Life, the Universe & Social Responsibility
The Dean's Column
"Class of 2017, on this milestone day—your day—ticking of time intercedes. Ticking of time may even be top of mind for some of you. This training thing feels like it’s been going on forever, and still no end in sight!"
On May 23, 2017, SKMC Dean Mark Tykocinski, MD, shared the following comments at Jefferson’s 193rd commencement ceremony. His remarks appear here in lieu of his usual column.
For me, too, time has been top of mind of late. There’s nothing like an out-of-the-box, neverdone- before merger of two universities—endless timelines—to get one thinking about time! The institutional clock. The professional clock. The personal clock.
Last September, the CEO of a Dublin-based pharmaceutical training facility opened a session with this provocative statement: “The person who will live a thousand years has already been born.” Well, that certainly caught my attention—and seeded the topic for today: time trajectories, and why an SKMC graduate should even care.
Let’s start with the grand panorama: We’re getting an ever more precise fix on origins of the universe, origins of life on Earth. Turns out the rate of universe expansion has been underestimated, meaning we’re closer to the end than we thought. Another new find: Life originated on our planet much earlier than we thought—3.7 billion years ago, to be precise—a mere 800 million years after Earth came into being. Meaning: Life popped up super quick, raring to go!
But life spans intrigue me more than beginnings and endings.
Harriet, a giant Galapagos land tortoise collected by Charles Darwin in 1835, lived about 175 years. A sea turtle in the Guangzhou Aquarium is believed to be 400 years old. If any of you budding investigators sort out the science behind that longevity and apply it to us, I guarantee you fame and fortune!
In April, Emma Marano died in northern Italy at 117, the last human survivor of the 19th century—albeit only the fifth-longest life ever verified. Far short of a thousand years, but safe to say that life-span norms in the 120 range are now within sight, almost certainly during your practicing lifetimes.
As physicians, we reflexively think: chronic disease management. But we must consider deeper—and more difficult— questions. What will longer life spans really mean for your patients, their lives, their roles in society? For society itself?
Let’s talk science. Longevity could influence the kinds of experiments scientists choose to do. Not long ago, an amazing piece of engineering, the Large Hadron Collider, shook the physics world when it confirmed the existence of the elusive particle that explains mass. This discovery was the culmination of a 20+ year journey. Interestingly, the physicists who embarked on this journey did so before all the technical challenges of their powerful toy had been solved. They had an abiding faith that their ingenuity would somehow solve the remaining issues on the fly. They also bet they’d be around to see the payoff.
Longevity would reinforce more bets like this—fostering more scientific patience. Think NASA and space exploration. New Horizons hurtled three billion miles through space, for nine-and-a-half years, before revealing the marvels of distant Pluto. The long, patient view will take on new meaning.
Let’s talk work life. Our recent graduates will be practicing medicine in what some are calling the “end-of-work era,” when relentless automation and artificial intelligence lead to wholesale reformation of the employment landscape and a reshuffling of how our work time is spent. Longer lives will undoubtedly translate into more non-working time.
This may all end very well, or very badly: self-growth nirvana in a workless utopia, or social collapse? And what effect will all this extra time have on our psyche? We will need to face those added years of ups and downs with far more resiliency. And that resilience will be needed big time to withstand things like the spooky landscape of predictive medicine.
We’re approaching the $10 genome—three billion base pairs of your chromosomes sequenced for little more than the price of a Starbucks latté—data we now use to predict diseases yet to happen. But if that’s not scary enough, investigators are taking it a step further—rumbling about new molecular tools for predicting when you will die, invoking terms like DNA tape recorder and predictable death spiral. Too much information? And what happens when that news is irretrievably bad? With more time at stake, a prognosis for early onset of disabling disease, or early death, will hit your patient’s psyche like a sledgehammer.
So this free-form reflection on time turns from the frivolous—universes and turtles— to more serious matters of real concern.
Armed with MD or PhD diploma, I implore you to lead—even to provoke— debates on society’s biggest issues. My lifetime mentor, world-renowned Harvard cardiologist Bernard Lown, won the 1985 Nobel Peace Prize for cofounding International Physicians for the Prevention of Nuclear War, an outgrowth of its predecessor organization, Physicians for Social Responsibility. A cardiologist yelling to the rafters about nuclear calamity? Why? Because of his conviction that physicians cannot sit idly by, holed up in clinical cocoons, while society surrounding them is melting. We, and you in particular, are all accountable to society at large. We have social responsibility. I trust that Jefferson has by now imprinted this message in your core, in which case, think of these commencement remarks as a booster dose.
Recently, researchers at Mt. Sinai examined genes of 32 Jewish men and women who survived Nazi horrors, focusing on a gene associated with the regulation of stress hormones. The amazing finding? This gene was epigenetically tagged the same way in both the Holocaust survivors and their children.
Turns out that our life experiences are physically time-stamped onto the DNA we pass to our children. Bona fide chemical moieties attached to specific DNA that switches genes on and off. Epigenetics—as distinct from genetics. Astounding—a parent’s experience can actually find its way to his or her child, even though not part of the genetic code per se. Transmission of trauma across generations: Our experiences enter our children’s constitution, creating an intergenerational legacy.
If this finding is substantiated, the implications go far beyond survivors of the Holocaust and other genocides. I recently moderated a panel discussion on “A New Urban Future.” The conversation took us to the plague of youth violence in our inner cities, and a chilling thought surfaced: The stress genes of youths reared on our gun-infested streets are likely being epigenetically tagged—and so passed on. Add this to potential DNA tags for poor nutrition and other scourges of poverty, and suddenly intergenerational inheritance becomes a curse as it morphs into a bona fide urban problem.
Class of 2017, to sum up these reflections on time: I urge you to pay heed to the richness of the subject of time. Humans will live longer lives—both individual lives and intergenerational lives. Steadily increasing life spans have profound implications, and challenges, for our professional pursuits, our work lives, on our very psyches. You will need to look further, beyond your patients, and stand front and center to help our society through these trials. Be physicians with social conscience.
And recognize that your time extends to subsequent generations, for better or for worse. As teachers and mentors of tomorrow, for after all that’s what physicians are, you can live on. Yes, the dark side to intergenerational legacy only magnifies the challenge of social responsibility that you will face, but—and here’s the silver lining—also the degree of benefit you have the power to impart.
So, strain your vision to see time’s broader applications. From James Joyce’s Ulysses: “It is as painful perhaps to be awakened from a vision as to be born.” And from George Orwell: “To see what is in front of one’s nose needs a constant struggle.” As too many of our leaders skirt the pain of being awakened from their narrow visions, you be the ones to see what is right there in front of your noses.
Graduates, embrace your responsibility to society at large, because you hold a special privilege to disproportionately impact it for the good. You are encased by time, your very responsibility stems from it, and by recognizing time’s full implications, you can also be empowered by it.