2019 Last Lecture with Dr. David Wofsy

2019 Last Lecture with Dr. David Wofsy

November 12, 2019 1 By Stanley Isaacs


Hello, everyone
>>[NOISE]>>Welcome to the eighth annual UCSF last lecture. My name is Aishwarya Thakur and I’m the Vice President of the associate
student body of the School of Medicine. Thank you all so much for
coming out tonight. Please take a moment to ensure that your
phones are on silent before we begin tonight’s program. So we began the process of tonight’s last
lecture months ago when we asked students from the student governments from each
school to put together our nominee list. From this list, hundreds of students
from all of our UCSF programs voted and the winner of our speaker tonight is Dr.
David Wofsy.>>[APPLAUSE]>>Dr Wofsy started his medical career at UC San Diego, and
then received his residency and rheumatology fellowship here at UCSF. He is currently a professor of medicine
in Microbiology and Immunology and also the Associate Dean for
admissions for the School of Medicine. His research is directed towards
developing novel therapies for autoimmune diseases. And he’s been a part of
numerous NIA studies served on the Arthritis Advisory Committee
of the FDA and also is part of the American College
of Rheumatology. He was honored with the presidential
gold medal in 2015, the American College of
Rheumatology’s highest honor. During his time as dean of admissions,
he has been a part of thousands of future physicians’ journeys, and
has been able to admit a class that continues to be more diverse,
more talented and more passionate. When I was interviewing for medical
school, any time I would visit my parents, my dad would always put on
the UCSF YouTube videos on TV.>>[LAUGH]
>>Among the videos he would subtly, not so subtly make me watch were
the UCSF last lecture series. I have a suspicion he really wanted
me to come here if I got in. Months later I did get in,
my dad’s, thank you. [LAUGH] My dad’s wishes came true and
my dream came true. And I still remember Dean Wofsy’s simple
email that said, congratulations, I hope to see you at UCSF in July,
sincerely David Wofsy. It feels very full circle to have
the honor to introduce him today for today’s last lecture. All of those who have had the pleasure of hearing Dean Wofsy’s welcome
speech during interview day can attest to the fact that he has
a way of making us all feel special. Like we belong, and we deserve to be here. Dean Wofsy announced his
retirement earlier this year. And this coming year will
be his last year with us. Dean Wofsy, we’d all like to thank you for
your kindness, your thoughtfulness, your dedication
to students and medical education. And your chocolate chip cookies.>>[LAUGH] [APPLAUSE]>>And so, on behalf of the UCSF student body, I ask Dr. Wofsy, if you had but one last lecture to give,
what would you say?>>Thank you, [LAUGH] thank you so much.>>[APPLAUSE]>>Wow, well, first of all, thank you for
that wonderful introduction. Thank you all for the warm welcome. I’ve had some nice honors in my career,
you heard about some of them. I don’t expect ever to have
one that’s more meaningful to me than to have been chosen by
the students to give this lecture, nor one more intimidating,
I might add [LAUGH]. So anyway, I wanna thank the students for
this opportunity. But even more than that for
the sort of warmth and friendship you’ve shown me over all
the years, I really appreciate it. I imagine many of you know the origin
of the last lecture series, but for those of you who may not, it’s
probably worth a minute at the beginning. About 12 years ago, a faculty member
at Carnegie Mellon, having learned that he was terminally ill with cancer,
decided to give one last lecture. Mostly, it was a reflection on his life. And since that time
the lecture went viral. And other places have thought that
would be interesting to ask someone to, what they say if they
had one last lecture. Fortunately for me, I don’t qualify
on the same grounds that he did. So it will be part
reflections on my life but it also has some roots in a more
common academic tradition. In which an older member of
the community is asked to inspire the next generation and impart some profound wisdom that
students are presumed to lack.>>[LAUGH]
>>So first, and I can see you already think that’s laughable so I don’t need
to say that I think it’s laughable too. That’s not how I think wisdom works. And I brought along a book to make
that point before we even get started. I’m gonna read you a few things
from the first pages of that book. The book is entitled
The Physician Himself, which already gives you some sense
of the perspective of the author.>>[LAUGH]
>>And when you when you open the book, there’s a somewhat more thorough title,
The Physician Himself and things that concern his reputation and
success.>>[LAUGH]
>>Emphasis again on his. So a friend of mine called my attention
to this book a few years ago. It had been given to his father upon his
father’s graduation from medical school. And believe it or not, this book
was given to graduates from medical school in the United States, and
in England over a 50 year period through at least ten editions until
it was last published in 1931. And I thought you might be
interested to see what these two gentlemen thought was appropriate wisdom
to pass on to the next generation. And this is literally starting
with the first page of the book. So I’m gonna read to you
a few passages here. There are gentlemen in the ranks of our
profession who are perfectly acquainted with the scientific aspects of medicine. And can tell you what to do for almost
every ailment that affects humanity, who nevertheless after earnest trial,
have never achieved either reputation or practice, because they lack professional
tact and business sagacity. And there is nothing more pitiful than
to see a worthy physician deficient in these qualities,
waiting year after year for a practice and a consequence sphere of professional
usefulness that never come, okay? So here comes the advice for
those poor souls.>>[LAUGH]
>>Were such a physician to ask me, what shall I add to the strictly
scientific to make my success in practice more certain,
more rapid and more complete? I should advise him as follows. The location and appearance of your office will have
a great deal to do with your progress.>>[LAUGH] Select one in
a gentil neighborhood. So, they didn’t seem to be concerned
about service to the under served to later in this chapter I referred
to as the great unwashed, honest.>>[LAUGH]
>>Do not allow the ladies of the family to
lounge about your office, read your books, answer the office
bell etc, lest it repel patients.>>[LAUGH]
>>Do not induce young men to study medicine, as there are already three
doctors where one is required.>>[LAUGH]
>>Besides, either their success or failure may work an injury to yourself.>>[LAUGH]
>>Take care to be neat in your personal appearance, above all else wear
a clean shirt and a clean color for if you dress well,
people will employ you more readily, accord you more confidence,
expect a larger bill, and paid willingly.>>[LAUGH]
>>Even though you may have a homely figure and a baboon face.>>[LAUGH]
>>It’s the truth.>>[LAUGH]
>>You never heard a bank swindler or a confidence man or a counterfeiter or a pseudo gentleman of any kind Who
just shabbily or appeared coarse, such people are all close
students of human nature. And no matter how abandon they are, no
matter how tarnished their characters nor how blacken their hearts, they manage to
hide their deformity as avail from all but the few who know their true
