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Commencement Address at Stanford School of Medicine

Margaret A. Hamburg, M.D.
Commissioner of Food and Drug Administration
Stanford School of Medicine
Li Ka Shing Center for Learning and Knowledge
June 16, 2012 

Dean Pizzo, trustees, distinguished faculty, parents, families, and friends – thank you for inviting me to participate in this wonderful celebration.  I join all of you in congratulating the outstanding 2012 graduates of the Stanford University School of Medicine.

Whether you are receiving an MD, Ph.D, Master’s Degree, or a combined degree – you are graduating from an extraordinary institution…and you are poised to do extraordinary things.

As a daughter of Stanford, I admit to some bias, but there are few medical schools, anywhere, that offer the education and training that you have received. The dedication of Stanford’s faculty, the caliber of the teaching, the importance of its research, the quality of patient care and the effectiveness of its leadership have earned Stanford Medical School  enormous respect and admiration,  and secured its position as one of the leading medical institutions in the world.
 
And for the Class of 2012, you too deserve respect and admiration.  You have clearly succeeded – even excelled – in this exceptionally dynamic and demanding academic environment.  As I look out from this podium, I know that for decades to come you will save lives, solve medical mysteries, and invent technological wonders – building on what you have learned and accomplished here. 

There is an old saying that it is better to be lucky than good.  True or not, there is certainly a lot of serendipity in life.  But Louis Pasteur had a different take.  He said, “Chance favors the prepared mind.”  I was reminded of this every day while serving as New York City Health Commissioner because the quote was inscribed on a wall in our lobby. 

But you don’t need a reminder.  You are already far better prepared than most.  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 matter.

So on behalf of those whose lives you have already touched with your medical and research skills – and will touch in the years ahead – I say:  Thank you for working so hard – and preparing so well!  
 
And now I’d like to suggest that you also say – thank you.
 
First and foremost, thank your families. They’ve stood by you.  They’ve supported you.  And today they share your joy, excitement and pride.

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.

And thank each other too – because you never would have reached this auspicious day without the friendship, support, and collaboration of your colleagues.

For many years, Stanford was my home.  I lived right on campus where both of my parents were on the Medical School faculty.  Growing up, I was immersed in medicine and science.  My parents were physicians and researchers.  So were most of my friend’s parents.  It was the life I saw every day – and it looked fun, exciting and rewarding. 

I went to college wanting to be a doctor, but when I got there, I discovered that pre-med courses weren’t so fun, and there were plenty of other interesting things to do in life.  I got involved with the school newspaper, and for a while considered a career in journalism.

My father now refers to this as the period when I was “drifting.”  But eventually the “prodigal daughter” saw the light and came around.   And when I was admitted to medical school, my Great Aunt Winnie – who was like a grandmother to me – exclaimed “Oh sweetie, I’m so happy – now finally you can marry a doctor!” I did not.

Back then I was absolutely not planning on a career in government or public service.  I wanted to be an academic physician engaged in research, teaching and clinical practice.  But that old Yiddish saying is true:  People plan and God laughs. 

For me, my path took a dramatic turn as I watched the HIV/AIDS epidemic emerge. As first year medical school students, we had been told that with the advent of antibiotics and vaccines, medicine was on the verge of ending the era of infectious diseases.  

How wrong that was. Soon cases of a mysterious immune deficiency syndrome began to present.  No one knew what caused it.  No one knew how to care for it.  No one even knew what to call it.  But it was AIDS.

By the time I was an intern in New York City, I was taking care of a great many AIDS patients.  Even one of my fellow interns was lost to this devastating disease.  But we had no effective treatments and no medicine on the horizon.  We could offer neither a cure nor hope.  For a newly-minted, idealistic doctor like me – that was humbling.

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

The AIDS crisis propelled me into the world of public health and health policy.  And yes, this terrible disease opened my eyes, but it also opened a door – the unexpected opportunity to become the New York City Health Commissioner. 

My first reaction was:  “This crazy! I’m not qualified.” Frankly, I was scared.  My Aunt Winnie was not altogether happy either.  “You will be throwing away the chance – after so many years of training – to be a ‘real doctor’,” she admonished.   My father tried to calm her down, explaining that I would still be a real doctor – but instead of having one patient at time, I would have 8 million.  Now, as FDA Commissioner, I guess I have more than 300 million.
 
I am telling you this because when I sat where you are sitting today, I had no idea that I would one day end up in any of these jobs. Your future will definitely hold many opportunities.  You’ve guaranteed that with the degree you are getting and all your hard work.  But what path you choose will be neither obvious nor easy, nor without risk

So be open to and enthusiastically seize new opportunities, wherever and however you find them.  Let chance favor your prepared minds, and make sure that you translate your ideas and opportunities into real world action.  Even when the path is hard.

