发信人: docrockville (docrockville), 信区: MedicalCareer
标 题: Mayo Clinic College of Medicine Commencement Address given by an IMG
发信站: BBS 未名空间站 (Sun Feb 1 12:38:46 2009)
Dr. Elias A. Zerhouni
May 21, 2005
Thank you, Dr. Berquist [Director for Education, Mayo Clinic College of
I'm here today to honor the graduates, and I have one message for you:
Fasten your seatbelts!
You're truly in the driver’s seat. It’s your time, it’s your place in
As Dr. Cortese [CEO, Mayo Foundation] just said, you are tomorrow’s leaders
in medicine. Hopefully, you will take care of us, and also be leaders in
When I think about your graduation, I go back about 35 years when I had
decided that I wanted to come to the United States of America. I considered
the U.S. to be the greatest country on earth, one that had the best
So, I made the decision to emigrate here. I had an uncle who was a
radiologist and, as you can guess, he motivated me to go into radiology.
That made sense because I had a background in math, physics, and engineering
. But he also convinced me that radiology would be the next great field in
medicine. I asked him where I should apply, and he told me the Mayo Clinic
or Johns Hopkins.
Well, since I was turned down by Mayo, I couldn’t resist the invitation to
give the commencement address!
Truly, this is probably the most dynamic, fast-paced, high-stakes world we
could imagine. And though you just finished one phase of your career —
albeit a very important one — I am telling you that the real ride is to
come. Trust me, it’s going to be a challenge, but also an era of great
opportunities. I think it will be a revolutionary era.
I came to this country from Algeria with $369 in my pocket. I was very lucky
to be accepted into the residency program at Johns Hopkins. When I began my
radiology career there, the field was not considered a front runner in
medicine. In fact, at the time, it was mostly a backwater. Well, as it
turned out, we were entering revolutionary times for medical imaging, and
very few had predicted the future of this area.
I’ve been fortunate to live in the most exciting 30 years in medicine, and
in medical imaging, and I thought that there could not be another 30 years
like this. But let me tell you, I’m wrong. I think what we’re going to
witness over the next 25 to 30 years is going to be, again, a period of
As you do your job as a scientist, you write a few papers and if you have
good slides you get invited to give a lot of talks. That’s the way to see
the world without paying the bills! I invented a few things. I started a few
companies. I got into a lot of problems, and I solved a lot of them.
Then, 3 years ago, President Bush asked me to serve as the Director of the
National Institutes of Health. I believe that it is our duty to serve our
country, because our country really serves us in ways that no one — no one
— can equate around the world. When I was nominated, he told me that I
represent a good example of what America is all about, and I said, “No, Sir
, this says more about America than it says about me.”
So, yes, I've had to fasten my seatbelt a few times in my life. And since I'
ve been working in Washington, I've had to be sure I had an airbag too!
But I did not come here to talk about me, I’m here to talk about you. And,
on this occasion, I’ve come to give you a few words of wisdom about where
you are in the world during this time in history, and what the Mayo has done
This day reminds me of a graduation I went to 2 years ago, the graduation of
my older son. I was sitting in the audience and I was thinking about him, a
little baby having fevers, about all the problems and difficulties he faced
. All the anxiety I had about whether he'd be able to succeed, how I could
help him, and how I would pay his tuition!
He made it — he graduated, just like you today. So I was thinking about
that day, and I thought, “You know, in so many ways, the reason you’re
here is because of your parents and what they’ve done for you.” So I’m
going to ask the graduates, the faculty, and all of those here who are not
parents of the graduates to give a round of applause to the parents of today
You have gotten this far, and I’m sure that many people have told you, “
Don’t take yourself so seriously.” But going through what you have gone
through and succeeding in the ways you have is very unique. Very few people,
very few Americans, have had that privilege.
So, that’s why I want to encourage you to do the opposite, to take yourself
very seriously, because we’re depending on you. You will have to lead us
through the most dramatic time in medical history. Some of you will make the
discoveries that transform medicine, and others will put those discoveries
into practice for millions of people.
