Remarks as Prepared; Not a Transcript.

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

Keynote Speech: 170th Anniversary of Tulane University Health Sciences Center

Saturday, October 2, 2004
New Orleans, Louisiana

Opening the "Doors of Discovery"

Thank you so much for inviting me today to celebrate your 170th anniversary. It's an honor to be with you.

It's exciting to see the work that you are doing today, but also exciting to see how far you've come and imagine where you're going.

Your work is important because all of society wins as we broaden the breadth and depth of medical science.

As a national leader in medical and primate research and a global leader in tropical medicine you bring pride to the community and medical promise to the world.

You are helping to ease the pains of today and to shape the future of life.

In the past two centuries, this nation has seen a lot. It's grown in size exponentially. It's grown in stature in the world even more. And among the medical hope of the future, we stand alone in terms of dollars and determination.

I remember as a first-year med student taking introductory microbiology, virology, and biochemistry at the University of California/San Francisco over 25 years ago, seeing first-hand the seeds of what would later grow into the biotech 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. 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 research in bioengineering, a then-futuristic complex concept. His name was Herb Boyer, who went on from meager beginnings - driving a beat-up old car and teaching me, and my classmates - to found Genentech; a world leader among bio-tech companies

At the time, their work seemed very futuristic, almost incomprehensible. But we live in a time, when yesterday's science fiction is becoming today's science fact.

For those of you who don't know me, I'm a "recovering" surgeon. I say that because at times surgery can be considered a barbaric process, especially in light of the new, evolving medical procedures.

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

We cut her open, remove the organ or the cancerous area, and clamp off the bleeding. All throughout subjecting her body to trauma, shock, and the possibility of infection.

Or, 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 surgeries, a thing of the past.

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

And changing medical procedures and uncovering medical discovery, starts with the work that is going on all over the country, in places like Tulane University.

Your hard work and dedication is recognized in Washington throughout the Department of Health and Human Services and especially at our National Institutes of Health. NIH has sent more than $71 million in direct research funding to this university over the past two years.

This commitment demonstrates the confidence we have in your work and the need for your success.

The future of science is here, and it is now.

Let me talk about where I believe we're going with the science in the United States and how, by working together among government, universities, and corporations we can walk hand-in-hand to a healthier tomorrow.

As we know, the best way to good health is prevention.

Prevention
And it is important that we look at prevention two-fold.

First, we need to encourage a flex in our societal thinking about how we treat and manage health. We need to change from a treatment-oriented society to a prevention-oriented society.

Think of the incredible evolution of public health in the past century. In 1900, our leading killers were infectious disease like influenza, pneumonia, diphtheria, tuberculosis and gastrointestinal infections.

We fought these illnesses through prevention strategies like sanitation, 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.

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 like smoking and excessive consumption of alcohol.

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.

While tobacco remains the leading cause of preventable death in the United States, excess weight is closing in and will probably soon take over as the number one preventable killer in America.

Combined, the death toll of smoking and excess weight will cost about 850,000 Americans their lives in 2004.

Try to grasp the gravity of that. 850,000 people will die this year because of their decisions to either continue smoking, or eat an unhealthy diet and not exercise.

President Bush and Secretary Thompson were among the first to recognize that the federal government had to get involved in trying to get people healthier.

The president introduced his HealthierUS initiative in 2002 and just this past week, more than 40 communities received over $36 million to help them reduce their preventable deaths.

And guess what, New Orleans is one of those communities.

So I'm happy to announce that, after receiving $1.2 million last year, New Orleans will receive $2 million this year…the second year of their five-year project…to help increase physical activity and reduce smoking.

I don't know if the mayor is here tonight…but Mayor Nagin, we'll be sending you some money to help get your citizens healthier.

Family History
The second component that can help us in preventing death and disease doesn't deal with changing behavior…instead it deals with changing perception. Recognizing that disease may begin before birth.

As I just discussed, many of life's chronic diseases are preventable through behavioral change…however, some cannot.

For those, we want to begin to look at the molecular level. And while our research into genomes and molecular science is still in its adolescence, we have learned a lot.

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

Already, researchers have identified "susceptibility" genes for many disease states, including prostate cancer. They have developed new DNA micro-array technologies that make it possible for physicians to accurately diagnose the specific cause of some diseases, including certain cancers, 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.

NIH's National Human Genome Research Institute is working as part of its Vision for the Future Initiative to work with scientists to develop the small molecule approach that will offer researchers the ability to screen the tiniest molecules, and then use those screens as chemical probes to study the functions of genes, cells, and biochemical pathways.

This will lead to better ways to understand what causes many diseases.

