Remarks at the Albert Einstein College of Medicine Commencement

Remarks by FDA Commissioner Margaret A. Hamburg, M.D.
Wednesday, May 30, 2012

Dean Spiegel, members of the board of trustees, distinguished faculty, parents and grandparents, families and friends.  I join all of you in congratulating the outstanding 2012 class of the Albert Einstein College of Medicine.

Let me begin by thanking you for including me in this wonderful event.  This is also a good time for this year’s graduates to say thanks.

First and foremost – to your families.  Especially your parents!  They’ve stood by you.  They’ve supported you, and today they share your joy, excitement and pride.  Thank each other, as well – because you would never have reached this auspicious day without the friendship, support and collaboration of your colleagues.  And thank your professors – the faculty and staff who put so much time and effort into teaching you, guiding you, inspiring you, and sometimes prodding you.

Whether you are receiving an MD, a Ph.D; or are one of 15 physician-researchers earning both – you are graduating from an extraordinary institution.  Einstein is one of our nation’s best medical schools, dedicated to cutting edge science, innovation, and biomedical research.

But Einstein is about more than medicine and science.  This school is dedicated to the development and education of physicians and researchers who embody the highest standards of ethics and compassion.

As your motto says – Einstein puts "medicine at the heart of science."  And the class of 2012 has certainly proved that.  I know that most of you are involved in community outreach – in the Bronx for sure.  And some of you have taken your skills and a passion for health – a passion I share – across many continents and to some of the world’s poorest corners.  In doing so, each of you has enabled Albert Einstein’s vision that, "concern for man and his fate must always form the chief interest of technical endeavors."  For that you all deserve respect and appreciation.

As I look from this podium, I see a group central to the future of medicine, science, and the health of the public.  I admire each of you, and if I think back far enough – I can even remember being rather like you.

I love coming back to New York City.  I wasn’t raised here – but I feel deeply rooted here.  I did my medical residency at Weill Cornell Medical Center and research at Rockefeller University. 

And after a stint at the National Institutes of Health in Washington, DC– I came back to New York to serve as the City’s health commissioner.  That job – and others – taught me that learning never stops.  And neither will the opportunities that come your way to make a real difference.  There is perhaps nothing more wonderful about the careers you are embarking on than that.

It may be bad form at a medical school commencement to quote a lawyer, but exactly 128 years ago today, the great 19th century jurist – Oliver Wendell Holmes – said to a group that he was addressing: "It was given to us to learn at the outset that life is a profound and passionate thing."

This is a truth you’ve been taught by your outstanding faculty, your studies, and your patients.  And you now belong to a very elite group that has the tools and training to improve the lives of so many – whether it is through research, or medicine, or public service.  What you do will really matter.
 
Your adventures in the vast realm of science, medicine and health – whatever your path – are just beginning.  When I was at that stage, I wanted to be an academic physician.  I would teach, do research, and treat patients – most likely in the field of endocrinology.  I was certainly not planning a career in government or public service.  And I would have bet large sums of money that I’d never become New York City Health Commissioner or Commissioner of the FDA. Who would ever be so foolish?
 
But over the years, I’ve learned that the old Yiddish saying is true:  People plan and God laughs.  Doors open – often unexpectedly.  And when they do, you should walk through them – using your innate talents and the skills you’ve learned to make a difference.

My first big career milestone is the same one many of you are about to reach – my internship.  It was a daunting prospect; but as I look back, my year as an intern probably did more to shape me as a doctor, professional, and person than any educational experience before or since.

Being an intern is hard.  You work long hours.  And it’s scary. You never know what situation will need to be managed…who is going to be presenting with what symptoms…but now you are the one wearing the name tag that says – "doctor."  People look to you with new expectations, but there were many days and nights when I felt like I was walking a tightrope.  My fellow interns felt the same. 

We knew we were making imperfect decisions with imperfect knowledge.  We knew we were doing our best – and that sometimes our best might not be good enough.  So the first thing I learned was humility.