For thousands of years, humankind has worked toward better ways to treat
disease and improve people’s health. You’d think by now that we’d have it
done. Solved. Case closed. Well, the case isn't closed, and in fact it is
actually more open than ever. We're at the beginning, and we still know very
Think about the history of life on Earth, which began 4 billion years ago.
The explosion of human intelligence occurred about 100,000 years ago. So the
last 100 years in which we’ve been really active in medical research is
less than the blink of an eye in the course of the hour we’ve spent
Today marks the end of your formal education, but it’s truly a new
beginning. An acceleration in the rate of change in science will require you
to be lifelong learners. In fact, what is most important about your
education at Mayo is not so much what you learn, because I can assure you
that about half of what you learn is wrong. And half of what you learn is
right — but, not completely right.
What you need to do in the next stages of your career is learn to teach
yourself so you can eventually leave a legacy for the next generation. They,
in turn, will be able to prevent and cure disease more effectively than we
have in the past.
Medical science is an extraordinary frontier, and we need to explore it
aggressively. It is the land of the mostly unknown. You may argue with me
about that, after spending 4 years immersed in books, labs, and clinics, but
I am not kidding. I’ve asked leading scientists around the country to
answer the question, “How much biology do we truly understand? How much do
we need to know to be effective as scientists, as healers, as physicians?
Do you know what the answer is? About 10 percent. That’s what Nobel
laureates say, that’s what CEOs of creative biotech companies have told me.
And if you compare that percentage of knowledge relative to any other field
of science, physics for example, you'll get a very different answer, “We
know 80 percent of what there is to know in physics.”
It's just not so in the life sciences.
The challenges and costs of current healthcare are rising, as is the burden
of disease. If we do not find better ways of overcoming this disease burden,
through new discoveries made at a very rapid pace, we are in trouble. If we
continue to practice medicine the way we know how to do today, 20 years
from now we will have lost the most important game of the 21st century.
The 21st century is the century of the life sciences, of biomedical and
behavioral research. It is the century where we will have to find solutions
for our societal health problems.
As technology does its job at steering scientific progress, you will need to
learn constantly. The pace of biomedical progress is going to be
breathtaking. Imagine, for example, real-time remote wireless nanosensors in
pumps that administer medications to patients at home. Or at work. Imagine
that you could precisely identify patients at risk for various specific
conditions. More importantly, imagine being able to find out who is not at
risk, so you don’t have to intervene across large populations when only a
small percentage of the population is at risk.
You, as physicians, will rely on the basic discoveries that must occur for
us to be able to prevent disease before it strikes. Because once a disease
has struck, once we have lost normal function, the cost is enormous. That's
in human terms, not just dollars.
It has not been proven by anyone that biological processes are reversible.
In fact, I would venture to say that it’s more likely that pathological
processes that destroy function, like those that cause Alzheimer’s Disease,
are not reversible. Like aging is not reversible. But trust me, we’ll find
the solution to the hair problem!
But seriously, I think what is important in the message that I’m giving you
today is that it is critical that you stay grounded in the reality of today
. As Dr. Cortese said, we need to perform what we know, as best we know it.
But also realize that what we know is insufficient, and we need to fill in
the gaps rapidly because we are facing challenges caused by the aging of the
population and the burden of chronic diseases that none of us yet knows how
As Director of the National Institutes of Health, I am focusing on one goal
— to help people live longer and healthier lives. As a physician, I am all
too familiar with the limits of our current approaches to clinical medicine.
Even with the best medical care in the world, we don’t necessarily have
the best healthcare system in the world. I think we need to work on that.
And despite all the technological "wow" factors, I think we also need to
worry about how can we offer equitable access to all people and eliminate
unfair disparities? Simply expanding what we currently do is not enough.
The gains, as we have seen with managed care, are real, but they are
marginal. They only provide temporary relief, with relentlessly increasing
costs soon resuming their upward course. No better-managed way of just
providing what we offer today can be a lasting solution. Being good — or a
little bit better — at what we do now is not enough. We have to discover
new strategies that are orders of magnitude more effective than what we have
Our patients deserve the best. They are relying on us to push the frontier
every chance we get. We have to push that frontier fast, and it won't be
An ironic twist is that, in many ways, we are victims of our own success.
