Welcome to the the Office of the President

Getting Started

August 20, 2001

It is a delight for me to welcome all of you to campus today. As the newest students of the Medical University, you join an institution that traces its origins back to 1824. Of course, a great deal has happened over the past 175 years, both in the health sciences and at the Medical University. In fact, sitting here today, we may find it difficult to appreciate the distance traveled in that time. Let me try to put some perspective on the early years.

For those hoping to avoid ever sitting through another history lesson, let me remind you that you are now in Charleston. History is crumbling all around us here. Those of you living downtown no doubt will experience the pleasures of ancient plumbing. Moreover, the electrical wiring in some residences likely was installed by one of Thomas Edison's contemporaries. If we ever feel removed from the history of this place, the fresh aroma of horse droppings from the never-ending parade of carriage tours will bring us back to our senses. With that fragrant thought on our minds, let's travel back to the dawn of the Medical University.

When the first classes were offered here, Florence Nightingale was a four-year old girl in England. Another 30 years would pass before she would lead a team of nurses in their groundbreaking work of caring for wounded soldiers in the Crimean War. When the Medical University was founded in Charleston, Louis Pasteur was a two-year old toddler in France. Another 40 years would pass before he would develop the technique of heat killing microorganisms that would later bear his name.

A little closer to home, when medical education was initiated in Charleston, a nine-year old boy was growing up in a small rural town in northeastern Georgia. In 1842, at the age of 27, he would become the first person to administer ether as an anesthetic for surgery. This doctor's name was Crawford Long, and in that pre-managed care era of medicine, his fee was a grand total of $2.

Florence Nightingale, Louis Pasteur, and Crawford Long all grew up while medical education in South Carolina also was in its infancy. It is perhaps no coincidence that this institution was born at a time that would see great advances in the science and practice of medicine. Now is not the time for me to deliver a lengthy treatise on the history of this institution. On the other hand, as you are now joining the Medical University family, it seems appropriate for you to know about those who preceded you here.

A medical school was created in Charleston by the Medical Society of South Carolina, a group of private medical practitioners, who named it the Medical College of South Carolina. This first medical school in the South was only the fourteenth in the United States.

The initial faculty totaled seven individuals and 23 students enrolled in the newly created school. From the outset, the financing of the school was tenuous. The initial budget was cobbled together from a variety of sources. The state contributed $10,000 to help establish the school. The City of Charleston anted up $15,000 to compensate the faculty for providing medical care in the local hospitals. The remaining $11,000 was contributed by the faculty members themselves. If the support of the faculty seems surprising, consider the fact that today the faculty and staff members contribute over $200,000 per year to the University. Some things just do not change!

After six years of operation, the school was $7,000 in debt. Again, this sounds painfully familiar, as the University has struggled through some difficult times financially in recent years. The state legislature covered this debt, but did not provide any on-going subsidy to the school.

Finances were not the only challenge for the young school. Within a decade, the faculty wanted to become more independent of the Medical Society that continued to govern it. When the Medical Society resisted this change, the faculty went out on their own and created a separate school. Although the Medical Society attempted to reconstitute its school with a new faculty, ultimately they failed as competitors. Within a few years, the two schools merged, with governance separated from the Medical Society. Interestingly enough, to this day physicians in private practice and faculty physicians have a competitive spirit.

I could talk a great deal more on this topic, but I have digressed from my historical account. Let's return briefly to the history of the Medical University. There are certain events about which you should be aware, if not in the actual dates of occurrence, at least in their temporal sequence. Pharmacy was the second college added to this institution, beginning operation in 1882. A year later, the Nursing School opened.

