Mary Woolley
President Gershen, members of the Board of Trustees, faculty, senior leadership, parents and families, and members of the Class of 2010.
I am deeply honored to receive the honorary degree, Doctor of Science (Honoris Causa). It is a particular privilege to receive this degree from an institution with such a strong commitment to research as the means for improving health-and from an institution with such dynamic new leadership in the form of Dr. Jay Gershen, one of the nation's most effective advocates for the powerful economic impact of medical and health research.
But I don't have to tell anyone in Ohio about the power of research and innovation! With last week's vote to continue the Third Frontier program, and with the successes of that program thus far, the people of Ohio are setting an example for the rest of the nation. The state voiced its clear, bipartisan support for innovation as Ohio's future-or, as an editorial in the Cleveland Plain Dealer put it, the "link between innovation and prosperity."
It is thus a special privilege indeed to stand in your company at this leadership moment for Ohio to address you as we pay tribute to these accomplished graduates.
That you have been educated by the distinguished faculty of the Northeastern Ohio University Colleges of Medicine and Pharmacy is a distinction in itself. As a prime indication of that well-earned distinction, I note that the research portfolio of the University has more than doubled in the last few years. A cadre of outstanding faculty has been recruited to accomplish, maintain, and build on this impressive accomplishment. I salute each of you, faculty, staff, and students, for your contributions to the future of health and well-being of people world-wide - and for assuring a brighter future for health for us all - by conducting research even as you use the knowledge gained from past research to prepare physicians for the practice of medicine informed by the evidence that research provides.
There can be no denying that this year of your graduation is an extraordinary year in the history of health. Without recounting the details of the top domestic policy story of the last year and a half - health reform - I want to underscore the reality that you are embarking on your careers in healthcare at a time that will be forever memorialized as a landmark year, with passage of health care reform legislation regarded by many as as monumental as the passage of the civil rights bill or as achievement of voting rights for women; as the most important step in addressing the nation's healthcare challenges since the passage of Medicare in 1965. Because you are members of the College of Medicine's class of 2010, you are uniquely positioned to take the credit -- or part of the blame -- for everything that happens from now on, as this incredibly complex piece of legislation is implemented.
The truth is that implementation of the Patient Protection and Affordable Care Act of 2010 is going to be as difficult and contentious as was its passage. Special interests of all kinds are not going to stop protecting their interests now, any more than the public is going to stop paying attention to whether their hopes and expectations are being met, or being dashed. So much is at stake! The nation's health, every community's health, every family's health, every individual's health; our nation's economic viability, and our nation's ability to grow and help us all prosper. This is an awesome responsibility to take on; each of us should rightly ask ourselves, what's my part in all of this? What can I do at this unique moment of opportunity, to put my commitment to medicine, to health, to the treatment, cure and prevention of disease and disability, to work in the context of the profound change that is likely to roil health care for years to come?
I have a suggestion for you about what you can do. My suggestion draws upon the education you have received and the aspirations you hold dear. It points to the future and embraces the knowledge that much of what we believe to be true today about the best health care will change - some of it very soon, if history is our guide.
Because you have been educated to think in terms of critical pathways, to evaluate the evidence and seek more, you are comfortable with rapid change. Your patients, looking to you to decode the torrent of information, both right and wrong, that floods every one every day via every form of media, your patients will thank you because you know how to navigate those constantly changing and too often treacherous waters.
Too many health practitioners are not skilled at embracing new evidence or at helping their patients do so. I give you just one example, a memorable one for me. My grandfather was a GP in rural North Dakota and had a long and distinguished career, despite the fact that he was a chain smoker. That is relevant because, based on his experience, he believed that it was appropriate to recommend smoking to his patients, to help them reduce stress and lose weight. He completely rejected the then-emerging data on the dangers of smoking, and even quit the AMA in protest. This was a difficult decision for him and no doubt alienated him from many of his peers. The possibility that he may have contributed to the ill health of his patients was not something he was willing to entertain; the fact that his granddaughter confronted him with the data and that he rejected it was not a happy experience for either of us.
Unfortunately, I know that my anecdote is not unique. I know that too many well-educated, well-meaning, hard-working health professionals today are not practicing evidence-based medicine. This has to change if we are ever going to realize the promise of research to deliver better health and quality of life. I believe that the spirit, if not every letter, of the new health reform legislation will help make evidence-based healthcare a reality. Your role in making this happen is one of advantage, because you don't have to overcome old habits.
Dysfunctional habits are of course not limited to grandparent-aged people. I want to mention another personal experience that demonstrates that long-held views are difficult to change. How incredible it sounds to us today that just two generations ago participation in a large National Institutes of Health, or NIH, clinical trial on prevention of heart disease was restricted to men.
