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REMARKS  BY:	DONNA E. SHALALA, SECRETARY  OF  HEALTH  AND HUMAN  SERVICES
PLACE:		The University Of Louisville School Of Medicine Commencement, Louisville, Kentucky
DATE:		May 14, 2000

Let me start by thanking all of you for awarding me your honorary degree in public service. I've spent almost half of my professional life in public service. It has mostly been fun. I hope that each of you will find a way to serve your communities. It doesn't need to be full time.

As human beings we need to be part of something larger than ourselves. That "something" is a spirit of giving back. Like good medicine - it too makes us healthy and whole. After four challenging years at the University of Louisville School of Medicine, each of you are very embodiment of good medicine. So I am delighted to share your joy, your achievement - and your relief.

I'm actually very proud to be at the same great university - on the same day - as Muhammad Ali. I know he is this city's favorite son. I'm always in the Greatest's corner - he is a man of integrity and courage.

I want to join everyone in thanking our mothers. As I watched the Million Mom March, I thought if we turned government over to our Moms, we'd have a less costly and a much more sensible government. But even with our mother's guiding hand, many of the biggest and best decisions we make come dressed in luck, coincidence and serendipity.

I believe, what we decide is less important than what we do after we decide. That is the message of one of my favorite books: Don Quixote. I'm a big fan of the Man from La Mancha. Not because I look like Don Quixote. Frankly, I look a lot more like his short sidekick - Sancho Panza.

No, I admire Don Quixote because he - like you - went on a journey. Because he - like you - maintained his humanity through a difficult ordeal. And because he - like you - learned a thing or two along the way

. For example, you learned how to survive Black Monday. You learned what it means to be Kentucky pioneers - by being the first class to make it through IMP. You kept 80's music alive - by playing it at the Cadaver Ball. And lest we forget: You survived Dr. Polk's surgery rounds.

Retelling these tales will keep your children and grandchildren hanging on to your every word. They would also keep the writers of ER hanging on your every word. I learned this back in January when I gave a tour of the White House to the actors and writers of ER.

They were looking for story ideas. I could have said: "You want story ideas? Don't talk to me. Go talk to the experts - the Class of 2000 at U of L Medical School." But since I have to go out and find a new career - I decided to try my hand at being a script consultant.

So, as I was showing the actors and writers from ER around the White House one evening, we got into a conversation about how seniors sometimes share prescription drugs because they can't afford to buy their own. Two Thursdays ago, ER ran an episode about a couple who inappropriately shared a beta blocker medication. They gave me credit.

Flushed with success, I've been invited to consult with the writers on more episodes. That's why instead of writing one more commencement speech, I decided to write a memo to the writers of ER - and use it as a commencement speech.

To: The Writers of ER

Fr: Donna E. Shalala, Secretary of Health and Human Services

Re: Which Way is Up? Health Care in the 21st Century

Da: May 14, 2000

One year into a new century, we are living longer, healthier and better lives. We have big issues - the challenge of the uninsured -- for example -- the financing of health care for seniors as their population doubles, and the challenge of bioterrorism. So here, ER writers, are some story ideas for your consideration.

Episode One: What's Up Doc?

A realistic show about the practice of medicine in the 21st century will answer the W'ascally Wabbit's famous question: What's up Doc? Or more precisely - what's up for docs?

This episode is not about monitors and wires and intubating - all captured with a hand held camera. This episode is about maintaining morale, autonomy, and the sacred doctor-patient relationship at a time when our health care system is undergoing profound change.

Today, hospital stays are the exception - not the norm. Treatment plans are sometimes supervised - or sometimes even dictated - by non-doctors. Doctors are told - directly or indirectly - that managing costs not caring for patients is the bottom line.

Yes, the revolutions in managed care have helped keep costs down - and opened up new employment opportunities for young doctors who want to go into primary care.

But efficiency must never be a substitute for quality. We must keep as much decision making as possible in the hands of physicians and their teams. We must have a health care system in which you bound out of bed to go to work enthusiastically for the job you were trained to do: taking care of patients.

Episode Two: Quality, Quality, Quality

In 1997 President Clinton created the Advisory Commission on Consumer Protection and Quality in the Health Care Industry - co-chaired by the Secretary of Labor and me. The Commission issued a landmark report calling for a Patient's Bill of Rights.

A Patient's Bill of Rights must not be an empty promise. There must be strong protections for all Americans - including access to specialists - and a meaningful way to enforce those protections.

Quality is also about outcomes. As every young doctor knows - and every true-to-life medical drama would show - what counts most is getting the right result for the patient in the right way at the right time. Which brings me to:

Episode Three: Global Public Health Brings Global Prosperity

There's an old Jewish saying: Nine rabbis cannot make a quorum, but ten shoemakers can. This is not a saying about the power of shoemakers - or rabbis. It's about the power of numbers. There is strength in numbers. That's why it is in our nation's best interest to set up a worldwide public health infrastructure -- that includes research, surveillance and treatment.

