Month: September 2018

Dr. Zoghbi delves into her speech by stating “regardless of your individual path to this day, there is one thing I can predict about your future: it won’t be what you expect.” Then, she proceeds to share a moving account of her journey through life and medicine interweaved with four main points of advice on how to handle the unexpected. A major encompassing theme is to be open to and appreciative of the human relationships formed during one’s path in the medical field, especially during times of hardship.

“First, have a plan, but be flexible within that plan. There will be storms in the ocean that is your life and you have to learn to surf each wave as it comes. My drive to be a physician was strong, and that kept me going to medical school through four years, two countries, and one war. But the people close to me—my mentors Ralph, Marv, and Art, and my husband William—helped me see more clearly what it was that I really wanted to do. They taught me and they helped me to listen to that little voice inside that so often gets drowned out by the noise of obligations and the fear of leaving a well-trodden path. Listen to that inner voice.

Second, listen to other people, too. Listen to your patients and their families. The single biggest complaint I hear from people about healthcare nowadays is that their physician or nurse is looking at a screen instead of at them. We all want to make a difference in peoples’ lives, but sometimes the best thing we can offer our patients is our respectful attention. Thinking back to the first girls I saw with Rett, why were so many diagnosed with cerebral palsy, a diagnosis that would have been apparent at birth, when the girls were perfectly healthy the first year of life? The diagnosis didn’t fit; only a physician who didn’t trust the parents and didn’t trust their own eyes would try to make it fit. Or, thinking back to SCA1, why would each generation of a family develop more severe disease at an earlier age than their parents’ generation? Now we know the answer is a dynamic mutation, but at the time it was a puzzle. Pay attention to the reality in front of you, not the rules and models you learned in school. In 20 years, much of what you learned here will no longer be valid—so keep an open mind, and you might be one of the people who brings forth new knowledge to share with others.

Third, develop resilience. We are not born with patience, and perseverance doesn’t come into play until we meet circumstances in which it is possible to give up. Resilience is like a muscle. Hard times are never fun, but they’re the way we develop character.

Fourth and most important, cherish your relationships. You will have noticed that at each crucial juncture in my life there have been people who gave me opportunities. Meharry Medical College was willing to break the rules to let me transfer in mid-stream. My mentors and my patients opened my eyes and then opened their hearts to me. My collaborators and my trainees have made my career a joy. My husband William, who is a cardiologist with his own demanding career, has made our home a stress-free zone and helped me raise two beautiful children. Many other people have had a profound influence on me, and I have tried to honor their gifts by being generous in turn. I believe with all my heart that my strong relationships have enabled me to achieve the success and the happiness I’ve reached in my life.

As you reflect on your own paths, I am sure you can identify those who helped you get to this point. If there are fewer such people than you would like, then make it a goal to strengthen your relationships. Choose friends and loved ones who will help you become more resilient, pay closer attention, and listen to your own best self.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/339

About Dr. Huda Zoghbi

Huda Zoghbi is the Ralph D. Feigin Professor of Pediatrics at Baylor College of Medicine, where she is also professor of Neuroscience and Molecular and Human Genetics. She has been an Investigator with the Howard Hughes Medical Institute since 1996. She is also the founding Director of the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital. Zoghbi’s interest is in understanding healthy brain development as well as what goes awry in specific neurological conditions. She has published seminal work on the cause and pathogenesis of Rett syndrome and late-onset neurodegenerative diseases, and has trained many scientists and physician-scientists and is a member of several professional organizations and boards. She has been elected to the National Academy of Medicine, the National Academy of Sciences, and the American Academy of Arts and Sciences. Among Dr. Zoghbi’s recent honors are the Pearl Meister Greengard Prize from Rockefeller University, the March of Dimes Prize in Developmental Biology, the Shaw Prize in Life Science and Medicine, the Breakthrough Prize in Life Sciences, Canada Gairdner International Prize, and Honorary Doctor of Science degrees from Harvard University and from the University of Massachusetts Medical School.

