To the YSM and Alumni Communities:
The SARS-CoV-2 pandemic serves to remind us of the importance of science. In the last week, clinicians and other health care workers began receiving mRNA vaccines against SARS-CoV-2. Such a strategy would not be possible without the basic science that defined the role of mRNA, elucidated the function of RNA polymerase, allowed for the isolation and sequencing of the viral genome, or identified modifications to make RNA less immunogenic.
Similarly, in the last year investigators at Yale Cancer Center led clinical studies that led to new FDA approvals of four anti-cancer therapies. Those therapies were grounded in scientific discoveries made decades ago. As an example, the approval of osimertinib for the treatment of advanced non-small cell lung cancer with certain EGFR mutations is grounded in the discovery of EGF over 60 years ago and the identification of driver mutations in EGFR 16 years ago.
Yet today science is under siege. Anti-vaccination campaigns undermine science-based approaches to infectious diseases. Deep and appropriate concern over racial constructs has led to distrust of genetic studies and has undercut efforts to advance understanding of the molecular basis for diseases. Skepticism regarding scientific reproducibility and the expertise of “elites” in academia challenges support for research funding. Pressures to realize early returns on investment particularly disadvantage fundamental research.
Challenges to science are sometimes driven by well-meaning instincts. Recently a student asked me if we should eliminate all science requirements for entrance to medical school. Implicit in the conversation was a concern that training in science might compete with selection for compassion. That is a dangerous false dichotomy. A lack of understanding of the mechanism of disease(s) or response to therapies can kill our patients. Compassion for our patients must drive us to understand each of them as an individual and the factors that affect their care but must also drive us to make discoveries and increase knowledge.
Similarly, a mechanistic understanding of pathophysiology advances public health. In the 1970s my grandfather suffered from peptic ulcer disease. I remember his lying on the floor after dinner until the pain went away. His doctor told him to stop smoking and drinking and to eliminate stress. Indeed, a large epidemiological study published in the New England Journal of Medicine in 1974 confirmed an association between cigarette smoking and peptic ulcer disease. Had investigation stopped with that observational study, however, our approach to peptic ulcer disease would be very different today. Instead, the discovery by Marshall and Warren of curved bacilli in the stomach of patients with peptic ulcer disease, followed by hypothesis-testing (self-) experimentation, transformed our understanding of peptic ulcer disease, gastritis, and gastric cancer. Today we recognize that H. pylori causes widespread chronic infection and contributes to cancer risk worldwide.
Fundamental to the scientific method are critical thinking and review of the literature, hypothesis generation and testing, and agnosticism about the outcomes. (The most exciting experiments are those with unexpected results.) Yet how often during the SARS-CoV-2 pandemic have we seen leaders and citizens anchor on a media report or embrace data that has not yet undergone peer review to support an emotionally held view? A commitment to science and the scientific method underlies the Yale System of Medical Education. It is embodied in the words of our new mission statement. As members of Yale School of Medicine, I ask that we recommit to the pursuit of scientific ideals.
Nancy J. Brown, MD
Jean and David W. Wallace Dean of Medicine
C.N.H. Long Professor of Internal Medicine