characters by assuming the dress, and manners of gentlemen. Now, if the gentile dress and
polished manners can do so much for such fallen specimens of mankind, how much
greater influence must they exert for those who are truly gentlemen and
members of a lofty profession. So, I won’t go on that’s what these two
gentlemen thought was good advice for medical students. What they didn’t know is at the same time
they were setting a very low bar for my talk which I appreciate.>>[LAUGH]
>>So it emboldened me to construct
my own book for this occasion. And my book is entitled, Fleeting
Observations and Temporary Wisdom.>>[LAUGH]
>>Okay, so Chapter 1, in the beginning, there was Vophsi.>>[LAUGH]
>>So the first mention of my family is
recorded in the bible. And according to Numbers Chapter 13, Moses instructed 12 families to send sons
into the land of Canaan and report back. One of those sons was Nabi, son of Vophsi. Now as I interpret that biblical passage,
we were spies.>>[LAUGH]
>>[COUGH] I don’t really know what happened to Nabi,
if he ever got out the land of Canaan, but somebody from the family must have
survived because 4,000 years later, my grandfather is DeVophsi was born. All four of my grandparents were
born in Eastern Europe, and immigrated to the United States
around the turn of the 20th century. They were relatively poor, hard working, loving people whose courage in making that
trip and whose sacrifices when they got here are the things that provided for
me everything I inherited. All the opportunities. For me they symbolize the aspirations of immigrants
of all eras to have for their children the same things
my grandparents provided for us. My parents, we’re children
during the great depression. Newlyweds when my father entered
the army during World War II and political targets during
the McCarthy period in the 1950s. And for quite a while thereafter. Like my grandparents, they experienced hardships that were
far more than any I’ve had to endure. Their commitment to
progressive social change and to peace, shaped my values and
my view of the world. And while I’m introducing you
to the family in which I grew up that’s my sister Carla in the middle, and I’ll leave it to you to guess who
the little boy is on my father’s lap. [LAUGH] My father’s here today, all 97 years of him are sitting here,
>>[APPLAUSE]>>In the third row, [LAUGH]>>[APPLAUSE]>>And I have to say, one of the things that pleased me most when I found out
I was gonna get to give this lecture was the opportunity to thank him publicly
and to do my best to show off for him.>>[LAUGH]
>>That’s what children do. [LAUGH] And that brings me to Chapter 2,
which is entitled Just Lucky, I Guess. So, here’s a picture of my son Kevin,
age five days.>>[LAUGH]
>>I won’t try to deny the interpretation
you’ve already made. That I must have been looking forward
to playing ball with Kevin, [LAUGH]>>[LAUGH]>>But it didn’t work out that way, Kevin had not interest in ball sports,
it was obvious very early in his life. In fact, by the time he was six years old, my mother asked him,
why do you suppose you don’t like sports? And, he said, just lucky I guess, [LAUGH]. So, Kevin isn’t here today, his talents ended up to be in music and
writing and performance and in those pursuits, I have to confess he
never torn ACL he never broke a bone. He never sustained a concussion, I’m sure he’s much happier where he
is today where he is is Detroit. He has a part time job as a working
as a roadie with one of the companies that performs Hamilton around the country. And I’m sure he’s a lot happier doing
that than he would be if he had followed an athletic career. So I had to explain to Kevin since he
wasn’t gonna be here to see it for himself, I had to explain to him the whole
concept of the last lecture, right? And so I did, he thought about it and
he said, I’ll tell you a story. And he told me the following story. He said, I once took an art
history class from an old and very renowned art historian. And he walked in on the first day
of class and he set down his books, and he said, welcome to art history 413 or
whatever number it was, you may have noticed that I wrote
almost everything on your reading list. So let me explain, at my age I have little
patience for other people’s opinion.>>[LAUGH]
>>So some of you in the audience know Kelvin and will immediately recognize
his irreverent style of humor but I think he was also just
trying to remind me not to be too full of myself just because
I was giving this lecture. So there’s Kevin on
the right as he looks today with his partner Bret Betts here today. And I’m thrilled that he’s
representing Kevin so.>>[APPLAUSE]
>>In any case, It turns out I was like Kevin. I was lucky in ways that I never
anticipated, both personally and professionally. Professionally, I consider myself
extremely lucky to have been at UCSF during what I consider
to be a golden period. And I assure you, luck played a role. Maybe luck plays a role in everybody’s
life, but luck played a role for me and I’m gonna describe it. So here I am, about the time that my
fellowship was ending in the immunology lab at the VA hospital. I was getting ready to leave UCSF. I’ve been a resident here, I’ve done
my training in rheumatology here, I figured it was time to move on. I’d already had a conversation with
my division chief who had said to me, I suppose you know you
have no future at UCSF.>>[LAUGH]
>>There’s several people in the audience that
know this is an absolute true story. I won’t give you the background for
this quote, it’s not important. What’s important is what happened next. He left UCSF before I could.>>[LAUGH]
>>And that created a vacuum in rheumatology that brought Bill Seaman in at a young age
to be chief of rheumatology at the VA. And that in turn made it attractive for
me to stay, it was just lucky, right? I had nothing to do with my
boss’s decision to move to Texas. So years later,
I was at a Christmas party. Paul Verboding is here,
Molly Cook is here. It was at their house, and
a friend tapped me on the shoulder and said, I have the job for you. She was charing the committee
that was searching for a new associate deam for admissions. I hadn’t even applied for the job. Among other things, I wouldn’t have thought I’d be
a very strong candidate for the job. But she was the proverbial
friend in high places. And I was in the right
place at the right time. And I got the best job in
the whole institution. It was another stroke of
remarkable good luck. And I can’t help but
tell you that there was also a very interesting
coincidence associated with this. The person who saved my career at
the beginning, Bill Seaman, and the person who tapped me on
the shoulder about the admissions job, Maxine Papadacus, not only found me,
they found each other, [LAUGH].>>[LAUGH]
>>So, really in more ways than I can count,
I am fortunate to know these two people. But beyond these personal strokes of
good luck, I’m lucky to be at UCSF for the same reason we’re
all lucky to be at UCSF. And I’d be remiss if I didn’t use
some of the time in this talk to express that pride. At its best,
UCSF lives out the true meaning of what it is to be a public institution
with a public responsibility. In its educational mission,
in its clinical mission, in its scientific missions, and
there are examples in all of these realms. But for me, the prime example is always going to
be the early days of the AIDS epidemic. So the students in the audience and
amazingly, many of the young faculty in the audience,
