WELCOME TO THE CENTER FOR INNOVATIVE MEDICINE
I confess: I love Hopkins. You probably already knew that. If you think I love Hopkins because of the people, you’re right, of course––but only partially. I believe what makes Hopkins uniquely lovable are its values. Given all the uncertainties now swirling around us, I thought it might be useful to reflect upon our values.
Why has the founding of Johns Hopkins occupied such an important position in the history of medicine? It’s not just the remarkable doctors who made up our “Big Four” first faculty, although Hopkins has always been blessed with truly exceptional people. No, it’s because Hopkins changed the practice and teaching of medicine by bringing together, for the first time, three incredibly powerful values –– caring, science, and justice. In creating an institution based on these three values, our founders established Johns Hopkins as the first modern version of our driving vision at the Center for Innovative Medicine: Medicine as a Public Trust. This model was so good that all other great medical institutions have copied it.
In medicine, caring is clearly our oldest value… If, as anthropologists estimate, humans appeared around 200,000 years ago, surely human suffering – and caring – must be nearly that old. Every parent has witnessed the astonishing ability of empathy to alleviate pain caused by minor scrapes and bruises. And anyone who has undergone a surgical procedure or suffered from a medical illness knows that kindness and compassion are indeed potent medicines.
…But caring only goes so far. Tolstoy, one of my favorite authors, captured well the limits of caring in his masterpiece War and Peace, Pierre, one of the novel’s main characters suffers an illness; the good news, as Tolstoy wryly observes, is that despite all the physicians who tended to Pierre, felt his pulse, inspected his urine and other outputs, and administered many (unproven) treatments, Pierre lived! In 1872, when Tolstoy penned his novel, physicians had little scientific knowledge about the origin and treatment of diseases. Caring, in the absence of science, was often not only ineffective, but also frequently hastened death.
Johns Hopkins was the first medical center in the world to bring caring and science together to understand and treat human disease. To make sure that its medical students would be able to contribute to medical science, Hopkins established unprecedented admission standards. This was a revolutionary move in the late 1880s, when many American medical students had no college degree and only rudimentary educations. Johns Hopkins declared that all of its students must not only have graduated from college, but also have completed rigorous scientific courses. Moreover, all medical students at Johns Hopkins had to be able to read French or German, because those were the languages used by the medical scientists of the day. (The foreign language competency requirement was still in effect in 1973 when I applied to the School of Medicine!)
The Hopkins vision – that medical care must be based on science and caring – changed medical education throughout the world, and arguably has played a pivotal role in raising the average lifespan in the United States from approximately 40 years in 1893, when the School of Medicine opened, to about 80 years today.
What about the third value? Because of a simple mathematical error, Linus Pauling, the winner of two Nobel Prizes, mistakenly hypothesized that DNA was a triple helix, thereby opening the door to Watson and Crick’s discovery of DNA’s double helical structure (and blowing the chance to become the only person to win a third Nobel). But maybe Pauling’s notion of a triple helix applies more accurately to Hopkins. If caring and science are two crucial strands of Hopkins’ DNA, justice is the third..
Justice is a big and sometimes vague concept that makes some people smile and other people itch. What I’m talking about here when I use this word is the ability of justice to fortify human dignity. That’s how Mr. Johns Hopkins used it in his will, when he stipulated that his namesake institution was to provide medical care for every citizen of Baltimore regardless of the person’s color, creed, or economic might. Mr. Hopkins, a Quaker, truly believed that the dignity intrinsic to each person guaranteed the right to receive care in his hospital.
There was a fortuitous hiccup in the founding of the Johns Hopkins School of Medicine. We were saved by a powerful woman named Mary Elizabeth Garrett. In 1896, an economic recession reduced the payouts of Baltimore and Ohio Railroad stock, the main component of Mr. Hopkins’ original endowment, from 10 percent to zero. Miss Garrett contributed the needed funds, and she deserves to be regarded as a cofounder of the School of Medicine. But she was also interested in justice, and her money came with a key stipulation: Women must be admitted to the School of Medicine on an equal footing with men. Because of Miss Garrett, part of the revolution at Johns Hopkins would include the notion that merit, rather than gender, would determine who could become a physician.
Having the best values of any medical institution on the planet does not guarantee that these values are all always followed. Our great country serves as a powerful illustration of the chasm that often develops between an institution’s ideals and its reality. The United States was founded on the revolutionary idea that all people are created equal. As a nation we heralded this principle in the Declaration of Independence at nearly the same time that we ratified a Constitution that discounted African-Americans as only three-fifths of a person, legalized the enslavement of millions of people, and did not allow women the right to vote. The history of Johns Hopkins can be regarded in a similar fashion.
We should take no comfort in where we are. But we should appreciate that the founders of our institution created the “Mount Everest” of values for medical institutions with its peak formed not by rock, ice, and snow, but by caring, science, and justice. Having a peak composed of such values has, in my view, attracted the world’s best people who continue to try to climb towards the summit. I know we are not at the peak, and I don’t know if we will reach it in my lifetime. But I do believe there is nothing finer in professional life than to be with good people who are willing to give their best to try to get there, together.
And that is why I love Johns Hopkins.
David B. Hellmann, M.D., M.A.C.P.
Aliki Perroti Professor of Medicine
Vice Dean, Johns Hopkins Bayview Medical Center
Chairman, Department of Medicine