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The Rewards of Public Health – and Public Service

I still remember how I first planned my career in medicine. I was going to be an academic physician, with a professional life mixing clinical care, research and teaching. For a year before medical school and during the following summer, I worked at the National Institutes of Health in a neuroendocrine/neuropharmacology lab, and did additional research later at Rockefeller University. My plan was to do subspecialty training in endocrinology, after a residency in internal medicine.

This early vision did not last even through medical school, as I watched strange cases of severe immune deficiency emerge, generally in previously healthy young adults. No one knew what was causing it or what to call it, but we knew that something profound was unfolding before us. By the time I completed my residency training in Internal Medicine in New York City, the HIV/AIDS epidemic was well established.  As a physician, I’ll never forget how impotent I felt watching AIDS wreak its havoc.  In those earliest days, medicine had little to offer beyond supportive care, and science could not even provide an understanding of the nature of the disease and its cause.

The epidemic brought home to me how the important health care problems – problems I was dedicating my life to help solve – did not exist in a vacuum.  They often had a larger context:  the environmental, legal, social, genetic, and economic disparities that unfortunately still exist here and around the world.

This is when I began to think about a career in public health and health policy. My Chair of Medicine was very disturbed when, at the end of residency, I told him I had decided to work in what was then called the U.S. Department of Health, Education, and Welfare. He said to me, “If you are not back in two years, you will be throwing away all your training.”

I did not return .  .  .  and I cannot say that I have really looked back. Instead, by working for federal and other public health organizations, along with a broad array of scientists, health care providers, patients and patient groups, I discovered the great rewards of helping bring hope, relief and protection not only to individuals but also to entire populations. Even before coming to the U.S. Food and Drug Administration (FDA), I took profound satisfaction in working in New York to improve services for women and children, and to reduce the spread of HIV and TB. Later, I found a similar sense of accomplishment in helping to shore up our nation’s defenses against bio-terrorism.

My unexpected career path has been gratifying.  I know that new medical school graduates are blessed with a wide array of attractive career options in clinical medicine, surgery, research, and policy.  And yet I have been struck by the diversity of opportunities in government and public service for people with expertise in medicine and science.  As the Commissioner of Food and Drugs, I find these intangible but very gratifying rewards to be multiplied by the many ways FDA serves the public.

I lead an agency that protects the public health on a global scale by ensuring the highest standards for a myriad of products that include food, human and animal drugs, biologics, medical devices, equipment that emits radiation and cosmetics, and that also regulates tobacco. Medical and scientific experts are indispensable for FDA’s ability to shoulder this tremendous workload, and we are proud to employ several hundred of them.

Physicians are particularly critical for judging the risks and benefits of new drugs and vaccines, because they understand the conditions these products are intended to treat. But FDA’s medical professionals work in many fields that suit their experience and interests – for example, they direct FDA’s product centers, conduct cutting-edge research in toxicology and formulate regulatory policy; engage with stakeholders and communicate information on product safety; advise drug sponsors on study protocols and ensure the safety of medical foods; evaluate the performance of robotic surgery equipment; and prepare for catastrophic public health threats. An FDA medical doctor is stationed in Asia, improving the oversight and management of the drugs and devices to be exported to the U.S.

As medical students contemplate their professional future, I would urge them to consider public service. The careers at FDA and other public health agencies are challenging, but they offer more than an opportunity to become a top medical professional. Their special reward is a chance to use one’s talent and skills for the for the benefit of all.

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