Living with Innovation: Issues for Medicine in the 21st Century
I feel the honor of this invitation very deeply and appreciate the generous and collegial spirit behind it.
There's one other item in my resume that is relevant. I also happen to be the husband of a physician. Though now semi-retired, my wife Peg still sees patients in her ob/gyn practice in Indianapolis.
And if I had no other lens on the world of the medical specialist, that tie alone would be enough to win my admiration for what you do and my empathy for the sometimes trying circumstances under which you do it.
As for me, I would like to think that my remarks today can strengthen the lines of communication between the scientists and physicians who work in the toolmaking side of medicine and all of you who labor in the tool-using domains, in clinical practice and medical education.
Clearly, we are going to need all the wisdom we can find and all the unity we can build.
For this is a time when health care, particularly health care for the elderly, is once again a hot topic in the media and a live issue in Washington.
We've just seen the fight over a Patient's Bill of Rights. We may soon see another round, responding to President Clinton's recent Medicare reform proposal, featuring a prescription drug benefit. And of course there are many other issues in health care that could become the subject of political debate.
Whatever issues are not settled this year will likely be reappearing as part of the battle for the White House and the Congress in the 2000 elections.
The numerous fissures and faults in the political landscape tend to obscure what is really occurring. But step back, and you can see that this is like a problem in plate tectonics.
A huge surge of new biomedical knowledge and innovation is colliding with another continental shift in demographics, defined by the growing needs and finite economic resources of a rapidly aging population.
Health care in the 21st century will be shaped by the way these two forces play out, and therefore, I think it is very important for all of us in the medical community to help people understand the true consequences of their policy choices.
I am a partisan for scientific progress. I make no bones about it. So let me start with that side of the matter.
The art of medicine is ancient. But medicine as a science is very young.
It was not until the early 1930s, when the generation of doctors who trained my generation was in medical school, that medicine truly rediscovered and implemented the wisdom of Hippocrates--"Primum, non nocere"--first, do no harm.
The essential lesson those students learned was, in the great majority of cases, not to meddle because there was very little that the physician could do to alter the course of disease in a positive way.
And then something truly amazing occurred--the emergence of the first powerful anti-infectives, the sulfonamides, and then penicillin.
One of the young medical students of that time was the great Lewis Thomas. He remembered those events as two revolutions:
"The first, that the medical treatments in common use for all the centuries before our time didn't really work, did more harm than good, and had to be given up, left us with almost nothing to do to alter the course or outcome of a human illness.
"And then the second, that a form of treatment based on fundamental research, tested in experimental animals, then tested in controlled experiments in human beings, was possible.
"Medicine, it seemed, was off and running."
I suggest to you that all of us, in turn, were trained with the perspectives of both revolutions.
Certainly we have been extremely fortunate to be part of the flowering of therapeutic innovation that began in the era that Thomas describes. (Though I think I would date it from Banting and Best's discovery of insulin in the 1920s and the subsequent development and commercialization of that discovery by Eli Lilly and Company! …