Dr. Carl Nathan kept his speech short and sweet during the 2018 Weill Cornell Graduate School of Medical Sciences Commencement. Dr. Nathan was trained in internal medicine and oncology at Mass General Hospital, the National Cancer Institute and Yale before becoming a staff member at the Weill Cornell Graduate School of Medical Sciences. He has been a distinguished professor at Cornell University for over 3 decades, and current R.A. Rees Pritchett Professor and chairman of the Department of Microbiology and Immunology.

Dr. Carl Nathan makes his speech all about the impact the MD graduates have had on the people around them, including their parents, friends, and professors, and the impact they will have on the future of the medical field:

“You have given us new knowledge from your own minds and hands. You have given us fresh evidence that the prospects for scientific discovery are limitless. You’ve shown us that being the first to see something reproducible or to explain something mysterious brings as much joy and fulfilment as when van Leeuwenhoek first saw “wee beasties” through a microscope and Marie Curie discovered radium and thought of using it to treat cancer.

You’ve given us reassurance that no matter our inadequacies as teachers, your brilliance and resourcefulness let you absorb exponentially growing amounts of information with no sign of a limit to what the prepared mind can master.

Finally, in a troubled time, you’ve proven again that science is a form of communication that sifts fake from real and connects rather than divides, that creates a community transcending region, religion and origin. Many of you took precious hours from your pressured lives to share that message with children in the city around you.

What will you go on to give the world from your coming positions in colleges, universities, biotech, pharma, other businesses, foundations or public service?

You will help shed light on the unknown. Help cure disease. Help make cures accessible to those in need. Some of you will help create wealth. Help see that wealth distributed fairly. Help teach those who come up after you.

All of you can help defend the role of apolitical reason and scientific evidence in civic life and public policy. Help save this earth, its peoples and the diverse forms of life with which we share our climate, oceans, forests and fields.

The diploma you are about to receive is a symbol of the power you’ve proved that you have. Go use your power wisely. Then come back and tell us what you’ve done. Like your parents, partners, family and friends, your teachers and advisors are proud of the stories you are writing with your lives. All of us are eager to hear the chapters to come. ”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/334

About Dr. Nathan

Carl Nathan, MD is R.A. Rees Pritchett Professor and chairman of the Department of Microbiology and Immunology at Weill Cornell Medical College. After graduation from Harvard College and Harvard Medical School, he trained in internal medicine and oncology at Massachusetts General Hospital, the National Cancer Institute and Yale before joining the faculty of The Rockefeller University from 1977-1986. At Cornell since 1986, he has served as Stanton Griffis Distinguished Professor of Medicine, founding director of the Tri-Institutional MD-PhD Program, senior associate dean for research and acting dean. For eighteen years he co-chaired the Program in Immunology and Microbial Pathogenesis at Weill Graduate School of Medical Sciences of Cornell University, where he is now the dean. Nathan led the planning team for the Tri-Institutional Therapeutics Discovery Institute and is a now a member of its Board of Directors. Tri-I TDI is a not-for-profit corporation owned by Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center and The Rockefeller University. Nathan is a member of the National Academy of Sciences, the National Academy of Medicine and the American Academy of Arts and Sciences, a Fellow of the American Academy of Microbiology, associate scientific director of the Cancer Research Institute, a governor of the Tres Cantos Open Lab Foundation and on the scientific advisory boards of the Global Alliance for TB Drug Development, the American Asthma Foundation and the Rita Allen Foundation. He is a member of the national Pfizer Therapeutic Areas Scientific Advisory Panel and the Lurie Prize jury. He served for ten years on the scientific advisory board of the Cambridge Institute for Medical Research and the Board of Trustees of the Hospital for Special Surgery, where he chaired the Research Committee. He has been an editor of the Journal of Experimental Medicine since 1981 and presently serves as co-chair of its editorial board as well as on the editorial boards of the Proceedings of the National Academy of Sciences and Science Translational Medicine. He was awarded the Robert Koch Prize in 2009 for his work on tuberculosis, the Anthony Cerami Award in Translational Medicine in 2013 and the Milstein Award of the International Interferon and Cytokine Society in 2016.

