Find Events Find People Find Jobs Find Sites Find Help Index


February 12, 2001

Making stem cell citizens

Michael Johns is executive vice president for health services

Rebecca has given us, with her usual eloquence and insight, a view of how the word “reconciliation”came to represent the University’s inquiry into its own nature and aspirations as we enter the new millennium. And she has asked whether what we have learned and experienced throughout this symposium has meaning for us as a University.

I think the answer is yes, and, as she and every other speaker has suggested, there are many ways to look for and develop that meaning.

I want to respond to Rebecca first by talking a little about how I view the issue of reconciliation.

For me, the word reconciliation evokes a sense of one of the sacraments, a meaning left over from when I was a kid going to Catholic school and [my] time spent as a seminarian in Detroit. At that time we practiced the sacrament of penance—of seeing and confessing what you had done wrong and making it right. A personal version, perhaps, of Hannah Arendt’s setting anew, setting aright.

Then, by the time I left the seminary for medicine (my interest in biology having exceeded my interest in celibacy) the sacrament of penance had been renamed the sacrament of reconciliation, to emphasize less the need for punishment and emphasize more the need to set things aright—to restore, to use the Webster dictionary’s first meaning of reconciliation.

More recently, I think the word reconciliation has taken on a new significance and meaning, especially in the light of the reconciliation efforts in South Africa. For many people reconciliation now connotes public confession and penance for wrongdoing by a perpetrator, coupled with public forgiveness of the perpetrator by a victim.

This effort to reconcile two opposing paradigms, to bring two polarities together—especially when one of those polarities is considered to have committed very bad acts, maybe even evil ones—is a very profound and, I’m sure, quite painful exercise.

I believe this may be why many people who have spoken to me of this symposium since it was announced, even those who did so with excitement, have asked: What have we been doing “wrong?”

What are we meant to confess?

I think that’s the wrong question. I believe this symposium brings us together around a slightly different meaning of the idea of reconciliation. It has less to do with penance, with the sense of “mea culpa,” than with the sense of defining and finding commonalties and paths forward. To quote from Webster’s Third International, there is another definition of reconciliation that involves “making consistent or congruous, as in reconciliation of ideals with practical reality.”

Personally I prefer “harmony.” Perhaps we even need a new word like “harmonization.”

To me, the central question for us is: How can and should the University be a place where individuals can learn about and formulate ideas and ideals in preparation for their application to and reconciliation with reality?

To put it another way, how can we enhance our university as a place where we teach and learn ways to define and pose relevant questions and constructive solutions to life’s many issues and challenges?
How can we be a place where we take an active posture toward finding the best paths forward, where the work of individuals and communities of individuals is to develop the capacities for asking the right questions and finding the best answers?

From my own training and experience and from my reflection on the educational and learning process over many years, I have long maintained that the role of medical education, for instance, is to produce what I like to call the “stem cell” physician.

For those of you who aren’t or weren’t biology majors, a stem cell is a basic, embryonic, unspecialized cell that, as an organism develops, is capable of developing into one of any number of more specialized cells with specialized functions.

Such a stem cell has the capacity to differentiate from a single cell into an entire organ—such as a liver, or a heart or a lung.

So, taking the stem cell as an analogy, to me the best medical school education is one that can produce the stem cell doctor, an individual who is well rounded and well grounded; a person who can leave his or her medical school training with the ability to take any path forward.

To my mind, such an education must involve not just the biological sciences but also the history of medicine, ethics, law and medicine, public health, policy and politics, and related courses on the role of the physician in society. After all, how can you be an ethical physician if you don’t understand how society views you or your role in society? This also applies to nursing and public health as much as to medicine.

That means that the students we admit to medical school (or any of our schools) must not be just science jocks, but also well rounded and well grounded in the liberal arts, having had the opportunity to contemplate their place as scitizens of the world.

Further, picking up on Arthur Kellermann’s comments from yesterday and those of Bill Foege today, these students must understand that there is no conflict between public health and acute and chronic care medicine. They are all part of a continuum of caring for the health, wellness and sickness of the public. And that means all of the public.

I believe it is time to revisit our health professions and redefine their roles at their interfaces. So, for our university as a whole, I believe our goal is no less than to produce the stem cell citizen of the planet earth: a student who feels and has a passion and an awe-filled curiosity about the peoples and the world we live in, with an exposure to a range of issues from the origins of humankind to what “humanness” requires.

They should have the opportunity to learn from Greek tragedy and from the tragedy of the AIDS epidemic. They should investigate the intricate horrors of dictatorships and the intricate complexities of our genome and proteome.

As Duderstadt says in his wise treatise, “The University of the 21st Century,” the university should be a place where one learns to live as much as a place one lives to learn. The undergraduate experience should embrace the totality of the university missions of teaching (learning), research, and service.

The student should depart our great university having tasted all three of these vital offerings. Otherwise he or she may never know how great a meal can be found at the table of higher learning.
I believe this symposium has highlighted the ways in which the missions of the various components of the University—including those in the health sciences center—are entwined and can support and enhance one another.

And it points out so many pathways for further enhancing our missions: in the ways we teach, the ways we interact across schools and disciplines, even in the ways we need to adapt the new tools and technologies of learning in the 21st century and the ways our own students can teach us to use them with greater facility and effectiveness.

In the Woodruff Health Sciences Center, we certainly deal daily with extraordinarily challenging issues requiring reconciliation, whether in our patient care and service, in our research or in our teaching.

Although I used the traditional word, “teaching,” I think “learning” captures our mission more than teaching. The students, our community and faculty teach, but perhaps even more importantly, they learn from each other.

In May—when we host our Health Sciences Center Reconciliation Symposium which we have titled “Health Professional: Healer or Line Worker?”—we will be dealing with the challenge of reconciling the role of the health professional and educator within the new, market-driven health care environment. I urge all of you to attend what promises to be a very penetrating, faculty-led forum to delve deeply into personal and professional struggles to reconcile very complex, cross-cutting demands and responsibilities faced by academic health professionals, scientists and teachers.

So to close my response and reflection here, I want to agree with Rebecca and all the presenters, and reiterate that the university is at its best where it embraces the mission of reconciliation—or, better yet, harmonization—where it institutionalizes the relentless quest for knowledge and understanding.

It is in that relentless quest for knowledge and understanding that I think we find the best hope for developing stem cell citizens of the world, capable of finding new and constructive solutions to problems and challenges in their work, in their communities and in their lives.


Back to ER symposium page