Dr. Elizabeth G. Nabel delivered the Commencement Address to the Albert Einstein College of Medicine of Yeshiva University on June 2, 2009

Dr. Nabel - July 17, 2009

Dr. Elizabeth Nabel delivered the Commencement Address to the Albert Einstein College of Medicine of Yeshiva University on June 2 2009

Dr. Elizabeth Nabel delivers the commencement address to the Albert Einstein College of Medicine of Yeshiva University on Jun. 2, 2009.

“People First”

President Joel, Dean Spiegel, members of the faculty, Board of Trustees, alumni, distinguished guests, parents, and friends:

It is with great honor and pride that I join with you today in this distinguished venue, to celebrate the achievements of the Class of 2009 of the Albert Einstein College of Medicine of Yeshiva University. It is especially meaningful for me to be here in Avery Fisher Hall because I sat just where you are sitting 28 years ago at my own medical school graduation from Cornell, right here in Lincoln Center.

To the new physicians and researchers of the Class of 2009, we offer our most sincere congratulations!

Today, I want to also acknowledge another special group of people. They are the 50 physicians from the Class of 1959—the very first graduates of this medical school. In fact, I am so pleased to say that I know one of them--our earlier speaker, Dr. Lou Aledort. We met back in 1979 while I was doing a hemophilia project at Cornell with his colleague Dr. Margaret Hilgartner. Dr. Aledort is a renowned hemophilia researcher and strong advocate for patient care. You are lucky to have him in the Einstein family. [Story of Margaret Hilgartner – role model and clinical researcher].

Many other members of the Class of ‘59 are here with us today on the occasion of the medical school’s 50th anniversary. So please join me in giving them a round of applause and genuine thanks for sharing in this day with us!

Today, we celebrate 250 new graduate degrees. You are 181 new M.D.s, 59 new Ph.D.s—14 who earned both—and 10 new Clinical Research master’s degree recipients. All told, that’s over 1,000 years’ worth of work!

Each one of you has worked extremely hard to reach this day. Bask in the sunshine of your achievements and the warmth of the friendships you have developed on this journey.

Class of 2009--you and your families have made many sacrifices to get to this special time and place. They are so proud of what you have accomplished and see your future success on the horizon. Please join me in thanking these important people!

Some of you are the first in your families to attend college, and many are the first to go to medical school. Some of you also have full-time jobs as parents or caregivers—you have learned first-hand the real-world definition of multitasking. The challenges you all have faced have been far and wide, and your paths have all been different.

But today, our cause for celebration is not your differences but your commonality, the one thing you all share. You have all pledged to serve humankind through promoting good health.

Class of 2009--think of yourselves 10, 20, 50 years from now. At that time, you will cherish many special memories from this landmark period of your life. Relaxing with some good eats at the “real” Bronx Little Italy right here in this neighborhood, not the Arthur Avenue Little Italy impostor … Trading war stories at Gleason’s [bar] … Cheering for the Yankees, or the Mets, or the Giants, or the Jets, or any other of the many sports teams in this town. Or uncoiling the tension of a difficult week amid the tranquility and splendor of the New York Botanical Garden.

Some of you have met your life partners during your training: I can relate, because I met my husband Gary when I was a resident—he was just an intern at the time. Our first date was over a bet: about a patient diagnosis.

Albert Einstein College of Medicine has a proud tradition of blending clinical care and research, and a culture that maintains such a strong humanitarian ethos. Since the very beginning, Einstein has been open to students of all backgrounds—this was the condition imposed by your namesake, the brilliant physicist and compassionate humanitarian.

Yours is a richly diverse group of individuals, drawn from 16 states across the nation. One in five of you was born outside the United States, from Colombia to Japan to Trinidad & Tobago, and just about everywhere in between. Over half of you speak one of 23 different foreign languages!

And fifty-seven percent of you are female. We are so fortunate to have in our audience today Dr. Evelyne Albrecht Schwaber, one of only three women in the first graduating class of 50 students.

Reading Dr. Schwaber’s remembrances for this 50th anniversary occasion, I am struck by what a pioneer your school was from the very start. Dr. Schwaber writes that during her medical school years:

“[Einstein’s] expectations for excellence and for humaneness, respect for one’s personhood, were entirely egalitarian.”

Sometimes today we all take for granted the remarkable gains our society has made toward gender, ethnic, and religious equality, but let us recognize the foresight your founders had in these matters. For that you should stand extremely proud.

Now, let us look forward: What does your future hold? This is one of the most exciting times to be launching a medical career.

Look at what the revolution in science and technology has already given us. Sequencing the human genome is helping us unravel the genetics of heart disease, stroke, cancer, diabetes. It seems like each week new data gets us that much closer to the day when we can screen patients accurately for disease risk, and act early to prevent symptoms from ever surfacing.

Thanks to biotechnology and new understanding of the vastly complicated frontiers of the brain and immune system, we are closing in on treatments for neurodegenerative diseases that rob us of family and friends, and we are getting nearer to finding vaccines for HIV/AIDS, malaria, and TB.