Nathan is a member of the Bill and Melinda Gates Foundation’s TB Drug Accelerator and Principal Investigator of the NIH-funded Tri-Institutional TB Research Unit. His research deals with the immunological and biochemical basis of host defense. He established that lymphocyte products activate macrophages, that interferon-gamma is a major macrophage activating factor, and that mechanisms of macrophage antimicrobial activity include induction of the respiratory burst and inducible nitric oxide synthase (iNOS). He and his colleagues purified, cloned, knocked out and characterized iNOS biochemically and functionally, discovered the cofactor role of tetrahydrobiopterin in NOS’s and introduced iNOS as a therapeutic target. Although iNOS helps the host control Mycobacterium tuberculosis (Mtb), the leading cause of death from bacterial infection, Mtb resists sterilization by host immunity. Nathan’s lab now focuses on the biochemical basis of this resistance. Genetic and chemical screens have identified enzymes that Mtb requires to survive during non-replicative states, including the mycobacterial proteasome. His group is identifying compounds that kill non-replicating bacteria while exploring new collaborative models between academia and industry to help invigorate antibiotic research and development.

This week’s commencement speech is by Dr. Howard Bauchner, who spoke at the University of Texas McGovern School of Medicine in Houston, TX. Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA® and The JAMA Network® in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003-2011).

Dr. Bauchner focuses his speech on the morality of being a physician and ethical challenges one must face. He starts by emphasizing the trust patients will place on the graduating medical students: “What I want to focus on is the need to find a moral compass in your life as a physician. I cherish being a physician. Many patients trust us with their lives – thankfully we are no longer seen as a gods – and that is a good thing – but many many patients want us to help them with some of the most difficult and emotional decisions in their lives – how to care for a sick child, how to help a failing parent, what test or procedure should they have for themselves, and of course among the most difficult decisions – care at the end of life. This is your future as a physician, embrace it – and feel the privilege that it is to be so intimately involved in the life of another individual.”

He discusses the ongoing ethical issues facing the medical community such as high healthcare and drug costs, special interest groups that place the wellbeing of patients second, and difficulty of decision-making at the individual level vs the population level. He tells the graduates that they will have to face new ethical challenges with the advancement of technology, and must play the role of patient advocate.

To demonstrate the difficulty of managing such ethical issues, Dr. Bauchner shares a personal story of struggle: “I want to tell you a story of my own ethical failing – one that has haunted to me to this day.  I was attending on the wards at BMC – the old Boston City Hospital – and after days of caring for a child with pneumonia who was not getting better, and me resisting the idea of a repeat CxR, the child developed sepsis.  I was notified in the early morning hours at home, his temperature was 104, his WBC had increased to 35K, and a repeat chest CxR showed a large pleural effusion – likely an empyema.  He was whisked off to surgery, the effusion was drained, he was intubated, started on pressors for hypotension, and broad-spectrum antibiotics to cover the suspected bacteria.  I arrived the next morning – immediately went to the ICU – by this time his BP had stabilized, he had responded to the antibiotics, and was about to be extubated.  His parents came up to me and profusely thanked me for saving their child’s life – I stumbled – mentally and vocally – what should I say.  And to this day I feel ashamed, ashamed that I did not say what I should have, but you do not understand – it was my decisions that made your child so sick.

You will face many decisions – perhaps not quite as dramatic as this – that will affect your lives and the lives of your patients.  When do you speak up and when do you remain silent.  The colleague who does too many tests; the health care system that purchases practices so they can charge higher prices for care; the insurance company that blocks appropriate care; the pharmaceutical and device industries that charge prices in the US that are 5 and sometimes 10 times more than anywhere else in the world; and most importantly end of life decisions that you will make with patients and will be influenced by your own religious, cultural, and personal experiences.  You are likely to confront some but not all of these issue next year as a first year resident, but most will find their way into your professional life at some time.  There is no need to wrestle with all of them, since that can be overwhelming, but it is important to understand that these are ethical issues that demand and require much thought and reflection.”

Read the full speech in the Commencement Archive: https://www.themspress.org/journal/index.php/commencement/article/view/332

About Dr. Bauchner

Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA® and The JAMA Network® in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003-2011). At BUSM he was Vice-Chair of Research for the  Department of Pediatrics and Chief, Division of General Pediatrics. He is a member of the National Academy of Medicine (formerly the Institute of Medicine) and an honorary fellow of the Royal College of Paediatrics and Child Health, United Kingdom.