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Dean’s Column: 195th Commencement for SKMC

May 22, 2019
Verizon Hall at the Kimmel Center for the Performing Arts
Remarks by Mark L. Tykocinski, MD
Anthony F. and Gertrude M. DePalma Dean, SKMC

You’re off to see the world! As you set sail, two seemingly simple messages about seeing: see more; see openly.

Let’s start with “see more.” The Catalogue of Shipwrecked Books was published just this year about Christopher Columbus’ son, Hernando. Turns out, both father and son were gluttonous information gatherers. While Christopher, the intrepid ocean voyager, gathered information about the New World far across the Atlantic, son Hernando stayed closer to home, but with a gathering exercise no less ambitious. A great librarian, Hernando crisscrossed the European continent, decade upon decade, gathering a breadth of printed materials—books, prints, political pamphlets, guidebooks, posters, musical scores, ballads, pornography, newsletters—any printed material, in any language, on any subject.

Unlike his predecessors and contemporaries, Hernando didn’t limit himself to classics. His Noah’s Ark of civilization-in-print constituted the most comprehensive such collection of his day. His information avarice presaged our 21st century information age, accompanied by a 16-volume, cross-referenced index—a primitive search engine of sorts.

So the seeds were sown for our information-rich world, a world with a smartphone—a magical device created by our honorary degree recipient John Scully’s progeny at Apple—that offers us all a portal to the world at all times, in our pockets and just a hand motion away. A device that allows us to see the entirety of the world’s information on a little screen right before our eyes. Hernando’s library, magnified a trillionfold.

But sometimes you have to look past your screen and dig through basements for items to feast your eyes.

Last year I saw a fascinating exhibit at the Israel Museum, No Thing Dies. Artist Ilit Azoulay rummaged through thousands of objects and artworks in the museum’s storerooms, from prehistory to the present day, uncovering many valuable artifacts never publicly exhibited. She collected stories and photographed the objects, and then created mesmerizing photographic collages, merging histories and contexts, and proposing new scenarios—some dreamlike, some apocalyptic. Azoulay expanded our visual horizons by digging deeper and redefining the past. She literally unearthed visuals to see anew.

Sometimes we need to pioneer entirely new technologies to see anew. We do so because we are wired to believe—truly believe—only what we see with our own eyes. Seeing equals confirmation.

On April 10, we achieved an unparalleled feat of sight. We actually saw a most wondrous celestial entity: a black hole. A region of space-time deformed by an ultra-dense compact mass, exhibiting gravitational acceleration so strong that nothing, not even light, can escape from it. Black holes had bubbled up almost a century ago, mysteriously, from abstruse mathematics of relativity. Indirect evidence for their existence had been trickling in—most notably three years ago, a dramatic recording of sounds of gravitational waves—but this time, from sound to sight.

Eight radio telescopes, linked together to form a giant Earth-sized virtual telescope, transmitted a bona fide image of a black hole—an actual picture of a supermassive black hole at the core of supergiant elliptical galaxy Messier 87 in the Virgo cluster, with a mass about 7 billion times the sun’s, sitting way out there, 312 trillion miles away. The hot, shadowy edges of a light-sucking monster of the cosmos, theorized by Einstein, were now visible. A lighted donut encircling a lightless core.

Why the fanfare? Because we could finally see what had been unseeable. No longer an artist’s impression or computer simulation, but an actual picture of the abyss itself. Seeing is believing. While the mathematics and sounds had been compelling, seeing the celestial object clinched it.

We love seeing things, and the more the merrier. We crisscross continents to assemble print libraries, comb museum storerooms for forgotten objects, and probe the outreaches of space using dazzling technological tools to photo-document the cosmic predictions of our mathematics. Mankind has an almost insatiable appetite for gathering things to see. In our hunter-gatherer days, it was things for sustenance; now it’s also the ethereal. Books, objects, photos: We are information-gatherers in extremis, gluttons for information. We want it all, right there before our eyes. And we want it now.

And that’s a good thing! You can learn from this. Diversify your information sources; don’t limit yourselves to information that happens to seep in. Rather, aggressively seek out new information sources. Invest the effort. You owe your eyes the full spectrum.

Second message: see more, yes, but see openly. We are no smarter for all the pixels we process if what we see is bound and constricted by what we believe. The paradox: We go to such great lengths to secure visual evidence—we want to see it with our own eyes, we want to see it all—and yet, too often, even when things are right there before us, we refuse to really see them. Instead, we visually process only that which is compatible with our beliefs.

Stated another way, while seeing is indeed believing, what we believe too often frames and confines what we see. If seeing is believing, believing is not always seeing.

This past November, Steve Klasko and I found ourselves in the Anatomical Theatre of the Archiginnasio at the University of Bologna. This in-the-round amphitheater, dating back to 1637, showcases an elaborate dissection table at the center—mechanically configured to rise up from below to convey the cadaver from the basement morgue.

But more interesting than this contraption, jutting from a far wall of the amphitheater, one story up, is a wood-carved parapet. There the papal overseer would stand as he monitored each public dissection and ensured that all was proceeding in sync with church dogma.