In addition, this work may facilitate the development of new drugs by providing early stage compounds that will enable researchers to validate new drug targets, and move them into the drug-development pipeline. This work is particularly relevant for helping people who suffer from rare diseases, because drugs for these diseases may not be attractive for development by the private sector.

In addition, the newly funded National Technology Centers for Networks and Pathways are expected to yield extremely sensitive tools to study protein dynamics inside healthy and diseased cells. The centers will work together to develop novel technologies in the burgeoning field of proteomics.

The catalyst for all this work was the Human Genome Project. That project cost $2.7 billion. It has been a tremendous investment in our future. And recognizing the importance of genomic research, President Bush and Secretary Thompson have requested nearly half of a billion dollars to support the work of the National Human Genome Research Institute for the upcoming year.

As we look into the future, it is not inconceivable that all of the variations in our genome could some day be tested for less than $1,000.

This information will allow us to predict disease risk, treat illnesses pre-symptomatically, guide prevention, and target treatment if necessary with medications that will be without side effects.

While this might seem like we're shooting for the moon, until we fully succeed, we'll be falling among the stars of medical promise.

Our success isn't without danger, however. There is a moral construct that must guide science.

The great paradox of scientific discovery is this: As we learn more about improving life and creating life, so too do we learn how to manipulate and 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. Consequences we haven't considered or fully comprehend.

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 researchers do, and to not allow mad science to prevail in the name of scientific progress.

Family History Initiative
While the future is clearly very exciting, and the way medicine will be practiced in 10 or 20 years will look completely different than the way it is practiced now, we can take steps today, to use the information we have, to make people healthier.

Next month, just before the holidays begin, I will be launching a public health campaign with the National Human Genome Research Institute, called the Surgeon General's Family Health Initiative.

And this campaign focuses on a single, simple concept: That knowing your family's medical history can save your life.

If you know that breast cancer runs in your family, mothers and daughters should get tested earlier than doctors usually recommend for the general population.

Or if the men in your family die young from heart disease, then fathers and sons should be monitored for cholesterol and high blood pressure earlier than usual.

Surveillance can lead to early detection. And early detection can lead to more effective treatments. It's a simple and well-proven strategy.

But many people often don't take preventive action because they don't think they are at risk. Knowing your family's medical history can help you know whether you are at risk or not. And then, with your doctor's help, you can figure out what to do to prevent health problems.

So that's why we have created a new computer-based tool called "Your Family Health Portrait."

It's not available yet, but in November, I'll be releasing it with my friend Dr. Francis Collins, head of the National Human Genome Research Institute, for anyone to get and use for free.

The tool is a software program that you can download onto your own computer; so you control all the information.

It will walk you through a series of steps that help you collect and organize medical information about your family. When you're done, you can print it out and take it to your doctor - giving her your family history for your own medical record.

For those of you who may not be so good with computers and the Internet, there will be printed versions of the tool. And there will be versions in Spanish, too.

Now, most folks don't know very much about their family medical history. You might not know that Uncle Billy has high cholesterol, or that Aunt Susie has low bone density.

That's why I want everyone, all over America, to talk about their family's medical history when they sit down for Thanksgiving this year, or Ramadan or Bodhi Day, or Hanukkah, or Christmas and Kwanzaa.

The campaign will declare Thanksgiving to be Family History Day, but every time you get together with your family, you should have a conversation to learn more about who among your family and blood relatives suffered from what kinds of illnesses - and then write it down with the new tool or just on a piece of paper so you will remember to tell it to your doctor. You'll be amazed at what you learn - and not just about disease.

And one more thought: knowing your family history is a kind of peek into your own genome. Illnesses that run in the families show us something about what's going on in a family's genes.

As researchers learn more and more about the human genome, they will be able to connect specific genes with specific diseases - and specific family histories. This should lead to a time when diagnosing one family member with a particular problem allows doctors to diagnose all family members at risk for the problem. And, ultimately, this knowledge will lead to specific treatments that cure the problem, not just treat the symptoms.

So, in a way, by participating in this simple preventive health program today, you also will be preparing for the future, when the promise of genomic science makes a real difference at the bedside.

I will be asking for your help on making this project take root. As we roll this out in November, I'll be looking to leaders in the field, like Tulane University, to take hold and begin to encourage patients and others to take account of their family's health history and share that information with their family physician.

The effort of prevention is a small price for the value of sustained and healthy life.

With the synergy of our efforts promoting prevention and research, we can assure a brighter, healthier tomorrow for all mankind.

Thank you. Congratulations on your 170th anniversary, and I wish you many more years, and many great successes.

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Last revised: January 9, 2007