But when I was in my first year of medical school, my classmates and I were told that thanks to the advent of antibiotics and vaccines, we were on the threshold of ending the era of infectious diseases.  But in stark contrast, as our medical education advanced, we watched with dismay as a mysterious new illness emerged.  No one knew what caused it.  No one knew what to call it.  And no one knew how to care for it.  It was the start of the HIV/AIDS epidemic.

By the time I was an intern in NYC, I was taking care of many AIDS patients, but we had no effective treatments – and no medicine on the horizon.  We could offer neither cure nor hope. For a young, idealistic doctor like myself, nothing could have been worse.

But the early days of AIDS brought many lessons. It opened my eyes to the importance of research and global health, the need for an integrated health care system that harnesses the full continuum of medicine, science and public health, and that some of the greatest challenges in medicine exist at the interface of a broader set of social, ethical, political and legal concerns.

It was humbling indeed.  But my experiences as an intern also taught me to remain optimistic.  It taught me that I was capable of stepping up and taking responsibility.  It taught me to ask questions – and to trust my instincts.  It taught me to listen, to think through problems and to defend my decisions.  And perhaps most important – it taught me that – no matter how difficult the night – the morning always comes.  In other words, I learned I would survive and even thrive.  And I want each of you to know that you will too.
 
While both the anxiety and feelings of accomplishment that come with being a young doctor or researcher have not changed much since I was a student – the practice of medicine and the role of public health agencies certainly has. 

One big reason is new technology, ranging from electronic medical records and imaging tools, to gene sequencing, new diagnostics – and, of course, the widespread availability of all kinds of information. 

But there is no substitute for human instinct and compassion.  Patients do not put their trust in machines or devices – they put their trust in you.  We think of medicine as a science.  And it is.  But medicine is also very much an art – practiced by doctors who bring to the bedside not only their technology and training, but also their humanity, their caring, and their concern.

You have already spent years studying, training, doing research, and seeing patients.  And you likely have many more years of education ahead of you. But please remember that the more skilled you become, the more specialized, the more dependent on technology – the easier it is to lose your humanity, forget your compassion, and ignore your instincts.  This is true whether you spend your careers as practicing physicians – or go into research, teaching, public health, or government service. 

So while seizing the future, I hope you will never let go of the past – the abiding tradition, centuries old – of building the bond of trust and confidence that lies at the heart of medicine and science.  Trust and confidence that must be earned every day.

And a few other words of advice:  Be transparent in your dealings with patients and colleagues.  Be thoughtful and judicious.  Don’t hide mistakes and don’t be afraid to ask questions.  And follow the science wherever it leads.

Let me expand on this last point.  Every step in my professional journey has reinforced my belief in the importance of evidence-based decision-making…as an intern and a resident, as a researcher at Rockefeller University and NIH, and as New York‘s health commissioner. And it is certainly true today, when I direct the world’s leading regulatory agency.

One of the things I’ve learned as the head of the FDA is that it is very difficult to satisfy all of the competing interests. Whatever I do, someone is always unhappy.  So whenever I make decisions, I ground them in the best-available science, even in the midst of complex social and political challenges. But trust and confidence – and good decision-making – also demands that you listen carefully, prepare thoroughly, and weigh the risks and benefits of your decisions. 

One last piece of advice for gaining trust and confidence:  Hold on to the moral compass that has guided you to where you are today.   As future doctors, scientists, and public health officials – much will be expected of you.  That is why I urge you to recognize that with your training comes a broader responsibility.

William Butler Yeats wrote, "Though the leaves are many, the root is one." 

I hope each of you will always remember that while the leaves of medicine are many, the root is one – and that is the moral imperative to advance human health.  Whether you are treating individual patients as a practicing physician; delving into the mysteries of life as a bench scientist; learning which therapies work best for which diseases as a researcher; or addressing the broader issues of public health and health policy as a government official – you have the opportunity and responsibility to be part of a whole that’s greater than yourselves.   

The best way to address the needs of patients – the best way to make important advances in science – and the best way to improve the health of a community…of a nation – is as part of a team.  AIDS is now a chronic, manageable disease – not a life-sentence –  because the entire health care system worked together…from AIDS workers who walked the streets giving out accurate information and urging people to be tested, to doctors in clinics and hospitals who provided care and studied the disease, to dedicated and brilliant researchers in government, private and academic labs.