When you look at the history of disease over the past 30 to 35 years, we
have beaten down the acute conditions that hurt people in the short-term.
Nonetheless, our "reward" is disease that lasts a long time.
For example, you heard about cardiovascular surgery from one of the alumni.
Today, heart disease, in its acute form, is better controlled than it ever
was. And in making these gains, we have increased life expectancy. Since the
beginning of the century, we’ve gone from a life expectancy of 47 years to
77 years, and people say that most of the gain was due to advances in
public health and better hygiene. And that is true.
But let me describe to you an interesting statistic. Every 5 years over the
past 30 years, we have extended life expectancy by a year. If you look at
the past 30 to 35 years, much of our progress has been because of medical
research successes that control acute diseases. So, increasing life
expectancy has led to an era where 75% of our healthcare costs are related
to chronic diseases.
The diseases we fight are shifty, always evolving and adapting to humankind
and our attempts to control them. I don’t think I have to tell you about
diseases that are changing right in front of us. Take emerging and
reemerging infections, for example.
Back in the 1970s, we thought that malaria would be gone from the face of
the earth by 1985. Well, in 2005, it's back. And there are many others, such
as AIDS. We have more infectious diseases now than we believed we would
have, and we are further behind than where we were in the 1970s.
There are other emerging diseases. Obesity is a new trend, and we really
have to tackle it because it has the potential to reverse all of the
progress we’ve made in healthcare for the many, many years we’ve been
working at it.
We need to understand more about human behavior. What is it about humans
that they do things they know they shouldn't do? What is it about us that
makes it possible for us to smoke, eat a bad diet, not exercise, knowing
full well that all this is harmful to us? Research on human behavior is what
we will need to do over the next 10 to 15 years.
Let me give you a little bit of a perspective on the challenges facing NIH.
As you heard, the NIH budget is $28 billion, and you would think that this
would be more than enough money to solve all the problems that we have. But
I look at it differently.
What is the dollar amount per American that this represents? It’s $96 per
American, per year. That's what the NIH has to deploy to make sure that we
can sponsor the best research across the board.
And consider that healthcare costs are rising fast. We currently have an
expenditure of about $5,500 per American, per year, and it’s going up at a
rate of approximately 8 to 9 percent annually. There are several hundred
common diseases and a significant disease burden from obesity. On top of
that, we have 6,000 rare conditions that no one wants to deal with because
it’s not economically viable. NIH has a responsibility to tackle these.
So, we are going to have to be much more effective in finding new cures, and
putting these new cures into place, than we have been in the past.
This is where I think the efforts you’re making are going to be critical,
as are places like the Mayo Clinic. Very few institutions have the capacity
to meet the challenge of translating basic research into real changes in
practice. This is, I think, where the most opportunity exists for you as new
M.D.s and Ph. D.s.
So, on our end, we have to look at the potential for NIH to give you the
opportunity, if you are interested, to begin a research career as early as
possible. From NIH's standpoint, one of the most important things we can do
is to make sure that scientists take chances at the earliest age they can.
If we’re dealing with a world where we only know 10 percent of what we need
to know, maybe more ideas will need to be tested.
One of my great challenges is to find ways of giving you the stimulus and
the support to begin a research career early. I also want to be sure that
those who are going into the community remain lifelong partners with the
Why is that important? Because in the future, diseases that are chronic are
going to be seen by community practitioners. The patients with long-term
diseases like diabetes or other chronic conditions are not going to come to
major academic institutions. They’re going to be seen in a community
Therefore, it is critical for us to create those ties, linking academic
centers with communities. As the physicians of the future, you should
understand that it is no longer going to be the traditional relationship of
"one doctor, one patient" that we used to know. It is going to be "one
patient, one care team."
This is the big challenge for young doctors — being able to work across
multiple disciplines and find ways of integrating those disciplines in
practice. You'll need to find ways to break the silos between disciplines in
order to make a contribution to science.