The institution as a whole was in a pretty sorry state of affairs at the turn of the twentieth century. This condition was well documented by Abraham Flexner on behalf of the Carnegie Foundation in a famous study of medical education. Flexner visited all of the 167 medical schools then operating in the United States and Canada, reviewing each of them. He concluded that not only did too many schools exist, but more importantly, the quality of most of the schools was deemed substandard. Unfortunately, our school was no exception. In his report, Flexner noted that we had "very meager" equipment, no library "except for antiquated publications" and no full-time faculty members. Flexner's assessment was substantiated by the "C" rating assigned to us in the first survey of medical schools for accreditation in 1910.

The silver lining in the clouds of these critical reports was the attention focused on the need to improve medical education in this state. These enhancements required resources beyond those that could be raised through student tuition. The State of South Carolina assumed responsibility for the school in 1913 and almost immediately the accreditation rating was moved up a notch. The following year, the school moved to its present campus location. The façade of the first building on this site is the front of the Hollings Cancer Center, just around the corner from here.

Jumping forward in our time travel, the creation of a dental school was approved by the General Assembly in 1953, although the first class was not admitted until 1967. The College of Graduate Studies was founded officially in 1965. The following year, the Allied Health School, today known as the College of Health Professions, was created.

Fortunately, the long history of this university is not defined entirely by feuds between doctors, financial woes and accreditation problems. While we are well served to know the weak limbs on our collective family tree, we also should be aware of the strong branches. One of the early deans, James Moultrie, was a founding member of the American Medical Association in 1847. Three years later he became its President. Interestingly enough, a few months ago, a graduate of this institution, Dr. Randolph Smoak, completed his term as the 155th president of the AMA. As mentioned earlier, some things just do not change.

Returning to the 19th century, this institution was shut down between 1861 and 1865 because of the Civil War or as it is politely referred to in Charleston, "The Recent Unpleasantness." In dealing with the casualties of that conflict, the faculty made important medical contributions. Surgeon Julian John Chisholm invented the chloroform inhaler for anesthesia. When the Union government declared medical and surgical supplies as contraband of war, these materials came into short supply in the South. Faculty member Dr. Frances Peyre Porcher published a treatise in 1863 on local botanicals that could be used as substitutes for traditional medicines. Surgeon and Dean Robert Kinloch was the first to perform successful intra-abdominal surgery for a gunshot wound to the intestine.

A few decades later surgeon and Dean Francis Parker was the first to suture a severed nerve and restore function. In 1936, Dean Kenneth Lynch along with colleague William Smith linked asbestosis with cancer. In 1947, surgeon Horace Smithy conducted pioneering work on heart valve surgery. Albert Sabin, the developer of the oral vaccine against poliomyelitis, served on this faculty between 1974 and 1982.

So, as we can see, a fair amount has happened on this campus before either you or I set foot on it. From the historical perspective of this university, it is easy to conclude that your presence here as a student is little more than a footnote. If it makes you feel any better, sometimes I feel that way about my own contributions as president. Before you settle into easy anonymity, however, let me assure you that no event in this long history is more important than your arrival today.

Now, it may seem presumptuous for me to make such a grandiose statement about your matriculation. You may even think that my remark is a pathetic attempt to pander to your vanity. Please be assured, however, that I am not here to stroke your collective egos. Rather, my goal is to help you appreciate the expectations that will be placed upon you.

Admittedly, it may seem premature to speak of such expectations. After all, you have just arrived on campus, and in all likelihood, you are feeling a bit overwhelmed at the moment. You may not even know yet where your classes are meeting or what your schedule will be for the coming semester. No doubt, it seems all too soon to be talking about courses; instead we may need to focus on the basics of survival.

I can fully appreciate these feelings. Twenty-five years ago almost to the day, I arrived at medical school feeling equally overwhelmed. Although a quarter of a century may sound to you like a very long time ago, for me, it has passed all too quickly. Indeed, it is a sobering reality to me that most of you were not alive when I matriculated into medical school. Rarely do I feel like an old-timer, but today may be an exception to that rule. Hopefully, you will forgive me if the shadows of nostalgia fall too heavily upon the following observations.