You will begin your residencies next month, probably with equal doses of excitement and anxiety. Many of you will find it exhilarating but a little awkward to be called “doctor.” You will get on with life and all the responsibilities it brings. [Story of meeting my husband, Gary. Intern, resident, 25th anniversary].

What is the common thread to all the different roles your life as a doctor will introduce?

The answer, of course, is people, your patients. You have chosen a profession that is so much more than a job, or a career. It is a calling of the highest order. It is a commitment to keeping people first in everything you do. This is as true today as when Hippocrates penned his famous oath.

The person, your patient, is the center of all medicine. And due to the extraordinary research progress we have made—the dawn of personalized medicine is nearly here. It will be your commitment to find for your patient the right treatment, deliver it in the right setting, and at the right time.

Yes, some of personalized medicine will be about genomics and using customized biological therapies. But, really, the goal of personalized medicine is much more than that, for it is really about making good choices. Engaging your patients in their own care. Finding out what cultural factors will help a teenager stay healthy for a lifetime. It’s about understanding and listening to people first.

Your time at Einstein has readied you for this. Among this school’s pioneering educational initiatives is bringing first-year students into contact with patients and linking classroom study to case experiences. You have a faculty deeply committed to teaching the art of basic clinical skills—and it is an art--that requires patience, practice, and attention throughout your medical life.

Your commitment to being an advocate for your patients, to recognizing that what you do as a physician is a calling of the highest order, and to putting people first will be the keystone of your success as a doctor. And it will frame the opportunities and challenges that you will face during your career, many of which will extend far beyond the art and the science that you practice—wherever that may be.

Some of you will care for the very young, or for the very old. Hopefully, many of you will find a way to use all those foreign language skills to communicate with the rich diversity of patients that you will meet in the coming years!

Some of you will work tirelessly to bring health care to those who cannot afford it.

Some of you will choose careers that take you abroad—to work with communities very different from our own.

Some of you will make your mark doing research.

One of the most exciting programs I’ve had the chance to initiate as Director of the National Heart, Lung, and Blood Institute is our Global Health Initiative. We now are partnering with national research funding agencies in China, India, Australia, Canada, and the UK, to focus on prevention and treatment of chronic disease such as heart disease, stroke, diabetes, and chronic lung disease.

And next week we will be launching a partnership with the United Health Group, the largest health insurer in the US, to support 11 Centers of Excellence in research, training and health care delivery around the world – China, India, Bangladesh, Kenya, South Africa, Tanzania, Argentina, Peru, Guatemala, Tunisia, and the US Mexican border. I hope some of you will join us in these programs during your training.

That’s why I was delighted to hear about your colleague Mark Goldin, who journeyed to Beijing, China for a global health fellowship. There, he did genetic and epidemiological research on HIV infection at the Chinese Academy of Medical Sciences, at Peking Union Medical College.

During the only two months he was in China, Mark’s work contributed to learning about how the virus is spreading from high-risk groups to the general population. He also participated in a study looking at sequence data to assess the prevalence of HIV resistance to various anti-HIV treatment regimens.

I recently spent a week in China visiting with Chinese public health and research officials about collaborations, and I can tell you that partnerships like these are so important for our global community.

Einstein has a long and proud research history and all of you have been amid this environment of discovery throughout your time here. I encourage you to keep learning—during your residencies and throughout your medical career. It is vital that you learn the basic principles of translational and clinical research—and that is why your schooling here has been special.

Louis Pasteur’s famous words really are true: “Chance favors the prepared mind.” You need to be ready for what comes at you, so prepare yourselves to embrace new opportunities that will come your way, often unexpectedly.

Today, as director of the National Heart, Lung, and Blood Institute, I am so lucky to be immersed in the world of research every day. Science is a true passion for me. But in this role I also have the pleasure of helping people by leading several public awareness campaigns that reach millions of Americans.

One of these targets women and heart disease; it is called the Heart Truth. Heart disease is the number-one killer of women in this country, and we created the Red Dress as a symbol of heart disease and women.

My interest--my passion for this, really--comes directly from the lessons that I learned from one of my patients at the University of Michigan. Let me introduce you to this woman that shaped my career.

“Anne” developed diabetes in 1952, when she was only 7 years old. Insulin was available only on an experimental basis then, but Anne’s loving and determined mother, who was a nurse, brought her to the Joslin Clinic in Boston, where she could receive state-of-the-art treatment.

Over the years, Anne was able to take meticulous care of her diabetes, largely through the extraordinary devotion and support of her mother. I met Anne in 1990 when she came to the hospital with a second-life threatening illness--heart disease. Anne’s father and brother had both died of heart attacks in their late 40s, and Anne had a heart attack herself at age 45, undoubtedly due to a genetic factor. We performed an angioplasty, she survived, but she went on to ultimately require bypass surgery.

As I got to know Anne and her mother, I learned many lessons. Yes, heart disease can strike a woman at any age. And we need to get that message out. But also, I was inspired by the confidence of Anne and her mother that they could meet this challenge--or any other challenge--head on and overcome it.

