Medicine from the heart, as well as the head

Graduates hear a prayer for wisdom and humility, and a reminder to heed not only science, but also the spirit.

Sheltered under a tent to ward off a driving rain, 97 students received their medical degrees on Memorial Day and heard admonitions to retain their humanity, to find meaning in their lives and careers and to take comfort from lives of service.

Making their way through a sheltering gantlet of umbrellas, the Class of 2003 processed to the tent on Harkness Lawn where their families and friends waited. In his opening remarks, then-Dean David A. Kessler, M.D., told students to take pride in their accomplishment. “As you go beyond these walls,” he said, “you will increasingly recognize the degree to which you have been shaped by this place. Today you go forward to shape the future of American medicine. You are proof that this great experiment called the Yale System works and that you have been shaped by an incredible faculty.”

Joahd Toure, one of the graduates, offered an invocation of thanks and a call for humility. “Let us pray that success follows us from this place,” Toure said. “Let us pray for continued support from mentors, family and friends. Let us pray our education serves us well. Let us pray for knowledge to understand illness. And let us pray we remember that knowledge is not all that is needed to address the concerns of our future patients. Let us also pray for compassion, wisdom, patience, humility and grace.”

In her Commencement address, Rachel N. Remen, M.D., clinical professor of family and community medicine at the University of California, San Francisco, School of Medicine, continued with a similar theme. Medicine’s emphasis on intellect and science often disregards the instincts of the heart, she said. “It may cause us to believe that the perception of the heart is soft, unprofessional, even dangerous, that the heart will somehow mar our judgment and make us incompetent as medical people,” said Remen, author of Kitchen Table Wisdom: Stories That Heal and My Grandfather’s Blessings: Stories of Strength, Refuge, and Belonging. “It has taken me years to realize that being a human being is not unprofessional. … The heart is the strongest place from which to live a life, especially a physician’s life.”

This year’s Bohmfalk Prizes went to Sheldon M. Campbell, M.D., Ph.D., FW ’92, assistant professor of laboratory medicine, and Cyrus R. Kapadia, M.D., professor of medicine. Auguste H. Fortin VI, M.D., assistant clinical professor of medicine, received the Arnold P. Gold Foundation Humanism in Medicine Award. The Leah M. Lowenstein Award went to Susan M. Richman, M.D., assistant professor of obstetrics and gynecology. John S. Hughes, M.D., HS ’76, associate professor of medicine, received the Francis Gilman Blake Award, and the Betsy Winters House Staff Award went to Stephen M. Kavic, M.D.

—John Curtis

It takes “a posse” to protect the world’s health, former CDC director asserts

Jeffrey P. Koplan, M.D., M.P.H., says cowboys get a bad rap. In his youth he lived the cowboy life himself on a “quarter-acre spread in suburban Boston … A scene that stirred me repeatedly was the formation of a posse, setting off to apprehend the bad guy,” Koplan told the crowd gathered in Battell Chapel for the School of Public Health Commencement on May 26.

The world needs something like a posse to band together to solve public health crises, said Koplan, former director of the Centers for Disease Control and Prevention (CDC). In some circumstances, he acknowledged, “consensus is not possible. … But there are many more when restraint, dialogue, sensitivity and listening to others are called for. Not just for diplomatic show but to serve our national interests.

“There is a prevailing mind-set that we can reject a global warming treaty, be a nonsignatory to a land mine ban and seek to dilute a U.N. treaty [on tobacco control] … with no obvious penalties,” said Koplan, who is now vice president for academic health affairs at Emory University’s Woodruff Health Sciences Center and was elected in June to the Yale Corporation. The advent of severe acute respiratory syndrome, or SARS, makes clear “the value of having trusting and close working relationships with a wide variety of nations.”

Students graduating into the public health community form part of a posse “with a sacred mission to improve the health of people everywhere,” Koplan told the 121 men and women receiving master’s and doctoral degrees in public health.

Sahar Rooholamini and Andee Krasner gave the student address together. Krasner told their classmates “to seek justice as the prerequisite of health. It is our view that the greatest advantage of a Yale education is the platform it provides graduates to be able to amplify the voices of those who would otherwise not be heard.”