weren’t even born, right? When the first AIDS cases showed up, more
or less simultaneously in New York and Los Angeles, and San Francisco in 1981. But you all know as a matter of history
what a terrifying time that was. Some men would come in with a rare
cancer we hadn’t ever seen, some of us couldn’t remember
ever even hearing of it. Other men would come in with
a catastrophic pulmonary infection, spend a few days or a week or
two in the ICU and die. And at autopsy, they had an opportunistic infection
that never happens in healthy people. And first,
there was a trickle of these cases, and then there was a flood, and
no one knew what was going on. But one of the things that became
clear early was that this was a communicable disease, and it could
be communicated to healthcare workers. And by and large, healthcare workers and
their institutions, and society as a whole behave
badly during that period. There are only a few places that
behave properly from the start. And the most prominent of them
was the University of California, San Francisco, particularly at
San Francisco General Hospital. I mean, you gotta think
about this epidemic, right? This is an epidemic that could
not have more precisely targeted populations of people that were already
marginalized from the healthcare system. Minority communities, gay men,
IV drug users, prostitutes. So maybe it isn’t such a surprise
in retrospect that it was easy for a lot of people to turn a blind eye. But for those of us who were
here at UCSF at that time, it’s always a reminder of what it means
to be the healthcare provider for the disenfranchised
people in your community. It’s not just talk here. We were tested,
we rose to the occasion, and when we’re at our best,
we still do it now. Now I’m gonna ask you to indulge me
a personal photograph from that time of three of the leaders during the early days
of the UCSF response to the AIDS epidemic. That’s Donald Abrams on the left,
and Paul Verboding on the right, both of whom are still at UCSF,
and my late wife, Connie. Who took care of people who
were living with AIDS and people who were dying with AIDS throughout
her own terminal illness until her death from breast cancer in 1996. These weren’t the only
leaders during that time. Of course, there are many of them,
and many of them are still here. But some of the people who
played an important role in, people like Merryl Sandy, John Mills,
Marcus Conan, Jay Levy, Julie Gerbeding. And a host of others who took
care of people with AIDS, who developed strategies to prevent aids,
and new approaches to the treatment of AIDS. And then spread those
discoveries around the world, and eventually contributed to transforming
HIV from a uniformly fatal disease, to in most cases,
a manageable chronic illness. When UCSF sights its slogan, right? Advancing health worldwide. That’s what it means, it’s real. Now, you may be wondering,
right, it’s me, giving the talk. What was I doing during that time?>>[LAUGH]
>>Did I have any contribution at all to make? And the answer is, I absolutely did. I had a very key contribution
to make during that time. It’s been largely lost to history, so this is my opportunity,
perhaps my last opportunity to revive it. So while these people were dealing
with life and death issues and the most important medical
challenge of the times. I was toiling in obscurity in the VA
hospital in an immunology lab, taking care of mice.>>[LAUGH]
>>Waiting for my moment to come, right? And then one morning I went to
work in 1991, and it was my time. Rumors were swirling about, Magic Johnson had called a press
conference for that afternoon. And he was going to announce his
retirement from the Los Angeles Lakers. Because he was HIV positive. Well, Connie was a lot like Kevin. She had very little
interest in ball sports. So I thought I better call her up and
tell her what was about to happen so she’d be ready. And I did. And she said to me, who’s Magic Johnson?>>[LAUGH]
>>So. That was my contribution. I spared her the embarrassment of
asking anybody else this question.>>[LAUGH]
>>Well that’s all the time I have for
the clinical mission of UCSF, but I am equally proud of
the scientific mission of UCSF. During the last 30 years, there have been
more Nobel prizes in medicine awarded to faculty at the University of California
San Francisco from medicine than any other place in the world.>>I mean, what an amazing accomplishment. Michael Bishop and Harold Varmus for the discovery of the cellular origin
of retroviral oncogenes genes. Stan Prusiner for the discovery of
prions and novel infectious agent that most people didn’t believe
existed that’s responsible for degenerative neurologic disease. Liz Blackburn for
insights into the genetic basis of aging. And most recently, Shinya Yamanaka for demonstrating that mature cells can be
transformed into pluripotent cells. It’s extraordinary range
of important contributions. But it’s not important that we have more
Nobel Prize winners than anyone else it’s just nice, right?>>[LAUGH]
>>As I sometimes say to people, the way it affects me is sometimes I’m
standing in the lunch line next to a Nobel Prize winner and it feels good.>>[LAUGH]
>>Otherwise I don’t know how it affects me, but what.>>[LAUGH]
>>But what’s important is what it says about the quality of the scientific
environment that UCSF and the contribution that our scientists make to people who
will never walk through our doors. Okay, so in the same month that
Shinya Yamanaka received the Nobel Prize, UCSF received the Spencer Foreman Award. That’s the highest award of the American
Association of Medical Colleges for community service. And the simultaneous receipt of
those two awards has symbolized for me what we often talked
about as special at UCSF. We know there are other
great medical schools. It’s arrogant to say we’re
better than all of them. But if there’s a secret sauce that makes
us different, it’s the simultaneous equal strength in basic science and
primary care and community service. That’s what makes us different. And it used to be easier to maintain
a belief that that was the truth. When I started here,
the place was smaller. There were fewer faculty, there were fewer
sites, we tended to know each other. And it was pretty easy to maintain
a sense of mutual respect between the clinicians and the clinical
and translational scientists, and the educators, and
the basic scientists, for the essential contribution that everybody
was making to the entire enterprise. It’s harder now. The faculty is much bigger. We tend not to know people well who
do things different than we do. And people are spread
out all across the city. So this notion of
maintaining this genuine, mutual respect is harder to maintain. But I would argue that in this era,
especially with dwindling resources that tempt us to fight with each
other over a small pool. It’s probably more important than ever to
maintain that sense of mutual respect and importance. We are all in this together. If anything makes us different,
that’s what makes us different. And we are lucky to have each other. Now while I am talking about luck,
it turns out that for many years on most days
there comes a moment when I think to myself, how did I get so lucky? But it wasn’t until recently
that I realized that, that moment always comes at pretty much
the same time and here’s when it happens. I’m walking down the hall, I see somebody coming from
the other direction who I admire, who I feel privileged to know and I think
to myself, how did I get this lucky? And sometimes,
it’s somebody I know well, right, who might not be so surprised that