By example, during the Middle Ages, church teachings spoke to a seven-chamber uterus—three on the right available for a developing male embryo, three on the left for a female embryo, and one in the middle for a hermaphroditic one. Seven chambers, a number considered sacred, giving the uterus a holy symmetry. The demonstrator would hold up the organ at the dissection table, and right there—before the eyes of medical students and spectators—was a dissected uterus with not seven, but one, internal chamber. Yet, without skipping a beat, the professor of anatomy, sitting in a large, ornate chair elevated above the dissection proceedings, and reading from an anatomical text with commentary, would describe the “seven-cell uterus.”

All is well with the papal overseer. Belief in a seven-cell uterus is affirmed. Visual inspection be damned. Clearly, seeing is not always believing. There are times when dogma overrides one’s very own eyes.

But no need to go that far back. There’s a contemporary example, one that will resonate with our second honorary degree recipient, Walter Ricciardi, the champion of childhood vaccination in Italy. Hundreds of children are now coming down with measles, here in the United States and in Europe, right before our eyes. Reams of ironclad scientific data for all to see, and yet some parents, many highly educated, refuse to vaccinate their children. These anti-vaxxers somehow don’t see these measles-ridden children; they don’t see the data. Their line of sight is muddied by dogma pinned to stray articles peddling unsubstantiated findings. Clearly, too often, seeing is not believing. Seven-cell uterus, vaccine-induced autism, all the same—beliefs disconnected from sight.

That’s just one example of the emerging threat of science denial: a techno-scientific age on overdrive, yet with dwindling authority for that science. Science denial thrives when hard-set beliefs—dogma—wall off the visuals of science.

Class of 2019, dogma is not just political and religious. Scientific dogma can be just as limiting. That is, while science aims to overturn dogma, some dogma is itself scientific. Call it scientific correctness, decoupling scientists from what they see, sapping their will to seek out the unseeable. We scientists are enmeshed in our mythologies as much as the ancients. Not as enlightened as we’d like to think, we physician-scientists, reared in the science-centric Flexnerian tradition, at times unconsciously fighting off that which is glaring before our eyes.

The world of physics gets it—that scientific concepts are meant to be in constant flux, that today’s scientific dogma is tomorrow’s discredited belief. Think black holes, gravitational waves, quantum weirdness; physics loves that kind of stuff. But the world of biology, not so much. It is far more resistant to radical paradigm shifts. In biomedicine, we love dogma, and often let it shape—and sometimes limit—our lines of sight.

Take neo-Darwinism. By now, it’s bread-and-butter high school stuff: the notion that lifeforms on this planet have arisen through natural selection among mutational variants. What could be more central to our 21st century perspective of the living world? Genes mutate, cause phenotypic changes, and the useful ones get selected and propagated. After a few billion years, the biological world we now see has unfurled. So intuitive, so obvious. Case closed.

But is it? In a provocative book released this year, Darwin’s Doubt, University of Oxford’s Stephen Meyer argues it is not. While neo-Darwinism can reasonably explain microevolution, like how giraffes’ necks get longer or how the beaks of finches diversify in color, it’s an entirely different story when it comes to macroevolution, how we go from amoebae to slugs to chimpanzees—the big leaps. Interestingly, Meyer’s starting point is the visual evidence, keying in on a puzzling gap in the observed geologic record. One moment the body forms are simple. The next layer up, explosive complexity: the Cambrian explosion. No intermediate species in the geologic strata. That’s the visual puzzle. And an equally head-scratching molecular genetic puzzle also stares neo-Darwinism down.

By no means is this the forum to litigate neo-Darwinism. I raise it simply to reinforce a larger point: eyes wide open, not shut. Every dogma can be and should be challenged, even scientific dogmas. That is where breakthroughs happen.

Class of 2019, you are the generation that will be pondering, well into the 21st century, some of the most tantalizing questions in biomedicine like differentiation and development, emergent properties of complex biological systems, and consciousness. I urge you to be open to radically new ways of viewing such phenomena.

Noted physicist Paul Davies argues recently in The Demon in the Machine that new laws of physics will be needed to explain the spooky complexity and demonic magic of biology. Like this physicist, be brave enough to ask dogma-defying questions, even when they beckon entirely new laws as strange as information-driven genesis of lifeforms or adaptive Lamarckian mutagenesis. And when what you observe doesn’t fit neatly into that which is generally believed, don’t stop looking. Be willing to let in what you see, even if it threatens to shatter foundational beliefs. Rock those foundations. Challenge science with science.

To sum things up in two overarching messages: first, gather things for your eyes to see, diversify your sources, and even look to uncover things deemed invisible. Strive to see the unseeable. On a wall in the home of my lifetime mentor, Bernard Lown—a renowned Harvard cardiology pioneer, 1985 Nobel Peace Prize winner, and former Jefferson honorary degree recipient—there’s a framed letter from a colleague with the phrase, “Only those who see the invisible can do the impossible.”

And second, believe what you see, even if it challenges dogma. That dogma can be science itself. You must be willing to challenge biomedical science premises. Recognize that science can often wall itself off from things that are in clear sight. Scientific cocoons morph into stubborn scientific correctness. Observation trumps narrative. Liberate your sight. Wander into uncharted and strange territories freely. From Darwin’s Doubt: “You must not fool yourself, and you are the easiest person to fool.”

Graduates, go out and see the world!

Mark L. Tykocinski, MD
Provost and Executive Vice President for Academic Affairs
Thomas Jefferson University
Anthony F. and Gertrude M. DePalma Dean
Sidney Kimmel Medical College