St. George’s Graduation Commencement Address 2006 Dr Richard EW Halliwell

My warmest congratulations to each and every one of you!

This day marks the culmination of aspirations and dreams that all of you have had for many, many years. And I am sure that the path for some of you has not been an easy one. It is also the culmination of the dreams and aspirations that parents, family, loved ones and other supporters have had for you. Their support, given unstintingly and often involving considerable sacrifice has been crucial to your success. So on this very special day, we pay tribute both to you, who mastered all of the knowledge and clinical skills required of you, and also to those whose help and support has been so crucial to your success.

Some years ago, you made the decision to join the St George’s family. Your graduation today is not the end of that relationship, but it marks a new beginning as an alumnus. The St George’s family is noted for a very special spirit and esprit de corps. All of you went through the trauma of hurricane Ivan, that could well have seriously disrupted your studies. But your administration worked night and day to make alternative arrangements. In my case, as a visiting Professor, I had to trade the beach of Grande Anse for the cornfields of Manhattan Kansas. And however high my regard is for that august institution, and for the generosity and welcome that its staff extended to all, for someone coming from Scotland in November, it just wasn’t quite the same thing! But the spirit of camaraderie that was evidenced by displaced students and staff alike was nothing short of remarkable. There was an absolute commitment and determination to overcome the serious setback. And, of course, you succeeded. The true spirit of St George’s was never more evident than at that traumatic time. I urge you to continue to embrace this spirit in the years ahead. Keep in touch with your classmates, with other alumni and with the administration. In so doing you will help to maintain something very special for future generations of students.

Medicine and veterinary medicine have much in common – indeed some maintain that there is but one medicine, only with different branches for different mammalian species. Both professions, of course, are held in the highest esteem by society as embodying the finest characteristics as caring professions. But gratifying though that is, it places upon each and everyone of you an awesome responsibility – that of upholding the traditions of integrity and of high ethical standards that have made our two professions such pinnacles amongst society. The future will not always be easy. There will be difficult times when you will be faced with difficult decisions. But when struggling over which course of action you should take, be guided by the reasons that made you aspire to your career – which I am sure was desire at all times to do your very best to improve the health and welfare of the patients committed to your care – be they animals or human beings.

And then both professions are devoted primarily – either directly or indirectly, at the betterment of human health. The veterinary profession, of course, is charged with ensuring the safety and quality of foods of animal origin. But the very substantial health benefits that pet animal ownership conveys on their owners are less well-recognized. These benefits translate into substantially lower incidences of many common ailments, with cost savings in health care, and improved contributions to national gross domestic products that are measured in the billions. Then the stress relieving effects of pet ownership have been shown to very significantly lower the morbidity and mortality in patients with coronary artery disease, and pet-facilitated therapy is increasingly employed to enhance the quality of life for sufferers of chronic diseases. Yes, people can become allergic to their pets, but genetic engineering has now enabled the removal of the gene encoding for the major cat allergen from that species. There is also evidence that exposure of potentially atopic children to pets early in their life, lessens the likelihood of the development of severe allergies to other environmental allergens later in life.

And the study of comparative medicine can unlock secrets surrounding puzzling diseases that affect both man and animals. For example, both suffer from systemic lupus erythematosus, or SLE. There are anecdotal reports that this disease may be transmitted from dog to man, or vice versa. Yes, the reports are indeed anecdotal, but how many anecdotes are required – all suggesting the same thing, before a call for in depth investigations is answered.

In fact the value of the study of comparative medicine has been well-known for many years. A prime example was the remarkable observation of Edward Jenner in 1790, that people who contracted cow pox from milking cattle were apparently immune to small pox. This provided the basis for the vaccine that enabled the eradication of this appalling disease from the planet. But sadly not all zoonotic diseases are of such direct benefit to mankind. Indeed the past two decades has witnessed the emergence of serious diseases that continue to challenge both our professions.

Firstly, I mention that peculiarly British creation – bovine spongiform encephalopathy, BSE or mad cow disease. This has the potential to cause the invariably fatal new variant Creutzfeldt-Jacob disease in people. Although thus far less than 200 people have succumbed to the disease world-wide, the variable, and very long incubation period of the different genotypes makes it impossible to predict the ultimate impact with any certainty. The disease has been exported from the UK to many countries, and entered the USA via Canada. But is unclear how the calf born last year in Texas acquired the infection. Not only does BSE have implications for human health, but the economic ramifications for the US have been profound, with losses of export markets in Asia worth $10 billion annually.

Then there was the saga of SARS, or severe acute respiratory disease. The infection was caused by a coronavirus that it was believed had mutated from that carried by civet cats and/or raccoon dogs. But the true reservoir has now been shown to be the Chinese horseshoe bat. This disease caused close to 1000 deaths worldwide, with most concentrated in Asia, but with a significant outbreak in Canada. The disease has been eradicated from the human population, but whether or not it will re-emerge remains to be seen.

But the impact of SARS pales into insignificance when one considers the possible impact of the avian influenza strain H5N1. This virus appears to be endemic in a number of Asian countries, and shows highly variable biological activity in different species. Thus some duck species can act as carriers, whereas in swans and apparently also in cats, it is usually fatal. Deaths in humans are currently numbered in the low hundreds, but the reported mortality rate is alarmingly high at 50%. However one must emphasize that the disease surveillance in some Asian countries is such that one has little idea of its true incidence, and of how many mild or subclinical cases may have occurred. Thus far, it does not spread readily between humans, but it only requires a single point mutation to enable it to achieve rapid spread. When one realises that the Spanish flu epidemic of 1918, which killed some 50 millions world-wide originated in the same way from a mutation of an avian disease, the possibilities of a pandemic are truly alarming. They are even more so when one realises that the 1918 epidemic had a mortality rate of only 2%.

Yes, new diseases are indeed emerging at an alarming rate, and it is quite certain that they will continue to do so. Of these new diseases, it is estimated that 75% have zoonotic potential. So it was never more important that our two professions work together as one. Only by an ever closer partnership can we face and overcome the challenges that lie ahead. It was also never more important that public investment in health research is increased. And this investment should not be limited to expenditure in any one country, for disease knows no boundaries.

Your graduation today is not, of course, the end of learning – it is merely the beginning of a new phase of learning. Learning in our professions continues until the day we die, or we leave the profession. You are all fortunate enough to be faced with a plethora of opportunities in the years ahead. There are many branches, many specialties of medicine and veterinary medicine open to you. But do not readily discard the very important role that the general veterinary practitioner has, or that the family doctor has. These are indeed the backbones of our respective professions. And do please consider the possibilities of a research career. But remember also that many of the most important original observations have been made from practice. So, irrespective of whether you are in basic or clinical research, or in whatever type of medicine or veterinary medicine you end up, you all have both the ability and the potential to advance knowledge. So maintain and develop your problem-solving skills. Approach your cases with an open mind. Foster and develop your spirit of enquiry. Discuss your cases with your peers and colleagues. Develop the concept of self assessment, learn from your experiences, from your mistakes, and document your observations.

And amongst you, it is certain that there are future leaders of your respective professions – leaders who will play a role in your professional organisations, and who will influence government in shaping the health care policies of the future.

So, let me conclude by emphasizing that you are all today on the threshold of exciting careers – of careers that offer you an unparalleled and unique breadth of challenges and opportunities. You have been well-prepared for them.

Enjoy your careers, rise to the challenges, seize the opportunities, and may I wish each and everyone of you more than your share of good luck.

Published on 08/08/2006