When I say that, people say, “Well, that’s easy to say, but how do you get
If you look at the greatest scientists of this century, many of their
contributions were made when they were quite young. Look at Howard Temin,
for example. He was in his twenties when he did the fundamental research
that led to our understanding of reverse transcriptase and how to treat AIDS
. Look at Linus Pauling, who was also in his twenties when he described the
nature of chemical bonds. Marie Curie was in her late twenties when she did
the work that earned her a Nobel Prize, and in her late thirties when she
won a second Nobel.
NIH's Marshall Nirenberg, who discovered the genetic code, was 27 years old
when he started that work and 31 when he finished it. He got the Nobel Prize
Today, the average scientist becomes independent somewhere between 37 and 40
years of age. As the NIH Director, I want to change that. I want to find
ways to let young scientists take chances early in their careers because
they are usually the most creative at that time.
Of course, it doesn’t mean that others are not. I can give you the example
of Julie Axelrod, who passed away 2 months ago. He was extremely productive
in his lab until age 90. Maurice Hilleman, one of the great pioneers of
preventive medicine who died just about a month ago, was still working on
new vaccines into his late 70s.
So it’s not a question of age, it’s a question of opportunity. It’s a
question of having the chance to show how good you are, and we want to be
able to let you do that.
I know that your school is already making headway. Your Dean told me that
most students now take advantage of a complete scholarship program. This is
incredibly helpful, because at the end of your training, your debt burden is
not as high as some of your colleagues, and you're in a better position to
make a choice to do research.
My advice to you is to stay in the greatest game in science this century:
life sciences research. And let me give you some personal advice about how
to do this because, as I told you before, your world is going to change very
fast. The journalist Thomas Friedman, a New York Times foreign affairs
columnist, wrote a book called "The World Is Flat," that describes the
globalization of knowledge. That's what I'm talking about.
You will have to be more adaptive than at any other time in history — to be
able to work across networks, in global collaborations. So, how will you
get there? How are you going to break barriers and silos? This may seem
difficult, but I have some rules that I'd like to share with you. They're
called my “50/50” rules.
Progress often comes from areas of science and practice that you don’t know
about, but that knowledge still impacts your field. So, my first 50/50 rule
is that you shouldn't become so specialized that you lose sight of what’s
happening around you. How do you do that?
I approached it this way. Fifty percent of my colleagues were from my own
specialty. But, I always made a point to cultivate the other 50 percent from
different fields, like computer science and physics, and to know scientists
from all over the world.
The second 50/50 rule pertains to knowledge. How do you read? How do you
learn? Well, 50 percent of what I read was about radiology, and 50 percent
was about something else. You may say that’s not easy to do.
But I believe that, in this century, there’s going to be a need for the
rebirth of the so-called “Renaissance Man.” Today, we have information
systems that give you information instantly and easily. You don’t need to
record it, you don’t need to keep it, you can have access to the
information in real time.
So, you shouldn't fill your head with ways to find information. Instead, you
should concentrate on learning to learn. You know the old saying, “Don’t
give me fish, show me how to fish.” Well in today's world, the key will be
learning to spend 50 percent of your time on your specialty and the other
half on things outside your direct profession. You have to keep balance. The
other thing, though, is that as you look at the 50/50 rules, you have to
remember that there are exceptions, the most important of which is “In love
, there’s no 50/50 business!”
And, of course, integrity. This is not something you can split up, and you
have to keep it 100 percent. Last but not least, if you have a dream, don’t
have half a dream, have a 100 percent dream. Think the biggest dream you
can, because dreams are like little boxes — you can’t make a large box fit
into a small box. You can’t make a great life fit into a small dream.
I am not exaggerating when I say that the world is counting on you. Follow
these rules and understand the trends. Keep true to your intellectual
curiosity, your integrity, your compassion, and your desire to keep people
healthy. Keep alive your desire to advance human knowledge.
Let me just leave you with a very modest proposal. Fasten your seatbelts,
friends, it’s going to be a great ride. Enjoy it!
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