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CLASS SYMPOSIUM New Hope, Some Hype Since Med SchoolIn vitro fertilization was barely a blip on the horizon that summer day in 1977 when members of the HMS class stood in line to graduate. Twenty-five years later, in vitro fertilization and other assisted reproductive technologies have wrought a series of profound changes that are transforming the medical landscape.
Roger Steinert discusses the pros and cons of laser eye surgery. "LASIK offers freedom from optical prostheses, but we can do better by reducing aberrations," he said. (Photo by Graham Ramsay) Cloning and stem cells were just a few of the hot topics on the agenda at the HMS Class of 1977 symposium, which was held on June 6. Bioterrorism, the pros and cons of LASIK surgery, and more philosophical issues such as the limitations of medical technology were discussed. One of the themes to emerge was that things are not quite what you hear in the news. Stem Cell Promise"It has been an interesting ride for me to see stem cells become a topic of political and ethical interest," said Janis Abramowitz, professor of medicine at the University of Washington, Seattle. While enthusiastic about the promise of stem cell research, she said that some claims--for example, that stem cells drawn from blood have the ability to give rise to other tissues--have not held up. "That has led to a lot of excitement and to a lot of hype," she said. The claim is simply "not ready for prime-time television."She also described the hidden side of cloning. Yet her concerns--that cloned cells inherit the mitochondrial DNA and shortened telomeres of the mother and that the procedure is still inefficient--were counterbalanced by a sobering fact. "Technically, cloning is very easy," she said. "That's why it is potentially ethically very scary." Robert Barbieri, the Kate Macy Ladd professor and head of the Department of Obstetrics, Gynecology and Reproductive Biology at HMS and Brigham and Women's Hospital, said: "There is absolute opposition among the reproductive community to human cloning." Though not opposed to cloning for the sake of treating disease, he described how even older methods such as IVF, aided by newer techniques such as preimplantation genetic testing and cryopreservation, are being redirected to focus more on helping people with hereditary diseases and cancer. Eye Surgery PrimerWhile such advances build on a nearly 25-year-old technology, precursors to vision-enhancing techniques such as retinal implants and LASIK did not even exist then, said Roger Steinert, HMS clinical professor of ophthalmology. A LASIK patient himself, he discussed the pros and cons of laser eye surgery. "Many patients, even those relatively happy with LASIK, have some higher order aberrations," he said. He described recent attempts using wavefront technology to diminish side effects such as nighttime blur, haloes, and glare. Even so, there will be limits on who will benefit. "There is a common myth out there that we can take anyone and improve their vision," he said. "Don't get fooled by that."The past 25 years have been marked by the growth of new medical threats as well as technologies, said Robert Taylor, director of the Health Awareness Connection in Brookline. "I went into the area of sexually transmitted diseases because I thought that people tend to live with STDs," he said. "Little did I know that AIDS would arrive shortly after." After spending the first part of his career treating patients, Taylor underwent a transformation in 1995 when he discovered his love of teaching. He now spends his days teaching high school students about the risks of STDs. "My work isn't glamorous," he said. "But it's very, very rewarding to me." Another in-the-trenches perspective was provided by David Bell, of the Centers for Disease Control and Prevention (who also spoke at the Alumni Symposium). He was visiting Senator Ted Kennedy's office, which is in the same building as Senator Tom Daschle's office, when the infamous anthrax-laden letter was opened. "It's really quite sobering being on the receiving end of something like this," he said. The upside was that within 45 minutes, the ventilation in the building was shut down and emergency measures were put into effect. He also described how measures developed by his team at the CDC were delivered within seven hours to Manhattan on Sept. 11. "Preparedness training worked when it was given," he said. "We can get ahead of this problem, but we do have a lot of work to do." Stopping the threat of bioterrorism will require more than know-how and technological preparedness, said Ron Heifetz, founding director of the center for public leadership at the John F. Kennedy School of Government at Harvard University. It requires that Americans adopt a broader cultural perspective. "The classic problem in so many areas, including medicine, is we treat adaptive challenges as if they were technical problems," he said. "We're like Microsoft. We think everyone abroad ought to behave according to our operating system." Heifetz applied his message--that adaptive change occurs by helping others to find their own solutions--to the everyday situation of doctors advising patients. "When people face adaptive change, when they are asked to adopt new ways, they face a host of problems," he said. "You can't put them to sleep and solve the problem for them. They need to make the change." --Misia Landau |