I have warm feelings about them. But most of the time,
it’s a faculty member or a staff member who I don’t
know particularly well. Or maybe it’s a student whose name I
just can’t pull to mind until I’m five steps further down the hall, and it’s too late to address them by
name which I hate about myself. That’s when it happens. Those are the moments where I say
to myself how did I get this lucky? It’s about the people I’ve
worked with all this time. And frankly, I thought about, is there a
way in this lecture, to mention the names of all the people who would be surprised
to think that’s how I feel about them. But I can’t, it’s too many people and it’s
of no interest to anybody else but me.>>[LAUGH]
>>[COUGH] But there are a few people I wanna pause to acknowledge because they’ve
had such a big role in my success. And there are people on our staff who tend to be overlooked when faculty
members like me get all the credit. So this is Lydia Espino,
most of you don’t know her. Lydia has supported my
research in rheumatology, and the research of many others
in rheumatology, for years. You’re not going to meet a more
intelligent person, more dedicated, and hard working than Lydia. Nor anybody more kind,
more devoted to our patients, or more representative of
the best values of UCSF. More of you know these two people,
my closest colleagues.>>[APPLAUSE]
>>My closest colleagues in admissions
on the left is Kathy Ryan. Kathy was already working
in admissions and experienced at it when I started there. So she taught me most of what I
know about how to do admissions. And on the right, Helen Chung
my indispensable right hand for the last 12 years. Nothing we’ve accomplished in admissions
during that period of time would have been possible without the superb
work of these two people or their commitment to academic
excellence and diversity. If I were to disappear tomorrow, admissions would run smoothly it would
have fewer chocolate chip cookies. Other than that,
you might not notice the change. That’s not false modesty. That’s the absolute truth. If these two people were
to disappear tomorrow, that would be an immediate crisis. I also want to acknowledge three people
from student academic affairs and financial aid. Lisa Rasulinic, Annie Osborne and
Gerry Lopez their quiet, behind the scenes commitment
to maximizing scholarships for students is extraordinary. And it’s done without any
thought of personal recognition. So how do I feel about working with
all of these people like Kevin, just lucky, I guess. And that brings us to chapter three. Chapter three is entitled
Into Each Life Some rain Must Fall, subtitled Lessons on Hubris from Henry
Wadsworth Longfellow and John Steinbeck. Okay so, in this chapter we learn
that not all luck is good luck. So I decided to go into rheumatology
cuz it looked like the field of immunology was exploding about
the time that I was a resident. And it seemed like it was inevitable for
progress in immunology to be transformed into meaningful advances for
people with rheumatic diseases. I had no illusions about making
a singular contribution to that progress, but I thought it would be exciting and
rewarding to be part of the wave. That’s what I signed up for, and
that’s how it turned out to be. Not gonna describe what a career
in research is like but chapter three tells two
stories that in retrospect are part of a successful
career in academic research. So the first story is from really
pretty much the beginning of my time on the faculty at UCSF. I was studying a strain of mice that
spontaneously develops a disease that closely resembles
systemic lupus in people. Okay, so systemic lupus is
a serious autoimmune disease, it affects primarily young women. At its worst Lupus causes
autoimmune kidney disease and can lead to kidney failure and
in some cases, it’s fatal. This mice are similar in
the sense that the female mice are more severely affected than the males. They make the same autoantibodies
that people with lupus make. And the females developed autoimmune
kidney disease early in life, and they die young. So at about the time that I was
starting to study these mice, it had just been discovered that,
the difference between the female mice and the male mice could be entirely
explained by sex hormones. Female hormones,
estrogens made the disease worse. Male hormones, androgens
protected against the disease but no one knew how these hormones
exerted their effects. So we set out to try to understand what
cells might be involved in that process. And the way we decided to do that was,
we would take female mice, we would give some of them estrogens
to accelerate their disease. We’d give others of them androgens
to protect against their disease. We’d let the disease play out, and then
we would harvest cells from these mice, purified the different cell populations. Mix them together in different ways and
inject them back into healthy mice, and see which cells carried
the ability to advance the disease and which cells protected against the disease,
okay? So that’s that’s what we did and so
finally came the day we harvested cells from these mice,
we separated the B cells and the T cells. We took B cells from the estrogen treated
mice, combined them with T cells from the androgen treated mice,
put them into healthy mice. We did the reverse, right? B cells from androgen treated mice and T cells from estrogen treated mice,
injected them into other healthy mice. And, of course, we had controls,
mice that got B cells and T cells from the same source, right? And when you do that you have to
irradiate the recipient mice, so that you wipe out their own cells, so that what you see in those mice after the
transfer is the effect of the new cells. And when you irradiate the mice,
they’re immunosuppressed, right? And you don’t want them to get infections. So you take those cages off the common
watering system in the animal house, where they might pick up pathogens
from that common watering system. You put them in cages on on the counter, you put tops on the cages you put
water bottles on the top of the cages, you use acid water to further protect
them against infectious agents. Six mice to a cage you carefully
label all the cages, went great. Okay, very long day I go home, everything’s fine all we gotta do now is
wait and see what happens in these mice. Came back the next morning and went into
the animal house to see what was happening and to my horror, the mice were
having a granddaughter party.>>[LAUGH]
>>Okay?>>There were some cages with 11 or
12 mice, where there had been six the night before.>>[LAUGH]
>>And there were other cages with one or two apparently anti-social mice, and there
were some mice that were gone altogether. And I just stood there staring,
thinking who hates me so much that they would have sabotaged
my experiment in this way. Did someone come up from Stanford and sneak into
>>[LAUGH]>>Animal care facility? And I knew a couple of people at Stanford
during that time where it was a logical thing to worry about.>>[LAUGH]
>>[COUGH] Anyway, as I stood there, I watched the mouse crawl out of one
cage scamper down the counter and crawl into another cage. And that’s when I realized I was
the saboteur, cuz what had happened is when I removed the mice cages
from the common watering system. I hadn’t paid attention to the fact.>>That there’s a hole in the back
of the cages through which the spigot inserts that connects
them to the common watering system. Now I have to say all these years later, I don’t recall if I thought that hole was
