May 29th, 2014

Commencement Address at Baylor Medical College

Global Health

May 27, 2014

Finally! A bit late perhaps from my mother’s point of view, but now she has a child with a medical degree. I’m profoundly grateful to Baylor College of Medicine for that. In truth, my mother has had it much better all along. As she likes to say, she has every mother’s dream: her child married a doctor, 34 years ago. My wife Sonia holds the hard-won medical degree in the family, the kind that all of you graduates have done so much to earn today. I have long been the other kind of doctor, a social science PhD, the kind that looks longingly and enviously at real doctors and great researchers who heal patients!

Indeed, I believe that the healing arts are the very finest arts of our civilization. In my own cultural tradition of Judaism, the highest calling is Tikkun Olam, or to “heal the universe.” The greatest medieval Jewish sage, Maimonides, was also a doctor. It is no coincidence.

I’ve loved the field of medicine since I first encountered it as a young child. It is the combination of all that is right: the worthiest of causes; using advanced scientific knowledge; profound technological know-how; differential diagnostic skills worthy of Sherlock Holmes; offering an invitation to human compassion on a person-to-person basis; and involving a moral commitment worthy of the angels. A profession that begins with a solemn oath handed down for 2,500 years has something going for it.

We now understand that in dealing with human health, we are dealing with an extraordinarily complex system – the human body – composed of some 37 trillion cells, each with a genetic blueprint of some 3.2 billion base pairs. In each of our brains, there are some 200 billion neurons and perhaps 125 trillions synapses. In every cell, the sub-cellular organelles combine to carry out the cellular processes. The cells in turn combine to form tissues, and tissues combine to form organs. Organs combine in organ systems, and the organ systems together produce a functioning human body. Each level emerges from the complex interactions of more basic units. Health, illness, and survival depend on the nature of those complex interactions.

Of course the interactions don’t stop there. Indeed, for me, that’s where they begin. As a social scientist, I am involved with the levels of organization of whole individuals, as they combine to form families; as families combine in communities; communities in nations; and nations into what is now a global society. Additional properties emerge at every step. And the quality of the interactions of individuals, families, communities, and nations determine the health, illnesses, and even survival of our species.

I’ve been focusing all my professional life on the question of how to foster healthy societies. And I have found clinical medicine to be the correct template, offering up a model of what I have called “Clinical Economics.” Just as you need to make a differential diagnosis when your patient goes into shock, I need to make a differential diagnosis when an economy spikes a runaway inflation; or a banking panic causes credit to stop circulating; or a cancer of corruption eats away at the healthy institutions of the society. Economic development practitioners, like medical doctors, also confront crises of chronic undernourishment, when an entire impoverished society lacks the basic resources of energy, foodstuffs, and foreign exchange to maintain the metabolism of daily life.

The most important thing that I’ve learned as a Clinical Economist is that we need to have the same care and respect for societies as doctors must have for their patients. Suppose that an impoverished patient comes into the ER at mortal risk of starvation. We know that is not the time to lecture the patient about proper eating habits, or to berate the patient for having missed the chance to get a job or a high-school degree several years back. The urgent need is to attend to the emergency, and then gradually to nurse the patient to physical health, and then ideally to social health as well with an improved life plan.

The same applies when a country is facing an economic or public health emergency. When a country is overcome by an uncontrolled epidemic such as HIV/AIDS, or a banking collapse, or an acute budget crisis, the first order of business for the world community is to help the hard-hit country to survive. The crisis is not the occasion for sanctimonious lectures or even benign neglect. If the world simply stands by when a country is being swallowed by an economic crisis, the result can be violence, epidemic disease, mass migration, or worst of all, outright war. I have long found that a true emergency-room response – an injection of international aid to stabilize the floundering economy – can repay itself many times r by helping that country to avoid a descent to chaos and helping it to make a speedy recovery. Too often, however, we consider the suffering of others “not our business.” Pope Francis has powerfully described this as the “Globalization of Indifference.”

Of course any sound cure depends on the right diagnosis. In the late 1990s, as I worked in Africa as an economic advisor, I found that the best-laid macroeconomic plans were being overrun by epidemics of AIDS and malaria. To stabilize the economy one first had to control the epidemics. That was not the standard economic prescription, but the AIDS epidemic was not the standard crisis either.

