June 14, 2008

‘Do Research,’ Nobel Laureate Roger Kornberg Urges Graduates of Stanford Medical School

Nobel laureate Roger Kornberg, PhD, professor of structural biology at the Stanford University School of Medicine, will deliver the commencement address to the medical school's class of 2008 on June 14. Kornberg won the 2006 Nobel Prize in Chemistry for his discoveries of how DNA is converted into RNA, a process known as transcription. In recent months, he has met with national lawmakers to discuss the importance of continuing to fund scientific research. The text of his speech follows below:

"Dean Pizzo, members of the faculty, families, friends, and most of all, class of 2008.

"It is a privilege to speak on this occasion and to offer some observations on our profession and our times.

"Many of you will be aware, from the signs posted all around, that this is not only a special year for the graduates of Stanford Medical School, but also for the school itself, the 100th anniversary of its founding. What fewer may know is that modern medicine or, more particularly, medical science, is only about 100 years old as well. Little over a century ago, disease was attributed to an imbalance of humors, and the only treatments were bleeding and violent purgatives. Medical schools were trade shops funded by fees from the students, who gained licenses to inflict their ignorance on the general population. Change began in Europe in the latter part of the 19th century, with the germ theory of disease and the work of Pasteur, Koch, Ehrlich and others. Charles Eliot, then president of Harvard, was aware of these developments and of the appalling state of American medical education, and proposed to introduce medical science in the curriculum at Harvard medical school. The most powerful member of the faculty objected, "Eliot actually proposes to have written examinations for the degree of doctor of medicine. I had to tell him that ... more than half of (our) students can barely write.... No medical school has thought it proper to risk large existing classes and large receipts by introducing ... rigorous standards." Dean Pizzo assures me all of our graduates today can read and write. And all our graduates are imbued with the spirit of what followed in the 20th century, the rise of medicine from roots in science, from exploration in all fields from physics to biology.

"If I were to ask members of this audience what were the most important advances in medicine during the 20th century, most would make a similar list: X-rays, for both diagnosis and treatment; antibiotics, which have largely eradicated bacterial disease; cell culture, which led to the polio vaccine; noninvasive imaging, especially magnetic resonance imaging, or MRI, for early detection of cancer and other conditions; genetic engineering, which is the basis of most new medicines; the list could go on. These medical advances have one thing in common: They were all discoveries made in the pursuit of knowledge for its own sake, with no idea of any application, no purpose in the prevention or cure of disease. The lesson of the past is counterintuitive: To solve a difficult problem in medicine, don't study it directly, but rather pursue a curiosity about nature and the rest will follow. Do basic research.

"The success of medical science has become, in a way, its undoing. We are dazzled by the knowledge we have acquired and rush to apply it to medical problems. This is understandable, but often premature. Take the human genome, the true font of medical knowledge. It's all there, the answer to every question about human biology. The trouble is the answers are written in a language we don't understand. It is a multidimensional and dynamic language. The products of the genome, both protein and RNA molecules, interact with one another and with the genome itself in a dance of dizzying complexity. At present, we can only dimly perceive the significance. We can grasp a tiny fraction of 1 percent of what there is to know and understand. Just imagine, if the medicine of today flows from this tiny bit of knowledge, how much more would be possible if we knew the remaining 99 percent. What more persuasive call to the pursuit of basic research can there be?

"And yet this call is often unheeded. Traveling across the United States and abroad, I'm disheartened by a shift from research to application. It's ironic. Just as the lesson of the past century is learned, it is forgotten.

"This is not only a scientific but also a political problem. The support of basic research has traditionally come from government rather than the private sector, and for good reason. The timeline is very long -- basic problems take decades to solve. Only the public, with a lifelong interest, will support such an undertaking. Industry, with a short-term interest and eye on the bottom line, can hardly be expected to do so. What CEO could report to his or her board that a major investment has been made in research that may or may not become profitable in 10 to 20 years, or longer? Let me give you a specific, disquieting example. Pharmaceutical companies developing anti-cancer therapies are regularly forced to choose between a drug that cures cancer with a single dose and one that must be administered weekly and which only prolongs life by a year or two. Management invariably makes the right decision on behalf of shareholders, and pursues the less-effective drug. This is not an isolated or rare occurrence. It occurs on a weekly basis. Government clearly has a special responsibility and a unique role to play.

"Our government has performed this role admirably in the past. Some 50 years ago, in perhaps the most farsighted action of any legislative body in history, the U.S. Congress began funding basic biomedical research. The investment has been repaid many times over. How many people do you think were crippled or died of polio last year in the United States? The answer is virtually none, due of course to the polio vaccine. Imagine the savings in treatment and productivity, not to mention human suffering. Not only has the investment in medical research been repaid, but it was small to begin with. The annual budget for cancer research today is only $5 billion, less than 10 percent of our annual expenditure on soft drinks, less than a week of the war in Iraq. And yet, despite its small size, this budget has been cut repeatedly over the past decade. At a time when medical science is poised for the ultimate payoff -- the cure of cancer and other dread diseases -- many promising leads are being abandoned.

"Finally, you may ask, what does all of this have to do with Stanford and the class of 2008? The answer is leadership. Stanford Medical School has shown the way in American medicine because of a decision about 50 years ago to focus on basic science. Our medical school owes its pre-eminence in large part to achievements in this area. Today, in the face of retrenchment worldwide, Stanford must rededicate itself to basic science. What was good for Stanford and others before will be even better in the future. Stanford must continue to lead.

"And you, the class of 2008, have the most important role to play. You have received the best possible education in medical science. Let it guide your professional lives. Let your practice of medicine be not only compassionate, but also productive of new knowledge. Do research. Advocate for it. Yours is the legacy of 100 years of Stanford medicine and of American medical science. You will be the ones to carry it forward, to instill it in others, and to realize our hopes and dreams for the betterment of the human condition."

Stanford University Medical Center integrates research, medical education and patient care at its three institutions -- Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.

(NOTE TO REPORTERS: A high-resolution photo of Roger Kornberg is available for download at http://med.stanford.edu/news_releases/2008/download/Kornberg.jpg. The commencement ceremony will be broadcast live online at http://med.stanford.edu/commencement/.)