too small for a mouse to get through, or if I didn’t think about it at all, which
seems much more likely in retrospect.>>[LAUGH]
>>But that’s what was happening, mice were crawling out of these holes,
crawling into the holes of the next cage. I had no idea which mice had gotten which
cells, only the cages were labeled, not the mice. And months of work not just by myself,
but by other people in the laboratory, and who knows how many dollars of grant
money was blown in one act of stupidity that that you would have assumed
an eight year old wouldn’t do right? So [COUGH] That story number one
somehow I got through that story and went on to have some successes and these mice enough successes
to Advanced my career. And I’m gonna take this off the screen
I don’t like to look at it. [LAUGH] So in the 1990s,
we did a series of experiments that went really well that got me
my only publication on science, and it led us to think we
might have a treatment that would be effective in people with lupus. And that’s when I went through the
transition in my own career between being a bench researcher, to being someone who performed clinical
trials of novel therapies of people. And that was a long transition it took
us a long time to generate the grant funding to think about being able
to do a clinical trial in people. And it took us a long time to
get the drug company to agree to let us use the drug in
the treatment of people with lupus. But eventually in 2008 We
got to begin the experiment. And then it took 4 years to
enroll people in the trial, it took another year to let
them all get to the endpoint. And finally, on February 27, 2013,
we were gonna find out the answer. 21 year, right? The first experiment of mice
have been done in the 1992. This is a peculiar thing, specially for a bench researcher moving
to clinical trials. You don’t think of. 21 years of experiments all coming
to a head on one moment, but that’s what happens with a clinical trial. Because it’s blinded you don’t know
which people are getting which drug. And somebody you don’t know is gonna
push a button at a statistical center in North Carolina at 9 AM
on February 27th 2013. And tell you if your trial worked or
if it failed, right. So that was my situation the night
before and it’s very hard to think about anything else on that night,
you’re trying to pass the time. We had reason to think we would really, we were really optimistic about
what we would find the next day. I was communicating back and forth by
email with my closest collaborator and coinvestigator in New York
just trying to pass the time. And I finally thought, I’m gonna lookup if any famous
people were born on February 27th. And see what they had to say,
see if there’s any omen there, right.>>[LAUGH]
>>So Henry Wadsworth Longfellow was born on February 27th, 1807 and he had written, into each life some rain must fall, right. And that was not the quote
I was looking for.>>[LAUGH] [APPLAUSE]
[LAUGH]>>So I kept looking, John Steinbeck was also born on February 27th, 1902, I think. And he had written, man is the only
kind of varmint that sets his own trap, baits it, then steps in it.>>[LAUGH]
>>And, of course, as it turned out the next
morning they were both right, the treatment group and
the control group were identical. The treatment had failed. So I tell you these two
stories of failure and not stories about successes. Cuz the mere fact that I’m
standing up here in front of the room is evidence enough
that I must have had successes. What we don’t usually talk about, in
fact what we usually try to conceal, and it’s true for me too,
are our failures, our disappointments, in my case our acts of
incredible stupidity. But we get through it because
of the support of our family and the support of our institution
that let us keep trying. And because we know that even these
disappointments are part of the wave and that’s what we signed up for. And that brings me to Chapter 4. Now, in Chapter 2 I
expressed my pride in UCSF, Chapter 4 is about things
we need to do better. It focuses on three wishes,
two of these wishes are things that
are specifically about UCSF and we can make them come true. And I should be very quick to say
before I even describe these wishes, these are not just my wishes. These are the wishes of the majority
of people in leadership at UCSF and the majority of people in our community, many of whom are already
working to make them come true. I just happened to be the person who’s
in a position to give them voice today. The third wish is a wish for
the profession as a whole, we can’t accomplish it at UCSF,
but we can contribute. So wish number one. There needs to be a dramatic increase
in the diversity of our faculty, particularly with regard to
African American faculty. And it needs to happen on a timeline
that is entirely unprecedented in our history, okay, so.>>[APPLAUSE]
>>This figure shows the percent of our
faculty that are African American. And I call your attention to the y axis
because it wasn’t chosen arbitrarily. The y axis goes to 12, because 12%
of the United States population are African American,
somewhere between 12% and 13%. So in 2006,
2.4% of our faculty were African American. In 2018 the most recent
statistics that I was able to get from Renee Navarro 2.8% of the faculty are
African American, a sky rocketing change. At this pace of progress UCSF
faculty will reach equivalence with the US population in 120 years,
okay, the year 2139. When those are your numbers,
when this is your graph you have to acknowledge you’re part of
the problem not part of the solution. Okay, now things aren’t quite as
grim as this figure makes them look. There actually has been a substantial
increase in the absolute number of African American faculty at UCSF during
this period as the total size of the faculty has grown. And you can make out even in this flattish
line that all of the progress has been made in the last five years. And it’s been made because people have
been working very hard on this issue, launching new initiatives. Such as the Watson Scholar Initiative,
for example. So maybe we can sustain that rate
of progress in the future and it won’t take 120 years,
it’ll take 50, okay, and that’s too long too, right, so. The formula, in my opinion, for doing this in less than 50 years
is simpler than you might think. And it starts with simply making
a decision that there are no excuses and no rationalizations for the snail’s pace
of progress over the past several decades. No talk about pipeline issues, or
competition from other academic institutions, or
the cost of living in San Francisco. Just make a decision that no
other outcome is acceptable, then set a goal, track the progress
toward the goal, and make it happen. I know that sounds naive. I am naive about things like this, but I
believe that’s an essential first step and I believe if we take that first
step we can make it happen. And I think we have evidence in
our own community that it works. Wish number two,
UCSF should be true to the defining characteristic of public education and
that’s affordability. In recent years the graduation debt for a medical student at UCSF
has surpassed the graduation debt at our major private competitors,
okay. So this shows the comparison between UCSF
and Harvard, Harvard is the red line. 20 years ago the average debt
of a graduate from UCSF was 30% less than the average debt at Harvard. The lines crossed ten years ago,
and they’ve continued to diverge, and now the average debt at UCSF is 30%
higher than the average debt at Harvard. And there’s nothing unique
