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CLASS OF 1976 SYMPOSIUM Class Navigates a Sea Change in MedicineAlumni were treated to an unvarnished account of their four years at HMS at the Class of 1976 Symposium. "We came. We sat. We listened. We were tested. We passed," said Maria Savoia, HMS '76 and professor of medicine, University of California, San Diego School of Medicine. "We went to the wards. We saw patients. We turned in reports. We matched. We left."
"Twenty-five years ago could we have predicted where we are today?" asks Deborah German. "My answer is no." Photo by Graham Ramsay The lives of many graduates have become more exciting, and even turbulent, in the intervening 25 years, judging by the majority of presentations at the symposium, which took place on June 7. Casting but a brief look at their shared past, speakers launched into up-to-the-minute reports from a wide variety of medical fronts. There was a sense of urgency as they described how unprecedented changes in technology are transforming their profession. From classroom to clinic, the world of medicine has become a much more complex, challenging, and chaotic place than it was when they received their medical diplomas. Anatomy of Revolution"Many people who come back for their 25th reunion could say there has been a revolution in medicine," said opening moderator Joseph Bonventre, the Robert Ebert professor of medicine at HMS. As the first set of speakers made clear, new technology, and especially the methods of molecular biology, have redefined the nature of disease and treatment. "Cancer therapy is being guided more and more by the genetics of the cancer cell," said Ilan Kirsch, chair of the genetics department at the National Cancer Institute.Other areas of research like xenotransplantation are benefiting from the molecular revolution. Hugh Auchincloss, professor of surgery at HMS, described how cells from genetically modified animals are being transplanted into humans with diabetes, stroke, and Parkinson's in early clinical trials. Transplanting whole organs has been less successful so far due to problems with rejection, he said. The explosion in molecular biology is leading to new therapies for patients but also new challenges for medical students and physicians, said Phyllis Gardner, senior associate dean for education and student affairs at Stanford University School of Medicine. "We're facing a tsunami of information and it's all come about because of the digital revolution," she said. To stem the tide, new digitally based learning tools are being developed that integrate information. Simulation-based computer programs are teaching skills such as interviewing patients, introducing a catheter, and preparing for surgery. Medical costs are also being cut with the aid of computers, said Deborah German, senior associate dean of medical education at Vanderbilt University School of Medicine. She described a computer-based drug ordering program implemented at her school that shows how much a particular drug costs and what other drugs are available. The program saved her hospital $6 million. Yet technology and, in particular, the use of computers to monitor physician productivity, is making life more difficult for many physicians, added Hope Druckman, a physician at Virginia Mason Medical Center in Seattle. "I must say that most days I feel like Lucy in the chocolate factory," she said, referring to a classic episode of the TV show "I Love Lucy" in which chaos erupts as Lucy and Ethel try to decorate bits of candy whizzing by on a conveyor belt. "We're doing 17.5-minute visits with our patients, but instead of 20 visits like we used to do, we're doing 30," she said. "I think we're really in a crisis in primary care." The Politics of IllnessTaking a more global view, David Cohen, a former director in the NIH's Office of AIDS Research, described how the AIDS crisis is threatening the balance of world health. "Twenty-two million individuals have died from the HIV virus so far," he said. Most of these deaths occurred in sub-Saharan Africa and south and southeast Asia. He called on the government to take a greater leadership role in developing a vaccine against the scourge as they did in the 1950s to control polio.The AIDS problem is just one of many threats to world health, and by implication, the health of this country, said Nils Daulaire, president and CEO of the Global Health Council. "We all now paddle in a single microbial sea," he said. The resurgence of TB and other infectious diseases affects not just our health but also our national security. Take southern Africa as an example. Fifty percent of all adults in the region could die of AIDS, he said, leaving a generation without adult supervision. Countries would be forced to recruit ever younger soldiers. "Imagine a continent with 40 million child soldiers," he said. Given current birth rates, 80 percent of the world's adults will have grown up in developing countries by 2050. Thirty percent of these will have been malnourished and could suffer from cognitive disabilities. Many people say that addressing problems such as these is a hopeless task, Daulaire continued. But, in fact, improvements in medical technology are making the task doable. "In addition, everybody here has a very important role to play," Daulaire said. "It's the fundamental reason we became physicians in the first place." —Misia Landau |