So no matter where your career takes you – I hope you will always focus not just on the individual patient or research finding, but on the root – which is the imperative to advance human health for all. 

I hope you will speak up on behalf of America’s uninsured – nearly 50 million as of 2010 – many of whom end up in hospital emergency rooms sicker than they need to be.

And I hope you will always see yourselves as part of a team, and dedicate yourselves to collaboration, breaking down barriers, and staying true to science – forging new partnerships and building bridges that can span the broader social, legal, political and ethical issues that surround health and health care.

The practice of medicine – and biomedical research – has never been more promising, more exciting, and more fulfilling. From sequencing the human genome, to eradicating small pox, to curing some deadly cancers, to effectively treating HIV infection, much of what is possible today was unthinkable – or at best aspirational – when I was in medical school.  Huge progress has been made.

But we still have a long road ahead of us:  emerging infections and drug resistant disease; the growing burden of chronic diseases, including obesity and diabetes; neurodegenerative conditions and the mounting problems associated with our aging population, importantly including Alzheimer’s; environmental health concerns; and the list goes on.

We have no time to waste. That is why one of my most important goals as Commissioner of the FDA has been to help translate advances in science and technology today into the treatments and interventions people need – and count on-as swiftly and surely as possible.  Toward this end, I have focused considerable attention on building the field of regulatory science – the knowledge and tools needed to enable an efficient assessment of safety, efficacy, quality and performance of medical products.  This is vital to advancing biomedical innovation, and finding new treatments, prevention strategies, and cures.  But there are other challenges.

An unfortunate reality of the 21st century is the fact that even when well-established therapies exist – they are often underutilized or unavailable, especially in poor neighborhoods, rural communities, and tribal lands.  Not to mention impoverished nations.  The reason is almost always cost, access, or both.  The Affordable Care Act will not solve the problem of cost and access.  But unless rejected by the Supreme Court, it will certainly help us address a set of critical needs and extend health care to millions of Americans who are currently uninsured.

The quality of our health care is another 21st century challenge that awaits your skills, passion, and teamwork.  Yes, we have the best trained doctors, the most innovative researchers, and cutting edge technology.  But even in the United States, there are disparities in the quality and availability of health care.  And in many places around the world, health care isn’t just low quality – it barely exists.

We cannot solve these 21st century health care challenges if each of us stays inside our preferred field and fails to understand that the solutions lie in working across disciplines, across sectors, across borders; and that they are not someone else’s responsibility.  The responsibility for finding answers to today’s challenges belongs – collectively – to us.

The 21st century medicine is both a miracle to behold – and a mountain to climb.  The path is not easy. We have before us complex, multi-faceted, often deeply engrained problems. And the only way to solve them is through collaboration… with science and best practice as the guide, and a moral compass to hold us steady on course.

We struggle with these issues every day at the FDA. We must deeply understand the science and technology that comes before us, spanning different disciplines and different interventions.  We must work across sectors, be responsive to an array of stakeholders, and we must be mindful of both unmet medical and public health needs and unfulfilled opportunities for action. We must recognize the broader policy implications of our work. 

And we must understand that we have a collective responsibility to earn the trust of the American people every day.  This is especially important for a regulatory agency like the FDA that is mandated by Congress, instructed by science, and obligated by mission and conscience to always protect the health and wellbeing of our citizens.

As I reflect on the importance of the transition that today’s ceremony marks, I am reminded of The Diary of Anais Nin, a popular book during my college and medical school years.  She says many wise and wonderful things in this book, and one of my favorites is this:  "Life shrinks or expands in proportion to one’s courage."

This is a great lesson no matter where you are in life – or what career choices you make.

I hope you will always combine the skills you’ve learned here at Einstein with the courage of your own convictions to be great doctors and scientists, to be a voice for those who are in need or underserved, and to serve the cause of medicine and humanity, helping to shape the future for us all. 

Congratulations, Class of 2012…and good luck.