When I began as New York City Health Commissioner, the City was facing a fiscal crisis and budgets were being slashed.  New York City was not only an epicenter for HIV/AIDS, but we were struggling to deal with the resurgence of tuberculosis in epidemic proportions, and now in a more dangerous and harder-to-treat drug-resistant form. Communities in the city had health statistics that looked more like those of developing countries, and we faced a new threat—domestic terrorism—that required that us to think in new ways about what it means to protect health.

I felt unprepared for so many problems, big and small. Whether it was how to ensure that thousands of TB patients scattered around the city—many of whom were homeless, drug-addicted, or had multiple concurrent medical and social maladies—took their medications reliably for months on end so that they would be adequately treated and in order to prevent further development of drug resistant strains… or how, after a young boy had been bitten by a possibly rapid raccoon, to transport the raccoon’s brain up to the only rabies testing lab which was up in Albany when the only employees  authorized to transport biological materials were out on strike.

Nothing in my medical school curriculum prepared me with the answers.  But we found them: For TB, we  sent  healthcare workers into homes and under bridges or wherever needed, to make sure that patients took their medicine until cured; and for the raccoon brain,  an igloo cooler, a car service, and a willingness to skirt a few rules did the job…and possibly saved a boy’s life.
 
My experience as health commissioner was perhaps the best preparation for my job at the FDA. I entered this role in the midst of similar challenging circumstances. Economic uncertainty, budget constraints, mistrust in regulation, and concern about the future of health care overall. 
 
 But to be honest, when I agreed to lead this enormous agency, I did not fully appreciate the scope of the job. As you may or may not know, the FDA regulates drugs, medical devices, vaccines and biologics, the safety of our nation’s food supply, blood supply, cosmetics, dietary supplements, and most recently tobacco.  FDA regulated products account for over 20-cents of every dollar that consumers spend on products, and they represent things that people really care about—often in life-saving ways.

As an agency, we have to make hard decisions every day – and almost every decision leaves many people unhappy.  But as I have learned, especially in the face of complex scientific and sociopolitical challenges, the only way for the FDA to stay on course is to be open, responsive and accountable; have a clear and consistent framework for decision making; weigh risks and benefits carefully; and – above all – ground our decisions in the best-available science.

No matter what you do, I think this is good advice for all.

As future doctors, scientists, and public health officials – much will be expected of you.  I urge you to recognize that with your training – and your new titles – comes a broader responsibility.

The poet 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 imperative to advance human health for all.
 
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 clinical 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. 

Be willing to work across disciplines, across sectors, across borders.  Be willing to work with all those who have a stake in what you are doing or a perspective to offer.  I know that this philosophy of productive collaboration is embedded in Stanford’s  education,  research and patient care mission.  I hope that you have embraced it and that you will live it in earnest.  And why?   Because the complexity and urgency of the problems before us demands it.

AIDS is now a chronic, manageable disease—not a life-sentence – because the entire system worked together…from patients and their loved ones who advocated for their needs, to 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 academic, government and private labs who made crucial discoveries about the nature of the disease and how to treat it.

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 only a hope when I began medical school.  Huge progress has been made.  But there is so much more to be done.
 
So never stop learning; never stop asking questions; and never forget that medicine is an art as well as a science practiced by doctors and researchers who bring to the bedside – and to the bench – not only technology and training, but also their humanity, caring, and concern.

Patients do not put their trust in machines or devices.  They put their trust in you.  You have already spent years studying, training, doing research and seeing patients.  And you likely have many more years of education before you.

But please remember that the more skilled you become, the more specialized you become, and the more dependent on technology you become – the easier it becomes to lose your humanity, forget your compassion, and ignore your instincts. 

I have one last piece of advice:  never, ever lose your moral compass. 

AIDS was a crucible event that changed my career path – and my life’s mission.  Watching AIDS destroy so many led me to public service where I have had the opportunity to treat not just individual patients, but whole neighborhoods, communities, and populations.

You came of age under the shadow of a different crucible of events:  9/11;  a bioterrorist attack; two wars; a flu pandemic; the worst recession since the 1930s; a widening gap between rich and poor; and the specter of everything from unsustainable growth in health care costs,  to a widening gap between rich and poor, an aging population, growing conflict in many parts of the world, newly emerging biological threats—both naturally occurring, and deliberately caused, global warming… and I’m afraid the list goes on.

I hope you will take advantage of these challenging times to strengthen your moral compass – by directing your energies and talents to doing good, not just doing well; that you will combine the knowledge and skills you’ve gained here at Stanford with the courage of your convictions….to be great doctors and scientists, to speak for those in need or underserved; to advance science in the service of humanity, and to make sure you hand the next generation of doctors and scientists an even more innovative, responsive, curative and preventive health care system than the one that was handed to you.

But all of that is about tomorrow.  Today is about you – your joy, your pride, your achievements, and your well-deserved celebration. I offer you all my best wishes for your success and happiness.
 
Congratulations Class of 2012 – and good luck.