Several giants of public health, including your own Dean Peter Hotez, one of the world’s premier parasitologists helped me to understand that the pandemics could be controlled and at low cost. We worked together to convey that information to Ministers of Finance and Health. We were able to propose new institutions such as the US PEPFAR program to combat HIV/AIDS and the Global Fund to Fight AIDS, TB, and Malaria. Those programs have helped to roll back these killer diseases, and with Prof. Hotez’s guidance to expand the public health efforts to combat many other tropical diseases in Africa and Asia, such as helminthic infections and dengue fever. Shockingly, many of those same tropical diseases of poverty exist right here in Texas and throughout the Gulf of Mexico, and Prof. Hotez and the National School of Tropical Medicine at the Baylor College of Medicine have taken up the fight here at home.

Let me briefly address another major challenge of astounding risk. The planet Earth itself has a fever, and the fever is rising. In 1880, Earth’s temperature was 13.8 degrees Celsius. Since then it has risen by 0.8 degrees to 14.6 degrees in 2013.

Now you might consider that a low-grade fever, but you should know two things. First, the prognosis is not good. The current projections are that our patient, Earth, will spike a 4-6 degree fever by the end of this century. Second, Earth is already reeling under the current fever. Earth is experiencing both record-setting fevers and intense chills, such as the polar vortex that plunged the East Coast into extreme cold this winter while other parts of the planet were experiencing record-breaking heat. As the Earth’s physical systems are increasingly disturbed, the climate system is becoming increasingly variable.

To an untrained observer, a rise of 4-6 degrees Celsius might not seem much, but as a doctor you’d surely know to worry. At the lower end of the range you’d worry about delirium and seizures; at the higher end, about brain damage and even survival. You’d worry that the underlying condition, if left unattended, might soon prove to be a fulminant, life-threatening disease. Scientists have recently found that part of the West Antarctic ice sheet is already slipping inevitably into the ocean, enough to raise ocean levels by a meter or more in the coming decades or centuries.

I’ve watched and listened to my wife attend to fever in the middle of the night hundreds of times. Her systematic questioning, complex reasoning, and decisive life-saving actions are awe-inspiring. Can we afford to do less with Earth itself? Can we really stand to have our most ignorant politicians, or politicians on the take, say they don’t really believe the thermometer, or that fevers come and go, so not to worry, or that a little fever is after all a good thing? Of course we can’t afford that. At your graduation today we celebrate science, rigorous training, and a passion for excellence, not political quackery and corruption.

In fact, this time around the differential diagnosis is clear. While many things can cause the Earth to spike a fever – such as changes in solar irradiance, changes in the Earth’s orbit, or changes in the El Nino Southern Oscillation – in fact there is only one diagnosis consistent with Earth’s current fever. Starting about two centuries ago, Earth went on a high-Carb diet, that is, a carbon-based energy diet. We have been feeding coal, oil, and natural gas into our economy, and carbon dioxide into the atmosphere, in supersized proportions. Last year, we released 35 billion tons of Carbon Dioxide into the air, the Earth’s lungs, as part of the planet’s voracious carbon diet.

This diet will kill us if we don’t change our energy consumption patterns. There are much safer energy diets – solar power, wind power, hydropower, or even nuclear power if properly managed. There are even ways to consume high-carbon energy safely, a kind of power-plant dialysis known as Carbon Capture and Sequestration. In fact, there are many possible cures. It’s only the status quo that is unacceptable.

So today, on the day that you become a medical or research doctor, please also become a doctor of the planet. Please care for the world’s poor, the world’s unstable and suffering crisis zones, and the physical Earth itself, with the same rigor, professional care, and moral commitment that you will apply to your patients. You join the healing arts at a moment that the world needs your skills, passion, and virtue.

I feel confident that your patients, and our planet, will be safe in your hands. Go forth in excellence. Let me thank you again for this very high honor, to join your ranks today as a member of this treasured medical community. And most importantly, please accept my congratulations to all of you, friends, family, and especially graduates, of the Baylor College of Medicine Class of 2014.



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