about this comparison, if I were to show you comparisons
with our other two or three main private competitors
they all follow this pattern. Hey, when your graph looks like this. The whole concept of public education
loses much of its meaning, right? We don’t wanna be the people
who let this happen. Now there is good news and
I think many of you know it. In recent years here, it has become a very
high priority to reverse this pattern. And through the hard work of
a lot of people at UCSF and the generosity of some very big donors, there’s been a sharp increase in
philanthropic support for scholarships. At the moment, much of that philanthropic
support is still in the form of pledges. When those pledges come to reality, it may be possible to change
the shape of this curve. Although there’s no guarantee that
even then, it will be enough. And in any case, until that happens, we need to think of other
ways to impact this graph. Now, I think you’re aware of some of the
things that are happening on this campus. For example, in the last few years,
there’s been added to the budget, a cost of living adjustment for
all the students across the campus to help offset the high cost
of housing in San Francisco. That’s an important step,
but it’s not enough. And I would like to think
that at some point, we will at least enter into discussion,
about whether or not there should be a line item in the annual budget
of UCSF for student scholarships. Right now,
the sources of scholarships are these. The students and their parents contribute
to scholarship support through the tuition that’s paid a portion of which is
returned to students as scholarships. And the other source is philanthropy,
right? There is no line item in the budget
separate from those two sources that says UCSF is going to be using some of its
revenue to devote to student scholarships. I think it’s time to think about
whether that should exist. Now having said that, let me be clear, and
I truly believe that the students in this audience know and
understand what I’m about to say. Student scholarships is not
the only priority on this campus. It’s easy to talk a graph
without a context, okay? There are other very compelling needs
here that have just as high a priority, some might argue a higher priority, right? I mean, how do you prioritize the need
to provide a living wage to the people who work here so that they can live in the
same expensive city in which they work. You have to provide state
of the art resources for the faculty that are already here. That’s become a big issue on the Parnassus
Campus so that people aren’t tempted to leave and go to other institutions or
to private industry. You have to maintain really
appealing recruitment packages, so that the next generation of outstanding
people that are attracted here can maintain the standards that have
been set over the last generation. And those are problems
that defy easy solutions, especially when resources are limited. So I don’t wanna be misunderstood here,
this is one of many important priorities. But, at the moment,
I don’t think it’s on the table when the income of the institution
is doled out for next years budget. It may be that only a token
amount can be paid to that. But I think just adding
a line on to the budget would be an important statement to say,
we’re all in this together and we have a responsibility to
change the shape of this curve. Now before I leave it I
want to make a point. I know the medical school best and so
I’m showing you medical school data. And I’m guessing that most of the people
in the audience are from the School of Medicine. But I could show you figures
from the other schools here. If I showed you the Dental School debt it
would be considerably higher than this. This is not just the School
of Medicine problem. Wish number three is the big wish, okay? I hope and I believe that
health professionals will play an important role in solving
the daunting social, political, environmental, economic
challenges that have an adverse effect on human health in
the United States and around the world. Climate change, gun violence, poverty,
race hatred are among the social determinants of health where
we need to be outspoken. Okay, but
I’m not gonna talk about them today. I’m gonna talk about another
factor in which physicians have historically been activists, but
where I think we’ve become numb. Beyond the impact of climate change,
I think the greatest threat to human health and
to human survival is war, okay? And there are a lot of
ways to make that point. We don’t talk about it here. We don’t really feel it’s
part of our curriculum. But we live in an evidence based
environment here with a reliance on the medical literature. So I’m gonna make the point with
an article from the New England Journal. In 2008 there was an article
in the New England Journal that described
the Iraq Family Health Survey, okay? What the Iraq Family Health Survey set
out to do was to quantify the number of combatant deaths in Iraq during
the first three years of the Iraq War. But it also quantified the increase
in civilian non-combat related, health related deaths from diabetes,
from all causes. And what they found was that compared to
the three years prior to the Iraq War, there was an increase of 300,000 health
related civilian deaths in Iraq. Hospitals had been bombed, right? Doctors had fled the country or
been killed. Medications were in short supply and
access to them was extremely limited. The infrastructure was destroyed,
sanitation was awful, living conditions were awful, and as a result on
average during those three years, there was an excess of health
related deaths of 275 per day, okay? Hard to sort of adjust,
what does 275 per day mean? So I’m going to put it in perspective, at least in the way I’ve
tried to understand it. 275 civilian deaths every
day is the equivalent of one Twin Towers attack every
10 days for three years, right? In a country whose geographic size and population is about the same as Texas. So we don’t react to that
statistic in Iraq the way we would react if there was a Twin Tower
attack in Texas every week or two for three years, right? We just don’t feel war in
the United States the way it’s felt in the rest of the world. But I actually added up the number of
years in my life that the United States has been at war, troops on the ground
fighting in other countries. And the answer is about half my life. And for those of you in the audience
who are younger than I am, your country has been at war for
more than half your life. [BLANK AUDIO] I also
added up the number of countries we’ve bombed during that time. And if that brings a number to your mind,
I can assure you the number it thought to your mind is too low,
because the number is 25. What I haven’t been able to quantify
are the tens of trillions of dollars that have gone into those
pursuits or the effect that’s had on the social programs in the United States,
such as the ones I was just talking about. Public education and student debt, okay? Politicians aren’t gonna
solve this problem. In my life,
we’ve had this wars under all presidents. Liberals and Conservatives,
Democrats and Republicans. It really feels to me at this point that
the only thing that ever gets bi-partisan support anymore is the decision
to go to war or bomb somebody. This is gonna change if there
are movements of people. And I think there is
a compelling logic for physicians to have a leadership
role in those movements. And there’s evidence of it, and there’s evidence of impact from places
