Graduations
Graduation address given by Professor Anthony Basten
Professor Anthony Basten, Professor of Immunology and Director of the Centenary Institute of Cancer Medicine and Cell Biology, gave the following occasional address at the Faculty of Medicine graduation ceremony held in the Great Hall on 30 April 1998:
Graduation address
Deputy Chancellor, Fellows of the Senate, Pro-Vice Chancellor Young, Mr Dean, Graduands, colleagues and friends. It is a privilege for me to be with you today to celebrate this milestone in your careers. May I begin by adding my warmest congratulations to those of the Chancellor, to everyone of you on your graduation and to your families and friends for supporting you so well.
It is now 40 years since I graduated and 28 years since I joined the staff of this, your University. In the words of Oscar Wilde which the late Chancellor, Sir Hermann Black liked to quote so much “You, Tony Basten have a great future behind you”. On the other hand all of you have a great future ahead of you. At first glance, the world of medicine may look daunting. Healthcare along with education has become a political football, alternative therapies costing the community a billion dollars per annum are rife; litigation against doctors is rising every year and society is divided about whether euthanasia should be left in the hands of our profession or enshrined in legislation. But at the same time the advances in medical science have been little short of breathtaking and when all these facets of medicine are put into the one basket, the opportunities for those of you embarking on your career have never been more diverse or challenging.
One way of putting our profession into perspective and of illustrating the challenges it presents to you is to ask the question “what are the seven wonders of the world of medicine”? Everyone present will no doubt have their own selection of topics, but for what it is worth here are my seven wonders in some sort of historical sequence:
My first choice is the Hippocratic oath which has governed the ethics of medical practice for the past 2500 years. Two excerpts are worth quoting: “pure and holy will I keep my life and my art” is the first and is straightforward, but the second is more contentious: “I will give no deadly drug to any, though it be asked of me, nor will I counsel such, and especially I will not aid a woman to procure abortion”. These words highlight how opinions change and the challenge for you to adapt best practice to the society of today.
My second choice is the discovery of the circulation of the blood by Sir William Harvey who published his famous book De Motu Cardis in 1628 and whose bust adorns the front of the new medical school. Like Hypocrates, Harvey was a physician who practiced medicine as well as conducting experiments, epitomising the essential nexus between healthcare and research. The challenge for you is to take the cardiovascular diseases off top spot on the mortality table. Lipid lowering drugs are only part of the solution; even more important is persuading your patients that fast food with or without exercise is bad for the arteries.
My third choice may surprise you but I have selected it since it is in one sense close to home. I am referring to the controlled clinical trial and one of the best known, if not the first such trial was performed by Captain James Cook on his first voyage to Australia in the mid-18th century. He placed half his crew on limes (hence the American whalers term of endearment ‘limey’ for the British sailor) and the other half on standard fare. The result: conclusive proof that scurvy was due to a nutritional deficiency and could be prevented. What a wonderful example of best practice and preventative medicine. The challenge for you now lies in participating in similar trials within the limits of modern ethical standards.
Hygiene is my fourth choice for want of a better single word. The initial dramatic reduction in infectious diseases in the late 19th and early 20th centuries - then by far the commonest cause of death was not due to antibiotics, but to two other sequential events. The first was the recognition of a link between disease and the water supply and sewage. The second was the germ theory of disease. Although many famous names are associated with these discoveries I shall mention only two: the Austrian obstetrician, Semmelweis who showed that the washing of hands by accoucheurs reduced the incidence of fatal puerperal sepsis after child birth from 30% to less than 2%; the second is Louis Pasteur who not only raised the quality of French beer to that of the German through his studies on the fermentation process - his initial goal, but who showed conclusively that anthrax and rabies were diseases transmitted by living microorganisms. Appropriately his bust stands on the other side of the portal of the new medical school from that of Sir William Harvey. Despite the advances in modern therapeutics, however, infectious diseases remain the scourge of the developing world and the underprivileged in our own society. The challenge for your generation is to succeed in improving the lot of the underpriviledged where Governments and politicians have failed.
The remaining three wonders of the world of medicine are even more difficult to choose as the past 100 years has seen so many spectacular discoveries. What about anaesthesia, blood transfusion, even the contraceptive pill? Well, I have selected three others, the first being antibiotics and I am sure everyone of you in the Great Hall today will know that one of Australia’s most famous sons, Nobel Prize winner, Sir Howard Florey was responsible for developing penicillin for clinical use. When I was studying in Oxford I had the chance to read the case notes of the first two patients in the world to be treated with penicillin. The first a burley policeman was given 100,000 units and died, the question being was it penicillin poisoning or inadequate treatment of the infection that led to his death. Florey, dubbed the Bush Ranger by the British medical aristocracy had the conviction to give the second patient, a young woman with septicaemia 10 times the dose or 1 million units (still a minute dose by modern day standards) and she survived. What would have happened if she too had died is too terrible to contemplate, particularly just after ANZAC day which reminds us that almost as many soldiers died of wound infections in World War I as of the wounds themselves. The challenge for you of course is to cope with the problem of antibiotic resistance which will depend more on innovative ways of managing patients infected with vancomycin resistant organisms than trying to discover yet another antibiotic.
My sixth choice comes from our Dean, namely the eradication of smallpox in the mid 1970s by vaccination - at a cost to the World Health Organisation of a mere $300m. The smallpox vaccine was first used by Dr Edward Jenner, an English country general practitioner, in the latter part of the 18th Century and is a remarkable story in itself. What is less well known about Jenner is that his spare time was devoted to classifying the collection of botanical specimens brought back by Joseph Banks who accompanied Captain Cook on his second voyage to Australia. Now, thanks to Australia’s most recent Nobel Prize winner, Professor Peter Doherty and his Swiss colleague, Rolf Zinkernagel, we are looking at the prospect of being able to vaccinate not just against infections but against cancer, asthma and autoimmune diseases like diabetes as well - as an immunologist I envy you this challenge.
Finally comes the double helix or the discovery in the 1960s of the structure of DNA of which our genes are made by Frances Crick and James Watson who was recently lecturing in Sydney. This discovery set the scene for the truly remarkable expansion in our knowledge of the genetic basis of disease over the past thirty years. Thanks in no small part to James Watson the decision was taken in 1987 to learn all that is to be known about the 85,000 odd genes in the human body at an estimated cost of $3billion - ten times that spent on eradicating smallpox. The body responsible for this programme is known as the Human Genome Organisation and the current President is an Australian, Professor Grant Sutherland from Adelaide. Progress has been spectacular and it is predicted that the structure of the 85,000 genes within the human body will be known by the year 2003 - the prospects for curing genetic diseases are enormously exciting but with this knowledge comes the numerous ethical, social, and legal issues requiring resolution not just by the medical profession but by society as a whole. Remember the Boys from Brazil and Dolly the sheep. These make up your seventh and final challenge.
Well, I have done and no doubt one reason why you are stirring restlessly in your seats is that you disagree with my selection - but thinking and challenging are what modern medicine is all about. To quote once again from Sir Hermann Black, “your degree is uniquely a personal accomplishment”. May I wish you all well in the future. You richly deserve it.