Remarks as prepared; not a transcript

Vice Admiral Richard H. Carmona, M.D., M.P.H, FACS
Acting Assistant Secretary for Health
United States Surgeon General
U.S. Department of Health and Human Services

Future of Life Summit

February 21, 2003

"Future of Life"

I am grateful to Time-Life for putting on this conference. Much as the Asilomar Conference in 1975 formed the foundation of scientific debate for years to come, the issues we are discussing here will provide structure for the public debate over the next several decades.

You are shaping the Future of Life.

In fact, as a first-year med student taking introductory microbiology, virology, and biochemistry at the University of California/San Francisco over 25 years ago, I saw first-hand the seeds of what would later grow into the biotechnology revolution we are in the midst of right now.

Two young virology/microbiology instructors frequently and passionately told us of their research: their names were Harold Varmus and Mike Bishop, and as you know, they went on to win a Nobel Prize for their work just a few years later.

I also had a biochemistry teacher who was equally passionate in his digressions into his research in bioengineering, a then futuristic complex concept. His name was Herb Boyer, who went on from meager beginnings – teaching me, and my classmates -- to found Genentech.

At the time, their work seemed very futuristic, almost incomprehensible. Now we are living in the new world they’ve helped create.

For those of you who don’t know me, I’m a 'recovering' surgeon. I say that because, I strongly believe, and many of you may agree, that at times surgery can be considered a barbaric process, especially in light of the new scientific knowledge that is rapidly evolving.

If a patient has an injured or diseased organ, or a cancer growing in her body, what do we surgeons do?

More often than not, we cut her open, remove the organ or the cancerous area, and clamp off the bleeding. All the while subjecting her body to trauma, shock, and the possibility of infection.

Conversely, the oncologist may give poisons that kill cancer cells but also destroy healthy tissue and cause major complications.

But thanks to biomedical research and the great imaginations of scientists in academic, private, and federal laboratories, treatments are being developed that will make some surgery a thing of the past.

As an article in this week’s Time magazine points out, “Drugs like Herceptin for breast cancer and Gleevec for leukemia work by blocking the chemical signal that tells the cancer to grow. They herald the day when we can look back on the traditional slashing and burning of cancer patients as having been as primitive as bloodletting.”

We are already beginning to screen genetic information and target appropriate interventions to help people avoid physical and mental conditions and diseases years before their first symptoms would have otherwise appeared.

Someday, med students may cringe in horror at the tactics that we use today in an attempt to save human life.

Someday, simply by altering the genotype of a host, an organ will resist disease or heal itself.

I was chosen by President Bush and Secretary Thompson to be Surgeon General because of my experience in public health as well as surgery, emergency medicine and emergency preparedness to include bio-terrorism, areas we did not know would be so important to public health, even a few short years ago.

It was a tremendous honor for me to be appointed by President Bush, and it’s great to be able to do the things that a Surgeon General does. Like coming here to talk with some of the greatest minds in the world about the future of life.

Being here to celebrate the 50^th anniversary of the discovery of the DNA double helix, and seeing Dr. James Watson, is a true honor for me. Dr. Watson has spent his life serving humanity, as many of you have done also.

And to think just a few months ago, I was just another guy in Tucson, Arizona, working as a trauma surgeon, a professor, a public health officer and on the development of the southwest region’s bioterrorism response plan.

We don’t always know what the future holds. We don’t in our lives, and we certainly don’t in science. I could not have known that all my experiences were preparing me to be the Surgeon General for the beginning of the 21^st century.

We have to do the best we can with the information we have at the time. And we must also look beyond what the best scientific minds have to offer.

We must recognize how the disciplines of education, journalism, religion, art and ethics can shape our thinking as we look to the future of life. By doing this we can more fully consider the possible implications that science has on our lives.

One of my duties as United States Surgeon General is to find the best science and articulate it to the public for better health. Most of us in government positions are operating at the macro level. We are responsible for the health and well being of every single American.

Questions of public health and our challenges are necessarily different than those faced by scientists.

But there is an advantage to the slow, deliberative process: with it we have the opportunity to explain complicated ideas to the American people so that they will listen, understand and act.

With their understanding also comes their trust that policy isn’t getting ahead of them.

While public health functions on a macro level, scientific advances for the future of life are almost all occurring on the micro level: Genomics, proteomics, and all of biomedicine are building hope from the smallest of cells and biochemical structure.