And Anne has. She is now 64, having lived 57 years with type 1 diabetes and 17 years post by-pass heart surgery. She is doing extremely well. Her belief that she was equal to any challenge taught me a profound lesson that I never would have learned in any class.

The commitment you are making by becoming a doctor, a scientist, or both, is not just about upholding ethical standards for treating individual people like the Annes of this world, but also about your promise to make ours a society in which the very best of medical science is used in the service of all of humankind.

The value of the basic research that fuels medical progress cannot be underestimated. One of your colleagues receiving a Ph.D. today is a terrific example. Abraham Guerrero worked in the lab of faculty member Dr. Bettina Fries, studying the pathogenesis of Cryptococcus neoformans, a threat to immunocompromised people.

I learned that Abraham is the first in his family to complete a higher education degree, and that he has dedicated his thesis to all his teachers and mentors. He is already giving back, sharing his love of science with middle schoolers in the Bronx and staying active in the recruitment of minorities to medicine and science.

Good luck, Abraham, as you continue your journey at the “Hutch” Cancer Center in Seattle!

It is vital that we continue to invest significantly in the medical research NIH supports here and at institutions across the nation. You will be part of this effort, whether your primary role is keeping abreast of the latest advances in genomics, imaging, clinical informatics, or many other cutting-edge areas, and applying them to the care of your patients; engaging your patients and colleagues in clinical investigations; or finding the thrill of discovery in the lab, like Abraham, Mark, and others, delving into fundamental research questions.

There are so many opportunities to bring people of all ages in your community into the research process.

In 2006, Einstein became the only medical institution in New York City, New York State, and the entire northeast to serve as a research site for the Hispanic Community Health Study, the largest research study of Hispanic health ever. Through this effort, Einstein researchers are helping us look at the prevalence and development of disease in Hispanics/Latinos, and find risk factors that we can use for disease prevention. This is incredibly important work.

Your school was also the only New York City institution selected to participate in my Institute’s landmark Women’s Health Initiative. The results of this research, while at times difficult to interpret and explain to the public, have made an enormous impact on women’s health.

It’s clear that Einstein knows how to put the people in its community first. I am so pleased to learn of the efforts going on here with respect to programs like the Einstein Community Health Outreach (ECHO) Free Clinic. It is so wonderful that programs like ECHO, begun only 10 years ago--and the first-ever student-coordinated community health clinic in the state--provides medical care, health education, and social services to the uninsured in the South Bronx and neighboring communities.

It is through these collaborative efforts that we need to listen to people, understand their needs, find out what is going to be effective--and practical--in our complex and diverse world. Nowhere does “one-size-fits-all” apply when it comes to modern patient care.

And we all recognize that our social neighborhood has grown so much. We are all part of a global community, and it will be your job to contribute in any way you can to advancing the health of the world’s most needy citizens. As a doctor, you are an ambassador for preserving the health of all people.

Once again, here at Einstein, many of you have already had these opportunities thanks to the school’s ongoing strong commitment to global health.

In reviewing materials for this speech, I came across some other moving stories from students, like Mark Goldin, who participated in your school’s Global Health Initiative. We should celebrate the spirit of these efforts that go right to the heart of what it means to be a physician.

I was also inspired by Monica Payares’ story. Before reaching the age of 10, Monica knew she wanted to be a doctor, having two younger brothers in full-length leg casts for long periods due to a rare disorder. In honor of her father, who succumbed to an aortic stenosis at age 44, Monica established la Fundación Juan José Payares Bustos—to help provide care in her native Colombia. Last year, she organized the foundation’s first health fair for the residents of Galerazamba, Colombia.

There, she gathered a team of physicians who provided free screenings, medical exams, and general health and nutrition education and she says, “Many people had never seen a doctor. One man, who hadn't been seen by any medical professional for 15 years, was overjoyed to put on a new pair of glasses. "His first request was to read the newspaper,” Monica says.

And your colleague Victoria Costales did several global health fellowships during her four years here—traveling to the Philippines, Honduras—and just this March, to Uganda. There, she worked with Einstein faculty member Dr. Gerald Paccione, in the program he has established in Kisoro. With the help of Einstein medical students, Dr. Paccione has developed an inexpensive yet efficient approach to identify women at risk for cervical cancer, the leading cancer killer among Ugandan women.

These initiatives—whether in the Liaoning Province, Galerazamba, Kisoro—or right here in the poor sections of the Bronx—show us the value of putting people, out patients, first. It serves as a reminder of what it means to do the job we have chosen to do, that is, to comfort and to heal.

Class of 2009, congratulations! From here on, we are relying on your smarts, your competence, your diligence, and above all, your compassion.

And we are also relying on your voice. Speak out to ensure that what you know, what you see, what you experience, cannot be ignored as our nation and our world debates what direction we will take. You are tomorrow’s leaders.

I am confident that keeping people first, your patients first, will always lead you to the right decisions, and you will live the life of integrity embodied in the Hippocratic Oath.

Congratulations, good luck, and Godspeed.

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