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Remarks of President Lawrence H. Summers, School of Public Health Leadership Council Inaugural Meeting

The Charles Hotel, Cambridge, Massachusetts

Thank you, Dean Barry Bloom, for the splendid leadership you are providing to the Public Health School. You and Jim Ware and your team are making an enormous difference. I want to also acknowledge “Julie” Richmond, and I’ll just say this. There are thousands of Americans walking around today who would not be alive if Julius Richmond had not been surgeon general of the United States. Thank you for your lifetime of service, Julie.

We are going to hear in a few minutes about what Katie Couric has done for public health with her courage and her willingness to reach out and make a difference in the lives of very many people. We’re all grateful for that, Katie.

Ever since I had the chance to work on that world development report in 1993 and to meet Chris Murray and to meet many other public health officials, I have gravitated to this subject. Because it seems to me, and I measure words carefully in saying this, that there is no other area of human endeavor in which the application of thought and resources can make so profound a difference in as many peoples’ lives as in the world of public health. And that is why this School is so fundamentally important to the mission of the University.

Before I say anything else, I want to tell you something that is in a letter I wrote to the entire University today. I would like to say the University is well organized enough that we had arranged for this announcement to be made on the same day as this lunch was planned, but it was in fact a complete coincidence. But I have been asked by the Harvard Corporation to lay out a vision, a set of hypotheses, as to how Harvard should use its land in Allston. This remarkable opportunity that we have in an area in total seven times as large as Harvard Yard, to build the Harvard of the next century. There are a number of elements that I talk about in that letter, but one very prominent one that I have asked the community to explore and think very carefully about is the relocation of the Public Health School and many of its primary activities to the Allston campus, where it will occupy a role at the center of the University. And I have suggested that as an important commitment at the University, because I am convinced that if we think about what it is that is really important in terms of what the University is going to do in the years ahead, public health is very much at the center of those years. Let me say a little bit about why I came to that judgment.

One of the many things that is daunting about the position I hold is I’m only the seventh person to be president of Harvard University since the Civil War. That requires me to take a rather long view in thinking about things, and so I’ve asked myself the question, “What is it that’s happening in the world and in intellectual life here in this country that is going to matter 250 years from now?” If you think about it hard, there is very little. If you think about how many of us actually could say something about what was different during the period from 1725 to 1750, or the period from 1750 to 1775, most of us wouldn’t be very good at answering that question. But there are a few things that are happening right now that I think will be prominent in the history books two centuries from now. One thing that’s happening is the coming together of nations rich and poor – globalization – which carries with it staggering potential for human betterment. Already, a child born in Shanghai has a better chance of living to the age of 5 than a child born in New York City. Think about that. It has enormous potential for the emancipation of hundreds of millions of people. It has the chance for millions of people to live their dreams, to lead decent and comfortable lives for the first time in human history. But words like AIDS, Iraq, terrorism, ethnic violence, Rwanda remind us that there is no assurance that this coming together will be a benign phenomenon. But if you think about it, at the coming together of rich and poor nations, the work of the Public Health School will be of profound importance.

Let me give you a triumph of public health that I would guess not one person in this room, who is not a public health professional, has thought about before coming here this morning. In 1918, three percent of planet Earth died as a consequence of the flu epidemic. In 2003, less than 1,000 people, as best we can judge, died of the SARS epidemic. SARS was probably more virulent than the flu disease in 1918. It’s just the world knew a lot in 2003 that it didn’t know in 1918. That is a triumph of globalization. In fact, no small part of that triumph came from the first effective study of the epidemiology of AIDS that was done here in the Public Health School, where the two authors found that if nothing had been done, there was the possibility that as many as half of the world’s population could have been affected by that disease in a few months. That is making a difference with the problem of globalization.

The second great opportunity at the moment we are alive is the revolution taking place in the life sciences. There are a lot of ways of talking about the genomic revolution. Here’s the one that made it most vivid for me. What is genomics? Basically, that we can sequence the genome and we can read people’s DNA, and basically there’s a sequence of letters – 3 billion letters long – and they’re all A, C, T, or G. That’s what it is: 3 billion letters in a row. If you think about it for a minute, you’ll realize that if you were to try to print all these letters, and put them in a book, the book would be a million pages long. If you look at that book, and you turn to page 586,674, and you look 16 lines down, and you look half way across, and if it goes C-G instead of T-A, you get cystic fibrosis. And we understand it at that level of precision. Because we understand it at that level of precision, we are well on the way to doing something about that disease. Now, other diseases are more complicated; they’re called “polygenic,” and that means that what happens on a number of pages affects whether you’ll get the disease. But this puts us in a position to go from trial and error – which is basically how the great medical successes of the past happened – to actually figuring out the answer in an analytical way.

Now let me tell you about all this tremendous promise of science and why it is so important that we have institutions like the Public Health School. The American industry spent more money last year on pet disease than it did on tropical disease. The number of patents for pharmaceuticals dealing with tropical diseases made up less than one percent of the total number of patents, and a number of the most important patents for tropical disease actually came as a byproduct of the research on pet disease. And the malaria that Dyann Wirth is working on, and the diseases that many people are working on that don’t actually affect us here, but that are literally killing hundreds of thousands of children in the less-developed world, are every bit as amenable to science as the diseases that we are working on here. And surely an institution that is deeply committed to science and to human welfare is remiss if it is not doing everything it can to harness science to the challenge of global disease.