Scientists are nearly finished mapping the human genome’s three billion chemical letters – this work will have untold benefits throughout the history of man.

Already, they have identified ‘susceptibility’ genes for many disease states, including prostate cancer. They have developed new DNA microarray technologies that make it possible for physicians to accurately diagnose the specific cause of some diseases, such as breast cancer, enabling them to make better decisions about treatment.

And thanks to the discoveries of science we are on the brink of our next major evolutionary wave in public health.

Think of the incredible evolution of public health in the last century.

One major wave was the struggle against infectious disease. In 1900, our leading killers were influenza, pneumonia, diphtheria, tuberculosis and gastrointestinal infections. We fought these illnesses through sanitization, the development of effective vaccines, and mass immunization.

And while we are still struggling with emerging infectious diseases such as AIDS, for the most part this past cycle in public health is now complete.

Another major evolutionary wave in public health has been the struggle against chronic disease. We are still in the midst of this fight. As we made progress fending off mortality from infectious disease, the ‘new’ killers became cancer, heart disease, diabetes, and other chronic illnesses.

Unfortunately, in terms of numbers, chronic illnesses have replaced infectious diseases in their lethal force. However, the difference is that individuals can exert more control over the occurrence and outcome of their chronic illnesses through their behavior.

Most chronic illnesses Americans suffer and die from today are preventable through diet, exercise and avoiding risky behaviors.

One of my greatest challenges as Surgeon General is getting people to realize that health – whether good or bad – doesn’t just happen to them. It’s a result of the choices they make. . . every day!

My top priority as Surgeon General is communicating the prevention message in such a way that people will not only understand, but be willing to change their behavior. After all, we have heard the good health message over and over:

• Make healthy choices,
• Don’t smoke.
• Eat right.
• Exercise.

How do we communicate this prevention message in a culturally competent way, and in such a way that people will do it?

That is our big challenge, developing messages that effect true behavioral change.

The irony is that although we’ve made huge advances in understanding the molecular basis of disease, these simple lifestyle choices at a macro level offer the best chance for eliminating or preventing chronic illness.

We shouldn’t have to rely on good science to undo people’s bad choices.

Advances in science mean we are quickly moving into another major evolutionary development in public health: health promotion.

Public health for the past 150 years has been largely concerned with keeping people alive and alleviating suffering. But recent scientific discoveries will translate into our ability to help people avoid illness entirely and get the most out of life.

For instance, in the next decade, we will likely be able to screen populations for genetic information that will enable doctors to target interventions to individual patients to avoid adult-onset illnesses, years before their first symptoms would have appeared.

Molecular computers and hybrid bio-nano systems will push medical technology very quickly, allowing us to live longer and healthier lives.

Rather than looking at health as a state of being ‘disease free,’ the new health promotion paradigm will look at health as maximizing our abilities and feeling as good as possible during a larger part of our longer life span.

But how do we get there. . . from here? The same way we’ve gotten there in the past:

• Knowledge,
• Imagination, and
• Leadership.

Knowledge is the currency of the future, especially scientific knowledge. The wealth – and health - of any country will be directly proportional to this knowledge.

As technology increases, borders become less important. Disease does not respect international boundaries, and in our global economy there is financial fluidity between nations.

America has been importing an increasing number of scientists. And while we welcome them, we need to maintain preeminence in science, technology, and math. American kids need to exceed to succeed and they need to be challenged and encouraged to join the study of science and medicine. Right now our children are lagging behind in science, math and technological literacy.

There are many countries around the world that continue to lag behind the technologically advancing world largely because they have failed to make science education and research and development a priority. They have failed to embrace the factors that drive the new economy and continue to have economies based on old technologies and business practices.

This is extremely dangerous since it deepens the global economic divide, creates further disparities and fosters disease, famine and political instability in those countries that fall further behind as the select few race successfully to create the future.

In the U.S., elementary and secondary education in science and math is not improving fast enough for an information society that is increasingly dependent on those skills. All sectors – higher education, industry, and government – must assume greater responsibility for achieving educational excellence.

The United States cannot be a victim of technology and science. We must expand and improve because of it. With this leadership comes immense global responsibility. . . to reach out and be compassionate while making the world a better place. We have, we continue to do so, and we, the United States, have an enviable and unparalleled record in this regard.