The students honored Kaveh Khoshnood, M.P.H. ’89, Ph.D. ’95, assistant professor of epidemiology, with the Award for Excellence in Teaching. The Dean’s Prize for an outstanding thesis was awarded to Jennifer Collins and Amelia Shaw. The Henry J. (Sam) Chauncey Jr. Inspiration Award went to Sarah George, and Gina Engler won The Cortlandt Van Rensselaer Creed Award.

—Cathy Shufro

NIAID director receives honorary degree

At Commencement ceremonies on Old Campus, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief of the Laboratory of Immunoregulation at the National Institutes of Health, was awarded an honorary doctor of medical sciences degree. Fauci has been at the forefront of efforts to understand and treat HIV infection.

For young physician-scientists, a mentor is no longer a single sage but a network

Unlike past generations, physicians now entering the world of academic medicine no longer seek a single mentor, said Edward J. Benz Jr., M.D., FW ’80, a former Yale faculty member who is president of the Dana-Farber Cancer Institute. Mentorship for young scientists, said Benz, a prominent hematologist, has undergone a paradigm shift.

Unlike past generations, physicians now entering the world of academic medicine no longer seek a single mentor, said Edward J. Benz Jr., M.D., FW ’80, a former Yale faculty member who is president of the Dana-Farber Cancer Institute. Mentorship for young scientists, said Benz, a prominent hematologist, has undergone a paradigm shift.

Rather than learning from a succession of experienced scientists, as he did, young scientists now benefit from “spontaneously forming networks” of investigators in diverse disciplines, Benz told the audience at Student Research Day in early May.

Posters lining the corridors of the Jane Ellen Hope Building described the research of 63 students completing M.D., M.D./Ph.D. and M.P.H. degrees. Projects included a comparison of expected and actual waiting times in emergency departments, a study of a South African program to prevent vertical transmission of HIV, research on the impact of controlled ovarian hyperstimulation on the success rate of in vitro fertilization and a study of how the molecular genetics of KRIT1 affect the pathogenesis of cavernous malformations.

Reflecting on Benz’s description of changes in the system of mentoring, 7th-year M.D./Ph.D. student Stephanie Eisenbarth said she’d had several key mentors, in particular H. Kim Bottomly, Ph.D., professor of immunobiology. Graduate school, Eisenbarth said, is structured to provide students with a committee of three to six faculty members. “They, too, have a significant impact on your development as a scientist, and I think this is a positive influence on the process,” she said. Her study of the role of endotoxin in asthma pathogenesis was published in The Journal of Experimental Medicine last December.

After hearing presentations by five students with award-winning theses, Dennis D. Spencer, M.D., HS ’77, the Harvey and Kate Cushing Professor of Neurosurgery, gestured toward the presenters and commented: “We see not students, but future colleagues.”

Some of the student theses can be read online at http://ymtdl.med.yale.edu.

—Cathy Shufro

The war between ideology and science is costing lives, speaker tells AIDS gathering

People are dying because public health policy has fallen victim to “the war of ideology over science,” keynote speaker Geeta Rao Gupta, Ph.D., said at the annual AIDS Science Day at the School of Public Health in April. A health policy based on ideology rather than research “is not just wrong,” she said, “it is fatal.”

Gupta, president of the International Center for Research on Women, said social change arising from globalization has pushed societies “backwards to fundamental ideals and primary cultures, to hold on to what is seemingly sacred.” The reversion to fundamentalism typically limits women’s mobility and sexual and reproductive autonomy, she said.

The “most stunning examples” of ideology-based policy have come from the United States, she said, which has, at United Nations conferences, promoted abstinence as the only sure way to prevent sexual transmission of hiv and called for the deletion of “condom use” from a list of strategies to prevent infection. Such “ideological posturing,” said Gupta, “costs lives, tens of millions of lives.”

Policy based on research should include cultural analysis, said Gupta. For instance, women’s ability to protect themselves from hiv is limited by societal rules governing how women (and men) should behave. If an AIDS vaccine is developed, some societies will regard getting vaccinated as an admission of promiscuity.

“We just presume that once you have the solution, it’s a good solution,” said Gupta, adding: “Biomedical interventions are not gender-neutral.”

During the day of panels and poster sessions, scientists, anthropologists, social workers, faculty and students discussed an array of issues related to HIV/AIDS, including prevention and care in international settings, interventions to stop the spread of the disease and the implications of race, gender and poverty.

—Cathy Shufro


			Originally published in Yale Medicine, Autumn 2003. Copyright © 2003 Yale University School of Medicine. All rights reserved.