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REMARKS BY:		DONNA E .SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:			University of Wisconsin-Madison, Madison, Wisconsin
DATE:			May 16, 1997

I know that all of you have thanked your families for their love, support and endless patience that got you to this day. I hope you will also thank the hard working people of Wisconsin -- citizens you will never meet -- who pay taxes to maintain this great academic health center.

Somebody once defined home as "not where you live, but where they understand you." Let me just say, it's great to be home. Not that, in my heart, I've ever left this great university or this remarkable state. I'm probably the only Cabinet Member to ever stop in the middle of a big speech to Washington journalists -- so I could put on my cheese head.

I'll never forget the day I graduated. In the air, you could feel the sense of accomplishment, excitement, and the most chilling feeling of all -- absolute fear that the speaker would never end. They say Salvador Dali gave the shortest speech ever. He said, "I will be so brief I have already finished." Then he sat down.

We have come together at a moment where the past and future meet. You are graduating on one of the most important days in the history of medicine and public health, a day when we formally close one door on the past and open another to the future.

Because, in less than five hours, at a White House ceremony, President Clinton will formally apologize to the survivors and families of the Public Health Service's study on the black men of Tuskegee.

And when the President speaks, he will help our nation heal from one of the ugliest chapters in public health history. A chapter tinged with racism, with ignorance, and with good intentions gone awry. And a chapter that could never have been written if those physicians involved in the study had remained true to the most important part of the oath you will take today: "The health of my patient will always be my first consideration."

Because when the practice of medicine becomes unhinged from the moral purpose of medicine, when the progress of science becomes unhinged from the ethics of science, anything can happen. And in Tuskegee, it did.

Let me set the scene. The year was 1932 and the United States Public Health Service began an experiment in Alabama on 399 African American men with untreated syphilis. They called it the "Tuskegee Study of Untreated Syphilis in the Negro Male." And their goal was to examine the course of the disease for about a year.

Forty years later, despite the discovery of a cure, these men were still untreated. Many died. Some even passed it on to their children and wives. And all were scarred. Indeed our entire nation was scarred.

That was one message of the report issued by the Tuskegee Syphilis Study Legacy Committee, which is chaired by Professor Vanessa Gamble of Wisconsin. As her report made clear, we still see the scars in the deep distrust many African Americans have towards medicine and research. Distrust that has led some Americans to avoid care or clinical trials, to refuse to donate organs or accept advice from doctors. And to even believe rumors of genocide. And distrust that keeps us from closing the health care gaps that still exist for minorities.

To end that distrust and heal old wounds, the Legacy Committee called for the President to apologize on behalf of the U.S. government. Today, he will. The President will formally tell the victims and our nation: This will never happen again.

But, as Dr. Gamble made clear, we must make amends not just with words, but also with deeds. Armed with tough standards for human research and additional steps the President will announce today, we must be eternally vigilant. We must ensure that our ethics are always as sophisticated as our science. And we must always remember the past and use these lessons to build a better future.

Which is the message I want to leave you with today.

Because, for me personally, this ceremony is also a moment where the past and the future meet. I have come back to a place of old friends and wonderful memories. And I have proudly come to see you -- a new generation of doctors that is better trained, and more skilled, than any previous generation.

Medicine, perhaps more than any other profession, is about holding on to the sacred, while embracing the revolutionary. About tradition and change.

Yet, when I talk to young doctors and med students today, they often tell me that they're scared the profession they've trained for is not the same profession they dreamed about growing up; that the wonder years of Marcus Welby and Rex Morgan have been replaced by the frenetic years of ER and Chicago Hope; that the art of healing is losing its humanity.

These fears are very real, and perhaps many of you share them. Indeed, they have are part of a great tradition of medical graduates -- where each generation looks back at the way it "used to be."

I'll never forget a story I read about a young man who dreamt of becoming a doctor. So, he sits down to talk it over with his uncle, who is already a doctor. And how does the uncle react?

Let me quote the young man's own words. "Uncle Henri strongly advised against going into medicine. It wasn't what it had been in his day. Patients had become demanding. They pestered you for a yes or a no. You had to kill yourself just to make a living. In short, it had become a dog's trade."

Sound familiar? That conversation took place in the 1930s. The young man was Francois Jacob. And as it turns out, he didn't take his uncle's advice. Thank God. Instead he, like you, went to medical school, and in 1965 shared the Nobel Prize in Medicine for his work in genetics. And he, like you, was able to harness the health care revolutions of his day to improve the practice of medicine and the health of citizens all over the globe.

As the great Russian author and doctor Boris Pasternak once wrote: "The stake where we will stand will be the border of two different eras of history, and we are glad to be chosen."

Standing at a border between the old and new, you too are chosen -- chosen to uphold the tradition of putting patients first, while at the same time facing real revolutions in health care. Revolutions that bring both great responsibility -- and great opportunity -- for you.

Revolutions that mean an explosion of information, technology, and new delivery systems -- but also an interconnected world of medicine where you'll be wired to computers, data bases, research centers and the best medical minds in the world. Revolutions that mean more integrated care -- but also more collaboration, more shared risk, and more shared accomplishments.

Revolutions in biomedical research that yield not only new treatment options, but also new ethical dilemmas. Revolutions that have led to greater consumer demand for quality -- but also greater personal responsibility from citizens to take care of their own health.

Our responsibility is to invest in you, to make sure that our health care training remains the best in the world; and that you can spend the maximum amount of time improving health, and the minimum amount of time filling out forms.

While our job is to invest in you, your job is to be the leaders, the architects, and the conscience of America's changing health care system.

Because these revolutions in medicine are like a big ocean wave. You can ride it or wipe out. The choice is yours.

So, in the spirit of Boris Pasternak, I challenge you to stand at the border of history and choose to take the greatest ride of your life.

I challenge you to always live up to the words you will recite today: "The health of my patient will be my first consideration."

Put your patients first by making your medical education a lifelong commitment. By never letting paper work be more important -- or even seem more important -- than healing the people under your care. Because the calling of medicine must always be higher than the business of medicine.

Put your patients first by always being their advocates; and by making sure that decisions about what is medically necessary are made by you, your patients and their families.

Put your patients first by continuing to heal them both as individuals and members of a community; by making sure that women's health is never treated as a second class citizen; and, by exerting your leadership in medicine, public health, and the critical interplay between them.

That's the same commitment you showed in your MEDIC organizations --offering primary care to uninsured working poor in South Madison. And it's the same commitment I know you will show throughout your careers.

Because remember, you are now entering a world where you will be judged not by your MCATs or your grades, but by your character. By whether you live by the oath you will take today. And by whether you make a stand and choose as Boris Pasternak chose; and conquer, like Dr. Jacob conquered, a revolutionary medical world.

Whatever path you take from here, I hope you will take real pride in all you have accomplished at the University of Wisconsin. Enjoy the people you serve, the profession you perfect, and the wonderful careers you're about to start.

Congratulations and God speed.