The focus of my attention as president is on the present and the future. That is why I attach so much significance to your arrival today. After all, you are the future of the health professions in South Carolina and beyond. Our task at the Medical University is to prepare you not only for your immediate role as a student, but also for your ultimate role as a caregiver, a researcher, or an educator. While we orient you today as a learner, simultaneously we are beginning the process of assimilating you into your new profession.

In so doing, the best place to begin is to reflect upon the health of the population that we serve. A popular belief exists that American health care is the best in the world. In a certain sense, that is probably true. No other country in recent history has had as profound an impact as has the United States on biomedical science or clinical progress. Whether one measures that impact through publications, patents, medications, devices, facilities, or any similar indicator, Americans have been the leaders in discovery, innovation and invention. In this country, we go to extraordinary means to save a life, as demonstrated by such heroic efforts as organ transplantation.

It may surprise you, therefore, that the United States does not lead the world in indicators of the health of its people. For example, the World Health Organization ranks the United States 24th in life expectancy, a category in which we trail Malta, and barely outperform such powerhouses as Cyprus and Dominica. Similarly, despite all of the progress in managing high risk pregnancies and the intensive care of newborns, the United States ranks 15th in infant mortality. If for some reason you think that the death in the first year of life is not a representative measure, consider the probability of death for adults between the ages of 15 and 59. In this category, the United States ranks a disappointing 30th.

Another sad fact is that despite spending more per person on health care than any other country in the world, and despite leadership in medical innovation, the United States is far from the healthiest country in the world.

Should you think that South Carolina is somehow an exception to this rule, unfortunately, that is not the case. This state has the 5th highest death rate in the U. S. from heart disease, the most common cause of death. We have the highest death rate from stroke, the third most common cause of death. For many forms of cancer, such as malignancies of the prostate, pancreas, esophagus, oral cavity and cervix, we rank among the highest five rates of death.

As these statistics clearly demonstrate, the challenges facing the health care system are great. Those of you who are preparing for a career in the delivery of health services will be on the front lines of many of these concerns. Others of you will pursue careers in research, teaching or administration - a step removed from the clinical arena. Regardless of your professional pursuits, however, each of you will have something to contribute toward addressing these health challenges. In a real sense, that process begins today.

Surely, nobody could fault you if your current thoughts are much more focused on merely surviving the next few days than on the challenges that you will face years down the road. As the saying goes, "first things first." The rigors of your academic program soon will be upon you. In short order, you will find yourself confronted with more information than you or quite frankly any other human being, can possibly assimilate. Under these circumstances, for perhaps the first time in your life, you are likely to feel inadequate to the task.

Such feelings are quite normal – virtually everybody who has preceded you, myself included, has experienced them. By our very natures, those of us who enter into health professional schools are competitive people. We are accustomed to being at the top of the class and we will not be pleased with anything less.

As you well know, the pathway to academic success begins with intellectual ability. Everyone in this room has been blessed with a keen intellect. Talent alone has not gotten you here, however. You have demonstrated through your hard work that you can apply your abilities with enthusiasm and with purpose. Your achievements to date have convinced us that you are capable of success in this environment as well.

Still, in all likelihood a time will come when you question our judgment, or your own abilities, or the depth of your commitment, or all three. When that day arrives, and for some of you it may be soon, I hope that you will remember the following advice. A big difference exists between feeling inadequate and actually being inadequate. Feelings of inadequacy arise when our performance falls short of our own expectations, or what we presume to be the expectations of others.

The emotions of such situations often prevent us from rationally examining the assumptions under which we operate. My caution to you, therefore, is to try to evaluate if your expectations are reasonable. The assumptions that served you well in your previous academic pursuits may not be valid here. In college courses, for example, you may have been able to commit virtually all of the assigned material to memory. Except for those of you with photographic memories, it will be virtually impossible to recall all of the material to which you will be exposed here.