There’s a third thing that’s going on in this period that I think is not something that happens on any given day or in any given week or any given month, but I suspect that when the history is written two hundred years from now, will emerge as something very important that happened in human thinking during the time when we were alive, and that is that we are becoming rational, analytical, and data-driven in a far wider range of activity than we ever have been before.

Since it’s on people’s minds, I’ll mention my favorite example. Anyone who hasn’t should read Michael Lewis’s book Moneyball. It’s about an activity that you don’t normally think of as an application for high-powered statistics and econometrics: namely, winning baseball games. What the book demonstrates is that, over the last five years, the Oakland A’s won more baseball games than any other Major League baseball team, and they did it with a third of the payroll of most other teams, and they did it by drafting people, drafting players and pursuing strategies, not based on the hunches of guys who played baseball for a long time, but based on careful analyses of what aspects of a player’s prior performance best predicted his subsequent performance, and what strategies actually worked, and what strategies did not work. And it turned out that those hunches – you know, like hiring slick-looking guys who look like athletes and had high batting averages rather than small, wiry guys who got a lot of walks – hunches that were deeply ensconced in baseball for the last hundred years, were actually wrong. Now, that’s an example in baseball.

But you know, the most important medical innovation in the last hundred years, well, I don’t know that it’s the most important but certainly one of the 10 most important innovations in the last hundred years, was the double-blind clinical trial. It turns out that all kinds of clinical trials, all kinds of therapies and approaches that people knew worked, actually didn’t work when they were subject to a double-blind clinical trial. And if the medical profession has progressed, in a way that the field of education has not progressed, it is in no small part a result of this commitment to clear and careful experimentation.

But there are ways in which this can be better, and doing it in the right ways is expensive. We know how to do clinical trials of a new cold medicine. But you know, Walter Willett’s thoughtful work on the disparities across regions that Barry referred to make it very clear that the ways in which we eat, the ways in which we live, the moods that we’re in, make a profound difference over a lifetime in the way in which we live. You know, we can’t just do a clinical trial for three months, double-blind, and know the answer to that question. You have to have elaborate data on a lifetime’s habits and compare and study that data. The definitive study of that kind, the nurses’ study that has followed 200,000 nurses for decades, is work that’s done here at the Public Health School.

I’ll give you another example. For many of us, I suspect when you hear the words “AIDS research” it’s sort of exciting. When you say some of the other words, it’s exciting. When you say the words “biostatistics,” the heart doesn’t always pound faster. But you know, The New York Times had an editorial last week about an issue in biostatistics. A trial was underway of a drug that was potentially efficacious with respect to breast cancer. They were partway through the trial, and as they went partway through the trial, it was looking pretty clear that the drug was efficacious. And the question was, should they suspend the trial and start giving everybody the drug rather than the placebo because it was immoral to deny the control group the drug, or was that really profoundly irresponsible because it would shortchange science for the future?

Well, getting those questions right, figuring out how to structure trials so that you maximize the information content, and at the same time minimize the risk that you’ll carry it on too long and deny something that works, there is a whole field of statistics of sequential sampling is all about that. It is no disrespect to the medical profession to say that doctors who discovered new drugs or think they have discovered new drugs are not going to be terrific at figuring out how to design those trials in the optimal way. But you know something, making those judgments right is a matter of life and death for those people who might have that placebo when they didn’t need to have that placebo, or a matter of life and death for those people who might have the kind of experience that we saw in this country with thalidomide when trials were ended too soon. And that type of analysis is profoundly important.

There’s a fourth thing, something Barry really touched on. That is that some of what will be remembered 250 years from now won’t be ideas or trends or developments. It will be individuals who made a difference with their leadership. It will be individuals who brought people together to do large and profound things. None of us can predict who those individuals will be. None of us can predict which institutions it will have been that were most important in playing that role. But surely for an educational institution like Harvard, preparing people to serve the public is a profoundly important aspiration. That’s why I’m proud of the things that Barry said about the graduates of the Public Health School who had gone on to prominence at the World Health Organization. But for every one of those graduates who has gone on to positions of prominence where many of us would recognize their name, there are dozens who have made the flu not spread in an American city. There are dozens who have advanced scientific understanding and brought forward two months the development of a new vaccine that can change people’s lives. There are dozens who are bringing health clinics to villages in developing countries that would not otherwise be there. One of the things I have said often as President of the University is that I think the “every tub on its own bottom” system that we have at the University has served us very well in many, many respects. But at the same time, we must never confuse the average income of a School’s graduates with the importance of its mission. And we must recognize that professions like public health involve intellectual contributions that are truly profound and also offer us the potential to serve society in enormously important ways.

I just remembered something else. That is, what public health has done and is doing is saving millions of lives around the world. If all cancer were eliminated in the United States, it would produce an increase in life expectancy of two to three years. Since 1975, life expectancy in the developing world has increased by between eight and nine years. That is the equivalent in parts of the world where 90 percent of the world’s population lives, of solving cancer 4 times over. In our country – I was just reading these clever little questions they have on your name card and mine informed me of something quite striking – you look at the groups: white men, black men, white women, black women. Which group has seen the biggest increase in life expectancy since 1970? Black men’s has increased by more than 10 percent. Now there are twice as many vehicles driven in the United States as there were when I was a child, and there are 25 percent fewer fatalities than when I was a child. That is because of what public health has done. I could give more and more examples. This is not a field where we’re hoping for a breakthrough and we might have a breakthrough. This is a field where we know how to allocate thought, allocate resources. There’s a consequence: save lives and make humanity better off. And that’s why the School of Public Health is so central to the mission of Harvard University.

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