will, threatening lives and livelihoods. These threats are magnified for our most vulnerable citizens.
Here too, we should rely on science and evidence to guide us. If we can build a strong, equitable and science-based health system, we will be much better prepared to handle any challenge that comes our way, a point emphasized in the National Academy of Medicine’s recent publication series, Vital Directions in Health & Health Care, which provides a blueprint for building a better health care system committed to three core goals: better health and well-being, high-value health care, and strong science and technology.”In closing, he charged the graduates: “I’ve given you a lot to think about. I hope you leave here today with a strong dedication to providing your patients high-quality care based on the best-available evidence. Hippocrates said: “There are in fact two things, science and opinion; the former begets knowledge, the latter, ignorance.” Please, for all of our sake, go forth and share your knowledge with the world. Stand up for science. Speak up for truth and evidence. Tackle inequity. Do what is right.