like the International Physicians for the Prevention of Nuclear War or
the Physicians for Social Responsibility. So I actually think it’s
reasonable to wish this wish. Now there are a lot of important wishes,
a lot of things that need to be done. This may not be your wish, right? But I’m hoping that some of
the people who come through UCSF and go on in life will make this their wish. So I’m gonna pause here for a moment and
admit that for the last two or three weeks, I’ve struggled with whether
Chapter 4 belonged in this book at all. The chapter I just told you. I had it out, I had it in. I took out one wish, put in another wish. These are three very complicated
problems that I’ve dealt with, right? And you can’t deal with them, you can’t
do justice to them in five minutes. They’ve each had about
five minutes in this talk. My guess is that even people
in this audience who generally agree with me on these topics will
have said it a little different way or take an issue with something I said. And there are no doubt people in this
audience who actually disagree with some of the things I’ve said. But in the end, I left them all in,
because if this was my last chance to say anything these would be among
the things that are on my mind. A More Diverse Faculty,
Affordable Public Education, World Peace.>>[LAUGH]
>>And if not world peace, at least a more peaceful foreign policy. I’m serious about all of these wishes,
but I confess an ulterior motive for wish number three. It’s intended to make wishes number
one and two look really easy.>>[LAUGH]
>>Okay, so that’s all the heavy stuff, thank you
for listening, that’s what I believe in. The rest of the book is more personal, Chapter Five is entitled
Sleepless in Sapporo. In December 2004, I attended an
Immunology Conference in Sapporo, Japan. On the night before I was to fly home,
I was staying in a ryokan. A ryokan is a really nice inn in Japan. Functionally, it’s probably a lot like
a motel in the United States, but much nicer. But one of the things about a ryokan
is you sleep on a mat on the floor. And for that reason, and maybe others, I was having a lot
of trouble sleeping that night. But it wasn’t the usual trouble sleeping
where you’re going through your worries in your mind, and what am I gonna find when I
go home, and all the work that’s piled up. No, I was in a very good mood that night. And I had found my mind wandering to
the happiest experiences of my life. And then I did something
entirely out of character for me. I can’t tell you how
entirely out of character. I got up, opened my computer and decided to write down the happiest
experiences of my life. No rules about what was written. No filters. No preconceived notion about how
many things would be on the list. Would it be a top ten list? It’s just right as fast as
things came to mind and see what was there when I finally pause
and couldn’t quite know what was next. So I did that, and at the end
there were 13 things on the list. I’m not gonna read you the whole list. You’re probably thinking, what a relief.>>[LAUGH]
>>I’m not gonna read you the whole list, but I do wanna make some
observations about my list. Number one on my list, I truly believe would be number one on
the list of many people in this audience. And it’s only for that reason that I’m
not embarrassed to tell you what it is. Number one on my list was falling in love,
okay? There’s no experience like that, you can’t think of an analogy to that
experience, so that belongs number one. The rest of the list was
dominated by my children, and to a lesser extent,
other members of the family. So now is the time I should introduce you
to the children you haven’t met yet, okay? This is my daughter Susan. Kevin’s in Detroit but
I can always count on Susan to be present.>>[LAUGH]
>>And these four pictures, each one of them is from
a different item on my list of 13. So I am hoping that
Susan will see this and realize what a contribution
she’s made to my happiness. Now a lot’s happened since 2004. So if I made a list now,
it would definitely include a very unconventional wedding with Theresa
Fitzgerald and a very happy marriage. And it would certainly include a moment
that I always referred to as Wheels Up in Cincinnati when Grace
joined the family, okay? But what struck me most about
my list was what wasn’t on it. There was nothing on it
about academic achievement. I had devoted my career to academic life. I had been successful at it. I had enjoyed it and it wasn’t on my list. In fact, the only thing that was on
my list that pertained to my time at UCSF was an entry entitled memorable
patients, along with their names. I really wanted to say
their names out loud here. I’m sure every one of them, if they
thought that I would be mentioning their name in this context, would be thrilled. But I’m going to obey HIPAA.>>[LAUGH]
>>I know this is gonna be online, and I’ve already said other things that
are gonna get me into trouble.>>[LAUGH]
>>I don’t need to mess with HIPAA.>>[LAUGH]
>>But it was a shock to me. There was no time in my
career after my fellowship, that I devoted more than 20%
of my time to patient care. And patients were the only
thing that made my list. Now if I were to make a new list now, there would be an academic
achievement on it, okay? So in the 14 years that
I’ve been Admissions Dean, more than 2,000 people have come through
UCSF and graduated as doctors, okay? To have played a small part
In launching their careers has been an extraordinary experience. All of the things these people
will accomplish in their life. All of the patients they’ll help. All of the lives they’ll save. All of the discoveries they’ll make. All of the ways they’ll change and improve
healthcare delivery in the United States. That’s a legacy that
brings me great pride. And within that legacy,
the greatest pride, as you heard in the introduction is in
the growing diversity of the class. So this slide shows the diversity in the
student body at UCSF since the year 2000. I became Associate Dean for
Admissions in 2005. Prior to that time, on average 18% of
the student body came from racial and ethnic groups that
are underrepresented in medicine. Between 2006 and 2011, it was 29%. And in the most recent period,
2012 to 2018, 32%. Now, individuals don’t
make this kind of change. I just wanna be as
absolutely clear as I can, many factors go into this kind of change. Starting first and foremost,
with the extraordinary talent and quality of the applicants
that we’ve accepted, but also including commitment
of the admission staff. Of countless faculty who
are committed to this goal, and who participated in
the admissions process. It’s attributable to
the students who came here, and worked hard with us to
recruit the next classes. And it’s attributable to the people in
financial aide who worked hard to increase financial support for students, so that wasn’t an obstacle
to people coming to UCSF. And it certainly was attributable
to the people to whom I report, and who were unwavering in their support for
this change. Currently, Catherine Lucey and
Talmadge King. And before them,
Dave Erbe and Sam Hallgood. I mean, all of that went into this. You don’t make this change so
that you can boast about it. Right? We do this because it’s our job. There is compelling literature that says,
if you’re responsible to turn out doctors to take care of the diverse
population of the people of California, you better be turning
out a diverse workforce. If you don’t, you’re not fulfilling your
public trust, that’s why this happens. But even before you