As project manager and later associate director of one of the study sites, I drank the "Kool-aid" of the day - I often told potential study volunteers, as well as members of their family, their employers and the media, that whatever the trial discovered would apply equally to women as well as to men! How terribly misguided we were!
It took the steady rebuttal of common sense, as well as a healthy dose of outrage when nothing else would work, to drive change in that now-preposterous-sounding statement. It took years of advocacy by women's rights groups, grounded in common sense and later empowered by victories achieved by AIDS activists, to finally achieve, not quite 20 years ago, policy changes at the NIH to assure that women should be equitably included in clinical trials. Advocates made it happen; advocates changed research forever. Although heart disease remains the number one cause of death in women in this country, the research now going forward is driving the statistics in the right direction at last, and it's about time.
So, to emphasize, your patients and those they love will thank you over and over again for being evidence-based and helping them make health decisions based on evidence. And your patients will be grateful as well if you listen to common sense -- theirs, as well as your own. They will thank you for being their advocate when it comes to research.
There is another group of people who will thank you for basing your practice on research, and for conducting research, as well. The nation's elected and appointed officials will thank you if you can help them understand and support evidence-based decision-making on policies and appropriations, or funding, for health and health research. However, the fact is that they will thank you only if you get to know them and they, you. Can you make time in your career for relationships beyond those of your profession and your family? I suggest to you that you must make time if you wish to fulfill the hope and promise of your education and your goals. For the reality is that health care takes place in a societal and a political context, not in a patient-physician vacuum.
The context of health care delivery includes, in addition to cultural competency and public health considerations, laws and regulations, reimbursement and co-pays, insurance and contracts, government policies and appropriations. And the context of health care delivery is driven, in the final analysis, after all the interest groups weigh in and the expert testimony is carefully considered, by public sentiment. President Abraham Lincoln summed it up succinctly: "without public sentiment, nothing can succeed; with public sentiment, nothing can fail."
Elected officials, who determine so many aspects of the context of health care delivery, are dependent, in the final analysis, on public sentiment, on the votes of their constituents. As a constituent, you have influence to bring to bear on those who aspire to public office. As a member of one of the most trusted professions in the nation, whose profession receives great deference - recall that no argument held more sway during the protracted health care reform debates than the sanctity of the doctor-patient relationship - as a member of a profession of distinction, you have more than your vote to offer an elected official; you have your expertise; you have your well-earned, well-deserved influence. It is vitally important to us all that you use your influence - and that you not only use it wisely, but use it often.
I urge you to use your influence to assure that the future of health retains its promise of hope for all who struggle with disease and disability, their own or that of a dear friend, colleague or family member. I urge you to become advocates for the future of health; for evidence; for the research that drives discovery and its translation into practice.
All too often, those who conduct research and translate research to practice, behave as though it's someone else's job to engage in public outreach and advocacy. They believe that advocacy is a dirty business, aligned with the seamy side of lobbying, involving unsavory people who care only about money and power, and they believe that engaging in advocacy will result in loss of respect by one's peers or failure to achieve tenure or election to the Institute of Medicine.
These ways of thinking are as ancient, and as unrelated to evidence, as was my grandfather's prescription of smoking to his patients, or the conviction that heart disease is the same in women as in men. These ancient ways of thinking are damaging to our health. My plea to you is to stay strongly connected to research and do not allow yourself to become ancient in your own thinking, at any age. Former Surgeon General Dr. C. Everett Koop, still going strong as a champion of health and research for health at age 94, and just re-married last month, is famous for insisting that more specific warning labels - beyond simply "cigarette smoking is dangerous to your health," to note the risks of heart disease, cancer and pregnancy complications - be placed on every pack of cigarettes. He is also known for a public service campaign in the 1990s that said that "insufficient medical research is dangerous to your health." He would agree, too, that "insufficient advocacy for medical research is dangerous to everyone's health."
So please, take a little time out there to be an advocate and to recommend advocacy to others. If you're lucky, one day you will have a granddaughter to challenge you. I hope that her challenge will involve questioning your nostalgia for American Idol or Facebook and not involve questioning your practice patterns. And I further hope that you recount to her the difference your advocacy made to the implementation of landmark health care reform; that you recount the way you and your colleagues led the way in reducing needless suffering and death from cancer; spearheaded the transformation of healthcare via personalized medicine; discovered a vaccine for HIV/AIDS; eliminated health disparities; put malaria and TB in the history books and defeated the obesity epidemic.
I salute you today and I salute your future days. I'll be listening in anticipation of hearing your voice and benefiting from your influence in Washington and all around this nation, which awaits your talents and joins me in saluting your future.
Thank you.