Even if you could cram your cerebral cortex full of all that information, stuffing your gray matter is not the goal to which you should aspire. Effective health care professionals are not necessarily those who can retain the largest number of bytes of data. While random access memory may be critical in the world of computers, it does not have the same intrinsic value for human beings.

Instead, we hope that you will develop the skills to locate the relevant information, evaluate it, integrate it, and apply it. These are the ingredients of effective problem solving, and they are far more important than any particular set of facts. As new discoveries are made, what you are taught today as factual information is likely to evolve anyway. Believe it or not, when I attended medical school, just a quarter century ago, the human immunodeficiency virus had not been discovered. I was taught that diet and stress caused peptic ulcers, but today we know that most of these ulcers result from infection with a bacterium, Helicobacter pylori. When I trained in pediatrics, the leading cause of bacterial meningitis in children under age 5 years of age was Haemophilus influenzae - a bacterium that is now virtually eliminated among American children through the introduction of an effective vaccine.

I could go on at length about the advances in medical diagnosis and treatment that have occurred since I graduated. Again, perhaps I am dating myself here as some sort of relic. My point, however, is that the knowledge base that I acquired in school, although current at the time, rapidly became outdated. If anything, the pace of scientific discovery has accelerated since then. As a result, the shelf life of facts that we present to you over the next few years will be even shorter than that for the facts that I was taught. This is not an excuse to avoid learning the facts, just a caution not to worship them with undue reverence.

Far more important is your ability to reason through complex problems. Our goal is to help provide you with the skills necessary to solve these problems. In order to do so, you will need to be able to characterize the problems, collect relevant information, interpret the information that you have collected, and then act accordingly. Whether your ultimate career pathway takes you into clinical care, teaching, research, administrative work, or some combination thereof, you will need to call upon problem-solving skills.

It is worth taking just a moment to reflect upon why you would be interested in these skills in the first place. Undeniably, each of you has personal reasons for wanting to enter the health professions. For some, you may be continuing a family legacy. For others, the imperative of serving your fellow citizens is the motivation. For still others, the thrill of helping to advance knowledge, either through teaching or research drives you. I suspect some of you even found your way here in the pursuit of financial rewards. Regardless of the reasons behind your original decision, my task is to assure that your education here begins with the proper motivation.

It is tempting to think that you are here for yourself. After all, it is only through years of study and commitment that you have met the standards of admission into this University. At times, being a student here may seem like a lonely pursuit. Whether studying by yourself in the library or working alone in a laboratory, you may find greater focus in solitude. As you pursue these efforts, however, you should not lose sight of the fact that you are part of a much larger enterprise. I am not just referring here to the rest of the students in your class. I am not even limiting my reference to the students in your school, or even to all of the students on this campus. As of today, you are now part of the Medical University of South Carolina. You join almost 2,500 students, over 500 residents, more than 1,200 faculty members, and over 7,000 support staff. We value team effort and we applaud efforts that draw upon the knowledge and skills of all of our team members.

No doubt, an institution this large feels impersonal at times. One cannot possibly know everybody who studies and works here on a first-name basis. You may be tempted to assume, therefore, that you are just another face in the crowd. Let me assure you that you were hand-selected to join us. We feel privileged to have you here and we will do everything that we can to promote your success. For it is through your success that we will achieve our ultimate purpose, which is "to preserve and optimize human life in South Carolina and beyond."

As we strive to improve the health and well being of the citizens of our State, you are the agents of change. You will advance medical knowledge, educate the public, deliver care, and develop policy. Through your efforts, access to basic care will be made universal, regardless of financial means. You will work to remove disparities in health, along racial, ethnic and geographic boundaries. You will advocate for the needs of our citizens and become the voice for those who cannot be heard themselves. You will work to make our communities healthier and safer. You will translate new knowledge into clinical application for the benefit of our fellow citizens. You will lead the biotechnology revolution of our state and lay the groundwork for the industry of the 21st century. You will lead us into the future of the health professions.

As you can see, we have high expectations of you - let's get started.