Commencement address given at University of Connecticut School of Medicine, School of Dental Medicine, Graduate School, Storrs, Connecticut, May 11 2026
In Sickness Or In Health
By Gerald Chan
When I was growing up, my mother worked as a nurse. I remember her talking about a new kind of medicine that had the connotation of being a miracle drug. That was penicillin.
Until antibiotics came along, the practice of internal medicine amounted to diagnosis, prognosis, and supportive care. Being an internist largely meant being a diagnostician, mapping a patient’s condition to a taxonomy of diseases pioneered by William Osler.
In mid-twentieth century, the International Classification of Diseases had a few hundred categories. Today the latest ICD-11 has 17,000 disease categories. It is truly remarkable how many ways the human body can go wrong. But then, perhaps we should not be so surprised. The human genome codes for about 20,000 proteins. It also contains over two million non-coding regulatory elements that control gene expression. Even without external insults, every time a cell replicates, it has to copy 6 billion nucleotides with utmost fidelity, and there are 30 trillion cells in a human body. Look at it one way, every human being is a walking miracle; look at it another way, every human being is a ticking time bomb, an accident waiting to happen.
Given such odds, the mandate of medicine has always been one of remediation. It is reactive — doing something after something has gone wrong. It is like putting out fire after the fire has started. As a person ages, fires start more easily and happen more frequently. The Nobel laureate Macfarlane Burnet coined the term intrinsic mutagenesis to describe that with time, accumulation of mutations in the genome leads to progressive physiological dysfunction, manifested as aging, and eventually demise of the organism. This cumulative effect is why the consumption of healthcare skyrockets in the latter years of people’s lives.
Today, as we celebrate the 250th anniversary of this nation, the success of science and medicine, public health and economic development has enabled Americans to live twice as long as people did 250 years ago. This success has created an aging population with its own set of issues. While life expectancy is at the highest in the history of this country, the health status of Americans is at its lowest. Half of Americans are hypertensive or on blood pressure medications. About 4 in 10 American adults meet the criteria for metabolic syndrome. By the American Heart Association’s 2023 definition of cardiovascular-kidney-metabolic syndrome, 80% of Americans are affected. These risk factors have created a gap of 12.5 years between lifespan and healthspan in America, the highest among all OECD countries. Imagine living through 12.5 years of ill health at the end of one’s life.
Data published a few weeks ago by the UK Office of National Statistics showed that the ratio of healthspan to lifespan decreases in lockstep with socioeconomic deprivation. For people in the lowest socioeconomic decile in England, one-third of their lifespan is spent in poor health. Men in that decile live only 49.8 years in good health and 23.4 years in poor health. These data are beyond shocking.
Statistics are just statistics. To bring it all home, I want to tell you about my mother. She just turned 106. She got both pneumonia and Covid during the Omicron wave of the pandemic, was intubated for two weeks and has been dependent on the respirator ever since. For the last few years since she moved into a facility with 24-hour nursing care, various members of my family would visit every day to keep her company. Even though she is cognitively diminished, we are just happy that she is still with us. In January this year, I was in her room together with my brother. Out of the blue, he popped this question to me, “Do you think that Mom is happy to be in this state?” His question punctured the stillness in the room, shattering the quiet moment I was sharing with my mother. That question has haunted me ever since, a question to which I have no answer, and never will.
I have a dear friend whose wife is progressing from mild cognitive impairment to full-blown Alzheimer’s. Every few months I saw them and her decline unfolded before my eyes. For my friend, the husband, it is a daily fare of caring for a spouse whose very person is quietly slipping away. Nothing is perceptible from day to day, but the changes over time are as irrefutable as they are irreversible.
I, like many of you, took this vow when I married my wife — in sickness or in health, till death do we part. Before there were antibiotics, people died from acute diseases and the parting was swift and often unexpected. Today, with the preponderance of chronic and degenerative diseases, parting is protracted. It is gradual, it is insidious, it is a slog, it can be a grind. Dare we ask the question whether a protracted parting is sweeter or more sorrowful, gentler or more cruel?
The time has come that we have a reframing of the mandate of medicine. Medicine can no longer just be about putting out fires. We must do more to stop fires from starting, and that must be done at the population level. If healthcare resources were devoted only to people who are already sick, we will always be behind the eight ball. This reframing does not in any way take away from all the heroic breakthroughs in medicine we have had in the last century, but the emphasis, the allocations of resources must now be revisited.
Such a reframing changes the practice of medicine from being reactive to being proactive, from being remedial to being preemptive. The scope of medicine must be enlarged to encompass both those who are in sickness and in health. The work of the physician begins when the patient is still healthy. In this regard, medicine has much to learn from dentistry. We spend time every day brushing our teeth, flossing, using the water pick, and we go to the dental hygienist every so often to have our teeth cleaned. This is all so we do not have to come under the skillful hands of the dentist.
Biomedical research which has always focused on why people get sick and how to cure them must now include the study of why people do not get sick, a field now known as resilience. This is a higher challenge to medical science because methodologically, it is always easier to study why something happens rather than why something doesn’t happen. Those who do clinical trials know this well. The goal of such research is to help people’s healthspan to converge with their lifespan.
One critical player in this reframed mandate of medicine is the primary care physician. I want to acknowledge those graduates who are going into primary care which I think will be the most exciting area in the next chapter of medicine. We will recover the doctor-patient interaction that is relationship based and longitudinal and not merely transactional. With powerful new tools derived from data science, computation and AI, there is so much that the primary care physicians can do to keep their patients as healthy as they can be.
William Mayo, one of the brothers who founded the Mayo Clinic, said this in 1928, “The aim of medicine is to prevent disease and prolong life; the ideal of medicine is to eliminate the need of a physician.” While that ideal is admittedly idealistic, his words anticipated the need for medicine to address both lifespan and healthspan. To increase lifespan is to add years to life; to increase healthspan is to add life to years.
The opportunities before you graduates are many and varied. You are living in a most exciting time. With the advent of AI, science and medicine have never had greater potential for improving human health. I would give an arm and a leg to be young again like you, starting out on a journey with so many possibilities. But for today, I am happy to be a bystander cheering you on. It is to you that we look for leadership to truly make America healthy again.
With great admiration for your achievements, I send you my congratulations with all best wishes.