HHS Secretary Thompson’s frequent challenge to all of us who serve under his leadership is this — “If you’re not living on the edge, you’re taking up too much space.” He tells us that we must always be innovative.

President Bush constantly challenges his leadership to lead boldly, with integrity, and by example.

Let me also remind you of something that a visionary once said — “Imagination is more important than knowledge.”

You’ve all heard that quote before. What I believe Einstein was saying is that imagination is at the heart of innovation.

Imagination allows us to envision the future from a comprehensive perspective, not from what we see just directly in front of us.

Imagination is the scientist who figures out how to detect and switch off the B-R-C-A-1 gene, instead of the surgeon who just wants to develop a better surgical procedure to excise the tumor after it grows in the breast.

Imagination leads to integration. The disparate pieces of the DNA puzzle tell us nothing in isolation, but they tell us many things in relationship to each other.

In our expanding knowledge about the universe, the human mind and body, the cycles of ecosystems, the patterns of climate, and the paths of infectious diseases, we see repeated evidence of integration.

There seem to be few, if any, disconnections as we deepen our knowledge. What it comes down to is being able to imagine a completely new way of seeing or doing something.

The CD is an example of this type of imagining. What we don’t think about too often anymore is that when it was introduced, the compact disc was a completely new type of audio device.

It was not an improved version of anything already in existence.

Let’s never forget what imaginative leadership can do: transistor technology disrupted the vacuum-tube industry, penicillin forever changed how we treat disease, and the CD knocked off the needle in the groove.

There is also great challenge here for the nation and the world in the next few decades. We must understand that leadership in scientific research and education, in innovation, in competitive entrepreneurship, and in constantly improving public health, is an enduring quest, an ongoing process.

You know, it is ironic that we are discussing science as a means to enhance life at a time when we, as a nation and a global community are distracted by the use of science to destroy life.

While biotechnology gives us the ability to improve and enhance life, it can also be deliberately used to spread contagious diseases and destroy human flesh.

This is the great paradox of scientific discovery: As we learn more about creating and improving life, so too do we learn how to destroy it.

Science has the potential now to outpace human understanding of the ramifications of what we are undertaking. We need to move carefully but deliberately. There could be huge unintended consequences.

I have faith that most scientists care a great deal about the applications of their discoveries, and will not step over lines drawn by societal conscience.

And it is incumbent on those of you who would push science to its edge, to protect science.

To protect the goodness of the work that you do, and to not allow thoughtless science to prevail in the name of scientific progress.

You are the experts. And with your expertise comes the greatest responsibility and understanding of the intended and unintended consequences of scientific discovery and to relate them to the governmental leaders and to the general population.

Most people have a general sense and expectation that science continues to progress, however they don’t know what the implications are for themselves, or for their families.

While we, as a nation, will reap the benefits of science, science must take its time with the nation.

As we move forward in science, we must also take care not to leave the public behind.

There is a wide diversity of opinion in America from condemnation of the new technologies to unqualified endorsement.

While industry, government and academia are now engaged, the risk is to leave the public out of the debate, which will cause even greater disharmony and divisiveness.

We must ensure that Americans are informed, that they understand the context of scientific advancements, that they know that policies are based on knowledge and science, not ignorance and hype.

But by taking the necessary precautions and time required by society, we can assure a safe and reliable scientific process.

Whether it is someone in this room who makes the discovery to end all sickness or whether that discovery is still decades in the offing, the foundation for that discovery rests among us today.

As Thomas Merton said:

“My successes are not my own. The way to them was prepared by others. Therefore the meaning of my life is not to be looked for merely in the sum total of my own achievements. It is seen only in the complete integration of my achievements and failures with the achievements and failures of my own generation, and society, and time.”

As the greatest scientific minds of this generation, your work will live beyond your years, your mind beyond your body.

It is the responsibility of leaders, like you, to recognize the possibilities and pitfalls of science and guide us as we walk among them.

Let me leave you with this thought: we must always keep improving the scientific process with fresh ideas and a fundamental commitment to serving humanity. You are the future of science. You are helping to shape the future of life.

Please keep thinking imaginatively and critically. Keep educating, innovating and collaborating. As James Watson and Francis Crick did 50 years ago, keep asking the right questions.

Be bold, embrace the unknown, take us where no man has ever been, decipher life’s mysteries. . . but let the world you serve vicariously experience your awesome feats as you compassionately shape the future of life!

Thank you.

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Last revised: January 9, 2007