The event honoring the Zukier family for their donation to the Jacob and Gitla Zukier Medical Fund Oncology Fellowship Program was held on October 27, 2016 in the Joseph Fishman Oncology Center at Rambam.
Dr. Shlomit Strulov Schachar, a past Fellowship Program recipient who completed her fellowship in breast cancer geriatric oncology at the University of North Carolina at Chapel Hill, spoke at the event, as did Dr. Salem Billan from our Radiation Therapy Institute. He completed Fellowship at Princess Margaret Hospital in Toronto.
Two other physicians who are currently doing their Jacob and Gitla Zukier Medical Fund Oncology Fellowships abroad sent their thanks via video.
The program included an inspiring speech given by Professor Henri Zukier:
I would like to say a few words of envy and thanks. As a non-physician here, I will speak from a patient’s perspective.
Today’s celebration of the fellowships marks several promising beginnings. It also brings to mind the familiar yet mysterious Biblical narrative of beginnings. The Genesis story is enigmatic, but one thing remains crystal clear: the quest for knowledge is never a stand-alone intellectual pursuit. The cognitive quest is inextricably linked to moral dimensions and dilemmas. The “tree of knowledge” is not merely Etz Ha-Daat - - but Etz Hadaat Tov Vara. The expression is commonly translated as the tree of knowledge “of good and evil”. But perhaps we might also render it as “for good and evil”. Consider, instead, Greek mythology: Prometheus steals the fire from the gods on Mount Olympus and gives it to humanity. It is the very flame that still burns bright at modern Olympic Games. Yet Prometheus’s brazen act of cognitive assertion, his gift to humanity, and his eternal punishment by Zeus, conspicuously are devoid of a moral dimension.
The practice of medicine also uniquely demands a combination of two very different talents: a cognitive, knowledge-based and disease-centered approach; and a social-psychological, relational, patient-centered, and thus moral approach.
We understand today better than ever that the well-being of body and mind are bound together, and that both are affected by the doctor’s interaction with the patient. A similar insight about the critical role of the human factor has also arisen in economics. Classical economic theory viewed people as walking rational algorithms. The recent rise of behavioral economics shows that economic decision-making is a joint function of rational economic analysis and psychological dynamics. Evidence-based, algorithmic economics and medicine will forever remain mind-and- people-centered, for doctor and patient alike.
For the patient, we know that disease is far more than its objective, medical-biological condition. The course of disease is also shaped by the patient’s scary subjective experience of illness. The experience of the disease is filled with distress, dread, hope and imagination. It fuels what medical anthropologists call “illness narratives” - - stories, right or wrong, that create meaning for misfortune. We also know that one major mitigator of this subjective experience of “fear and trembling” is social support, trust, and some sense of control amidst the scary randomness. All these are, also scarily, in the hands of the doctor. The human factor is, for example, evident in the so-called “open-hidden paradigm”: The “open” standard administration of a drug or injection is significantly more effective than its “hidden” administration, where the patient remains unaware of the treatment. The good physician must be a healer of bodies and souls, storming the disease and embracing the patient. The realization of the critical role of mind in illness is part of the old- new Enlightenment in medicine. It stands alongside a more recent form of person-centered medicine: the prospects of precision medicine and its customization of treatments to the profile of the individual patient.
Lest you think the challenge is obvious, experience suggests that it is not, intellectually or emotionally. Jerome Groopman, then the Chief of Experimental Medicine at Harvard’s Beth Israel, reflected on his medical training. In a book chapter entitled “Unprepared”, he described how helpless he felt in dealing with a patient because his education had not prepared him for matters of the heart: ”I mistook information for insight”. Atul Gawande, the Harvard surgeon and another eminent physician-writer, echoes him: “What worried us was knowledge” and “it did not take [me] long to realize how unready I was to help the patients”.
Or consider an earlier physician, Maimonides in 12th century Egypt. He was at once the pre-eminent Jewish legal scholar with canonical authority to this day, and the most influential Jewish philosopher, with an astounding literary output. He also was a successful and influential physician and medical author, becoming court physician and treating the royal family. You might think that his medical work was a necessary activity to earn a living, an expedient way to support his other more “meaningful” pursuits. But that was not at all how Maimonides saw it. Instead, he considered his medical activities an essential part of his philosophical, religious and ethical commitment to the morally good life. He underscores the religious meaning of medicine in his religious writings, including in his Commentary on the Mishnah: “ The practice of medicine brings much by way of virtue… medical study and practice are among the greatest of undertakings. Medicine …enables us to put purpose into our actions and to make them truly humane”.
In Maimonides’s time there also was real dialogue and respect between the Jewish and Muslim communities. So Ibn Sana al-Mulk, a prominent Muslim poet and religious judge, described Maimonides’s medical outlook: “Galen (i.e.: the physician of Antiquity and author of the dominant medical framework) healed the body alone; Maimonides heals the body and the spirit as well”. For good measure, he added “If the moon only had the good sense to place itself in Maimonides’s hands, he would cure it of its periodic defects and disappearance.”
In my interactions at Rambam I have consistently encountered this blessed combination of excellence, dedication and compassion - - the Mensch in medicine. Just one example among others is Dr Shachar’s fellowship work: one of her papers examines internet tools to optimize physicians’ decision-making in cancer care - - showing the arrival of Big Data in daily medicine. This work is complemented by an empathetic focus on the needs of some of the most vulnerable patients - - geriatric oncology and palliative care.
This Rambam spirit of combining a focus on Big Data and on the Little Individual, of being a center for caring excellence, is profoundly inspiring. The association with Rambam enables us to bask a little in the reflected goodness of your daily generosity of mind and spirit and your long-term mission of creating and sharing excellence. Your vision for tomorrow is today’s reality of a purposeful, good and giving life. For this I wanted to tell you how jealous I am and how grateful I am.