fulfill your public trust, even before it impacts society,
it changes your institution. And all you know that. If we didn’t have a diverse class,
there is no way UCSF would have been among the few schools that
launched the White Coats for Black Lives movement that’s now spread across the
country, as a powerful force for change. And if that hadn’t happened,
the New England Journal wouldn’t have been writing about it, and wouldn’t been
addressing issues of racism in medicine. And if you didn’t have a class full
of people who cared about that, we probably wouldn’t have scoured our
curriculum to remove stereotype threat. And examples of racism, and
sexism, and homophobia. We wouldn’t have re-examined
our grading system, to look for unnoticed bias in
our approach to grades or AOA. We probably wouldn’t have
diversified the residency programs, which has been one of the big
pieces of progress in recent years. You don’t have to wait a long time,
to see the impact of diversity. It’s all around us, and
it’s made us better. And here’s the last chapter, I’m late.>>[LAUGH]
>>You laugh too much.>>[LAUGH]
>>It’s your fault, [LAUGH]. But this is the last chapter, and
it’s not as long as the others. I haven’t shown you the title
of the last chapter yet. The title of the last chapter is the same
as the title of the last entry in my list of happy experiences. And, I’m including it because it’s in the spirit of this
talk to be honest about who you are. So I’m admitting a guilty
pleasure to conclude. The last chapter in my book is entitled,
Baseball as an Emotion.>>[LAUGH]
>>My daughter is hiding her face but she is symbolizing baseball as
an emotion in this photograph. In a moment, I’m gonna read to you
the entry under baseball as a motion on my list, but
I need to explain something to you first. I was born in New York City when
the Dodgers, the Giants and the Yankees, all had New York teams. If you were a little boy in New York,
you cared about baseball. And I was born four months before
Jackie Robinson broke the color line. And I became a Dodger fan,
because of Jackie Robinson, and Roy Campanella, and Don Newcombe. And also, some of the white players,
Peewee Reese, and Duke Snyder, and lots of other people whose
names mean nothing to you, who will be vivid in my memory
until the moment I die.>>[LAUGH]
>>Okay, I was among those little boy Dodger fans who argued, that Duke Snyder
was better Lilly Maze, right? I even knew then it wasn’t true,
but I argued it.>>[LAUGH]
>>But somehow over the course of time, I made a transition that would have
been unthinkable to me as a child. I transferred from being
a Dodger fan to a Giant fan. But, that’s why my least is
equal parts Dodgers and Giants. Here’s what I wrote. An array of special baseball moments
should count as a single experience, call it the experience
of sport as an emotion. The Dodgers first world
championship in Brooklyn, listening to Sandy perfect
game on a portable radio. The polo grounds and Yankee stadium
in field with my father in New York. And 50 years later, returning
the favor by taking him to a game that Barry Bonds ended with a game winning
home run, in the bottom of the night. A Giants game with Kevin and
Susan for Father’s Day in 1998, being among close friends from Boston,
when the Red Sox finally beat the Yankees. Crying, every time at
the end of field of dreams.>>[LAUGH]
>>Okay, that was my 2004 list. It was a pretty good list, but now it would include three world
championships as a Giants fan. It would include taking my father to see
Tim Lincecum Pitch in the world Series, 74 years after he had seen Carl Hubble
pitch for the Giants in the World Series. He may be the only human
being who can say that. It would include taking Grace to her
first baseball game when she was three weeks old.>>[LAUGH]
>>And in one of those amazing things that just
shows you the unpredictability of life. Even Travis Jesse Carlin
might have been in my book.>>[LAUGH]
>>And if you don’t understand why ask somebody,
dear you become clear. I don’t know why sports moved me so
much, but they do. I don’t expect ever to understand
the deep psychological explanation for that, but one of the factors I’m sure,
is that in sports you know when you win. And you know when you celebrate. The game is over, the world series is
over, you look at the score board, you know you won and
it’s time to celebrate. Real life isn’t like that, real life doesn’t have a lot of absolute
victories and unrestrained celebrations. We tend to think more about
the disappointments and dwell on them. And I think preparing this talk for me and thinking back on things,
helped me sort of think through. Think about the fact, that I really
needed to notice the everyday victories more than I do, and
take time to celebrate them. I think, for
many people that sentiment is encapsulated in the phrase, smell the roses. For me, it may be closer to play ball.>>[LAUGH]
>>So. All of that comes under the heading
of fleeting observations.>>[LAUGH]
>>This is all you’re gonna get for Temporary Wisdom. Number one, it’s all about the people. I didn’t actually set out for
this to be the theme of the talk, it just became the theme organically and
I didn’t notice it until I was done. But it was about the people, and that’s
true of course in our personal lives we know that, but
it was true in my professional life. It’s about the people who gave me
the opportunities that I’ve had in my research career,
in my associate dean career. It’s about the people who stuck
with me when I did stupid things. It’s about the people I pass in the hall. It’s about the patients I remember when I
don’t remember much else about my career. It’s about the students who come through
here and go on to do amazing things. I have two friends here in the first row,
it’s about friends you trained with who come from far away because they know
you’re nervous about giving a talk, and they wanna be supportive. It’s all about the people. Number two,
be part of something bigger than yourself. Something you can’t achieve on your own,
but that you can achieve by
working with other people. So for me in my research career, it’s
been looking for better treatments for autoimmune disease and
lupus in particular, we’re not there yet. Someday that will happen and
I will have been part of that. And in my admissions career,
it’s creating a more diverse workforce. You can’t do that alone, but
if enough people do it, it will happen. So that’s the second piece of wisdom. The third piece of wisdom I haven’t talked
about at all, it’s my sister’s wisdom. Help the person in front of you. So shortly after my sister Karla died, her daughter told me something
that Karla had said to her. Karla had said, you may not be
able to change the world, but you can always help
the person in front of you. And I’ve always thought that’s about
the best advice I’ve ever heard, and I particularly like it in the context of
the second piece of wisdom here, right? The second piece of wisdom says be part of
something you can’t achieve on your own. And the third one reminds you there are
things you can achieve on your own, right? So these are my,
this is my temporary wisdom. I’m also gonna steal one piece of wisdom
from somebody else because it resonates so strongly with me. Change will not come if we wait for
some other person, or some other time. We are the ones we’ve been waiting for. We are the change that we seek, okay? And one last message from me,
try to celebrate. [LAUGH]
>>[LAUGH] [APPLAUSE]>>Thank you. [LAUGH]
>>[APPLAUSE]>>Thank you so much.>>[APPLAUSE]
>>Thank you.>>[APPLAUSE]