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Welcome to the the Office of the President

Governor's School of Science and Mathematics

May 29, 2004

President Brockman, Trustees, faculty, other distinguished guests, graduates, family and friends, it is a great honor and privilege for me to be with you this morning. Although I am a relative newcomer to the Governor's School family, few other associations are as meaningful to me as my participation on the Board of this great school. I stand in awe of the talent manifest in this graduating class. If you had seen my SAT scores, you would understand the magnitude of my awe, but that is an entirely different story.

Now, as you might imagine, given my occupation, I have heard more than my fair share of commencement addresses. In fact, my experience with graduation speeches is extensive enough to have warranted a bit of informal research on the topic. After careful analysis, I have concluded that there is one and only one factor that separates the truly great talks from all of the rest – brevity! With that in mind, I promise you that if nothing else, my remarks will be brief.

First of all, I would like to dispel a common urban myth about graduation. Some members of this class probably are operating under the mistaken impression that this ceremony is about them. Sure, you get to wear the ridiculous looking robes and headgear. Sure, you get to go parties where you will probably wear equally ridiculous items of clothing. Sure, you will have endless digital pictures made of you and your family, in which your parents will be wearing items of clothing that were ridiculous even when they were in fashion.

Yes, all of these things may be true, but just remember: clothing does not make the man (or woman for that matter). What makes women and men, of course, is their parents. I'm not talking here about the literal act of making you – after all this is a PG-rated ceremony. Rather, I'm talking here about the figurative act of making you. It is a surprising, yet undeniable fact of life that the same people who you find frequently to be infuriating and embarrassing, are also the ones who got you here in the first place. They instilled in you the values, desires and determination to be a success at the Governor's School and beyond. Let's take a moment to show our collective appreciation to them.

So, now you are expecting me to say something truly meaningful. Have you ever considered just how difficult it is to say something truly meaningful when people are waiting for you to say something meaningful? As a general rule, nothing discourages meaningful thought more than the expectation that it is about to occur. To the best of my knowledge, few earth-shattering insights ever have been made during commencement addresses. A rational listener, therefore, may choose to lower her or his expectation level for the next several minutes.

So, now that we are in the proper frame of mind, let me get right to the point. I would like to take a few minutes to talk about death. I'll bet you didn't see that coming! In fact, most of us never see death coming, and for that reason, we don't spend a lot of time thinking about it. Those who do give the topic some thought probably do not do so while waiting to be handed a diploma. Unless, of course, they are petrified that they are going to trip on stage and die of embarrassment. Don't worry; to my knowledge there are very few recorded fatalities that occurred during the actual process of receiving a diploma.

One of the reasons that most of us do not spend a lot of time thinking about death is that we don't have a lot of exposure to it. This was not true for the generations that preceded us, however. Just a century ago, for example, being born and giving birth were pretty risky events. In 1900, about one in every seven children died during the first year of life. Today, infants in the United States are almost 25 times more likely to survive their first year. Similarly, in 1900, women had almost a one percent chance of dying during a pregnancy or delivery. Today, the risk of maternal death is about a hundred times lower.

These improvements in health were rapid and dramatic, and without any prior precedent. Much of this recent progress can be attributed to advances in the science of medicine, such as the introduction of radiographic imaging, antibiotics, and vaccines. No doubt, you are aware of the many achievements of modern medicine. Still, it is useful to be reminded of the distance that we have traveled since your great grandparents were born. In just a handful of generations, the textbooks of medicine have been rewritten many times. In order to illustrate this point, let me cite some of the recommendations made in a vintage medical text, Charles West's Diseases of Infancy and Childhood. In his day, Dr. West was one of the most preeminent pediatricians in the world, serving as a physician at the Hospital for Sick Children in London.

My copy of West's textbook was published in the late nineteenth century. It is not the most current of my medical books, but it is one of the more interesting texts. In the second chapter, the author mentions several specific medications for the treatment of illness in children. These recommended therapies included mercury and antimony as anti-inflammatory agents, and opium as a sedative. Surely you recognize, even without the benefit of attending medical school (yet!), that mercury, antimony, and opium are not what we might describe as first-line pharmaceuticals today.

Whatever benefit might have attended the use of these drugs, the potential harm was at least as great. Antimony is known today to be toxic to the heart, and mercury can cause damage to the brain and kidneys. Opium is a highly addictive narcotic agent – hardly the first thing that a contemporary pediatrician would reach for in her black bag – if doctors still carried black bags.

One does not have to trace back to the dusty history of the nineteenth century to see how quickly medical knowledge becomes obsolete. I graduated from medical school in 1979. While that may seem like ancient history to some of you, humor me here for a moment. In the 25 years since I took the Hippocratic oath, medicine has taken more than a few steps forward.

To give you some sense of the magnitude of changes, consider the leading cause of death in the United States - coronary artery disease. When I graduated from medical school, the mortality from this disease was 345 deaths for every 100,000 Americans. Twenty years later, this death rate had been cut almost in half.

Examples of innovations in care for patients with heart disease include: the use of low dose aspirin to prevent clot formation in the coronary arteries and the discovery of statin drugs to lower cholesterol levels and prevent blockages from occurring. New imaging techniques have been developed to diagnose blocked arteries noninvasively, and clot-busting drugs were introduced to clear obstructions once they occurred. The field of invasive cardiology has burgeoned with the advent of balloon angioplasty, and arterial stents to restore blood flow in patients with blocked arteries, and the development of implantable defibrillators to treat arrhythmias.

Many other treatment advances could be cited, but I think that you get my point. Primed by an annual investment of over $50 billion a year, medical science in this country is moving at an incredible pace. Each month, 60,000 new citations are added to the medical literature. Think about this information explosion for a minute - if a physician reads five papers each and every working day over a 30-year career, she would only cover the articles published in two and a half weeks. In other words, every two weeks a career's worth of information is published in medical periodicals. It is beyond human capacity to keep pace with discoveries that are moving at the speed of light. Actually, with fiber optics and the digital revolution, it is hardly an exaggeration to say that medical information is moving at the speed of light.

Into this most exciting era in the history of medicine, some of you will be headed soon, as researchers or clinicians. Of course, I realize that not all of you will want to pursue careers in medical science or practice. There are many other equally rewarding career pathways available to you. Some of you are destined for work in mathematics, or engineering, or architecture, or the physical, social or biological sciences. Some of you may not even end up in the sciences at all, applying your quantitative skills to finance or commerce.

Still, I must confess to a bit of occupational prejudice, here, so please indulge me a little. It is my firm hope that many of you - clearly the best and brightest of your generation, will pursue careers in medicine. As the frontiers of genomics and proteomics and bioinformatics, to name just a few, unfold before our eyes, we need your creativity and intellect and energy. In your lifetime, you will witness medical advances far greater than those that I have seen during my life's work. You will not just witness this progress - you will drive it.

Those of us who gather here to salute you today will be the direct beneficiaries of your contributions to science and health care. We have a vested interest in your success and we have great expectations about what you will accomplish during your careers. It is, therefore, with abundant hope that we beseech the Lord to bless you and keep you as you go out into the world on this most glorious day. Congratulations and best wishes to all of the graduates!