ASCI Presidential Address Mentoring and teaching clinical investigation

A man walking along a road comes across three bricklayers. When asked what he is doing, the first bricklayer replies, “I am laying bricks.” When asked the same question, the second bricklayer answers, “I am making my living.” When asked what he is doing, the third bricklayer steps back, looks around, and responds, “I am building a cathedral.” It is my great privilege and pleasure to address the ninety-sixth annual meeting of the American Society for Clinical Investigation. I will begin with many thanks: to the council members who provide sage advice and a critical eye; to our staff, who provide dedicated direction and a keen sense of corporate memory; to the members of the ASCI in 2001, who felt it appropriate that I serve on the ASCI Council; and to the Presidents who have come before for providing the insights and precepts that have helped shape our Society into an organization of extremely dedicated men and women that continues as the leading advocate for scholarship in medicine. I will also try to follow the advice of the seventeenth-century Catalan philosopher Baltasar Gracian, who stated, “What is good, is doubly so if it be short; and in like manner, what is bad, is less so if there be little of it.” Most recent Presidential Addresses have begun with a palpable angst, prompted by one of the major challenges of ASCI leadership — preparation of the Address itself. Although I cannot speak for others, my apprehension was due to the sense of awe that developed while carrying out the unwritten oath of office requiring each President to read the prior Addresses in the months prior to the annual meeting. The angst of writing the Address comes from considering the accomplishments and panache of the individuals who have previously held the ASCI gavel and used this pulpit to espouse acute wisdom and uncommon insight and to create new professional diagnoses and level outstanding wit — the Clem Finches, Joe Goldsteins, Holly Smiths, Gene Braunwalds, and Don Seldins. We have a distinguished history and an outstanding cause, and I applaud the members of the ASCI. In reading over prior Addresses, I was struck by the many recurring themes that our past presidents chose to highlight: the spirit of science, the imbalance between MD and PhD biomedical researchers, financial support for clinical investigation and the favorable economics of investing in biomedical research, and diversity in the ranks of American academic medicine. But of all the challenges facing us as a Society within our broader society, I am most concerned about our ability to mentor and teach our learners, and am frequently reminded of the pure joy that endeavor can bring to the physician-scientist. Rather than being intimidated by the prospect of having my remarks compared to those of Presidents past — such as Joe Goldstein’s insightful 1986 talk formulating the malady of insufficient technical training and consequent lack of courage in junior faculty which I paraphrased to a group of junior faculty members just last week, or Tom Stossel’s witty and wise apocalyptic fable in 1987’s Brave New Medicine, or Ed Benz’s 1992 celebratory Presidential remarks — I relish the chance to convince you that perhaps our greatest challenge as advocates for the physician-scientist is the issue of teaching. We must teach, teach often, and teach widely. We must teach medical students the rewards of marrying scientific inquiry and clinical medicine; we must teach residents that the singular discovery of new knowledge can sometimes impact tens of thousands of patients; we must nurture our fellows and junior faculty members, providing them the tools of the trade and instilling in them the tremendous excitement that comes from solving the mystery of an idiopathic disorder or bringing effective therapy to patients. And because teaching can impact these constituencies, we must teach the public about the values and processes and power of biomedical science, replacing the fear of things unknown with a renewed enthusiasm for the reward and potential made possible by strong support for clinical investigation. To reiterate: it is clear that we must teach, teach often, and teach widely. And we must teach the grand landscape — the larger context of clinical investigation — to demonstrate to each of these groups how the act of asking scientific questions with a clinician’s intuition can build “cathedrals.”