We want to strengthen the health of every citizen - so that everyone can share in the opportunities of the 21st century. We also need a vigorous international effort to develop vaccines. Infectious diseases such as TB, Malaria and West Nile know no borders.

In addition to the humanitarian need for a global campaign against infectious diseases - we have a strong economic incentive to wage this battle. Today, 40 percent of our exports go to developing countries. We need those markets to expand - not shrink. But shrink they will if millions of people in the developing world are cut down in the prime of life by infectious diseases like AIDS.

Episode Four: Focusing Like a Laser on Prevention

We all know that great Louisville poet - Muhammad Ali. Well, another famous Kentucky poet, Robert Penn Warren, used to say: "A poem is not a thing we see; it is, rather, a light by which we may see."

Prevention is the same way. It lights our way to good health. Yet, the majority of preventable deaths in our country are rooted in just three behaviors: Tobacco, poor diet and lack of physical activity.

Doctors on television - and in real life - can save countless lives by promoting changes in behavior and early screening for disease. That means making sure we don't raise another generation of couch potatoes - or encourage young people to smoke. We all need to eat right.

I look at Dot Richardson and I want for every American a sound mind and body. As a kid, when I didn't have my head in a book, I had my hand in a glove or wrapped around a tennis racket. I still have trouble working indoors during the summer.

Episode Five: Keep Our Science Strong - and Our Ethics Stronger

America has the world's most talented scientists - and greatest biomedical institutions. University of Louisville medical grads completed their work in one of the best.

From the human genome, to cancer and vaccine research, to food safety - this century's blockbuster discoveries will come from America's medical and scientific genius -- and their colleagues that we support around the world.

Over the last eight years, funding for every science agency rose dramatically and steadily. But that's not enough. We must protect the treasure of academic health centers like the University of Louisville Hospital and other Louisville medical institutions - which will train the next great generation of doctors. I'm not talking about walling off academic health centers from revolutions in health care management. But I am talking about preserving the irreplaceable role these institutions play in training, indigent care and clinical and basic research.

Woody Allen once joked, "I was thrown out of college for cheating on a metaphysics exam - I looked into the soul of the boy next to me." Metaphysics is fine. But what we really need is some soul searching about science and medicine.

We must learn from history because - Science and technology are not inherently moral; the responsibility to ensure that they are put to a moral purpose belongs to society. That means we must never create a health care system where our genetic map is used to deny jobs or health insurance; where breakthroughs widen the gap between the haves and the have-nots; where we fail to protect human subjects involved in clinical research; and, most important, where our science gets ahead of our ethics.

This awesome responsibility belongs to researchers, clinicians - and above all, to the leaders of our great academic health centers and research universities. The integrity of our research rests on our ability to vigorously assure patients - and their families - that their interests and concerns are being safeguarded.

Remember the lesson of history: Science is not inherently moral. The responsibility to ensure that it is used only for moral purposes belongs to us - all of us.

Which brings me to my conclusion:

Episode Six: The Moral Challenge of Health Disparities

The comedian Chris Rock once said, "Why should I pay taxes? I won't get the money until I'm 65. Meanwhile the average black man in America dies at 54." Behind that joke is a moral challenge.

Yes, overall life expectancy for Americans is up. And yes, some gaps in health outcomes between minorities and the majority population are closing. But they're not closed yet. So we haven't finished our work yet. In 1998, President Clinton set a goal of ending health disparities in six major areas - including infant mortality, cardiovascular disease and diabetes.

We've made important progress. Still, when it comes to closing gaps in health outcomes, we are like Moses standing on the edge of the Promised Land. We are not there yet. But we will get to the Promised Land.

I hope this memo generates a few ideas for upcoming shows. But much more important I hope it inspires the graduates of the University of Louisville School of Medicine to seize the magnificent and challenging opportunities that await them in their own Promised Land.

That is the end of my memo - but not quite the end of my remarks. I began by mentioning Don Quixote. From my point of view, there are two great things about this book.

The first is that even though the hero, Don Quixote, dies - Sancho Panza lives. The second is: The book's message. It is the wisdom of an old man - given with warmth and grace to the young. If Don Quixote were here, I think he'd say to all of you: Stay optimistic. Hold on to your compassion. And never stop serving your communities.

Love your work. Love all the people who made this day possible - which includes your families, your friends, the wonderful faculty here - and the University of Louisville's generous alumni and friends.

And, of course, love what blessed fortune has given you. Remember, every moment counts. Every laugh is healthy. And every life saved is a gift to that person, that person's family - and to God. The physician's work is like no other.

Filled with joy. Occasionally touched by sorrow. And, I'm certain, in your skilled hands - forever noble.

Thank you and Godspeed.