Order of Proceedings Oraton by Professor Carmel Malla M.D., F.R.C.P.(Edn), FRCP (Lond.) Address by Edward Xuereb, a Ph.D. graduand and a representatve of the graduands. Conferment of Degrees Solemn Declaraton by Graduates INNU MALTI The Congregaton rses when the Dgntares leave the Hall. Oration by Professor Carmel Mallia M.D., F.R.C.P. (Lond.), F.R.C.P. (Edn) Professor of Medicine, University of Malta I would lke to thank the Senate of the Unversty for grantng me the prvlege and the honour to address you on this most significant day. I consder myself as beng favoured by serendpty n that t should have fallen to me to address ths dstngushed audence n ths hstorcal church, so closely connected wth the foundng of the Collegium Melitensae n 1593. The Collegium, set up through the drect nterventon of Pope Clement VIII and run by the Jesuts, was the forerunner of our Unversty. The Faculty of Theology formed the ntal nucleus of the Collegium. In 1676, three hundred and thrty years ago, Grand Master Ncolo Cotoner founded a School of Anatomy and Surgery at the Sacra Infermeria and apponted Dr. Fra Guseppe Zammt as its first director and teacher. Graduating today are members of the two oldest facultes of our Unversty, whch s one of the oldest n Europe and the oldest n the Brtsh Commonwealth outsde the Unted Kngdom. No wonder our Alma Mater s so rch both n tradton and n hertage. The strength of any unversty les n ts staff and ts students, and we all have the responsblty of mantanng ts prestge and emnence. Whle graduaton day marks a transton - an end of student lfe and a begnnng of lfe as responsble professonals - t s also a contnuaton of the lfe-long learnng process that each of us began at the start of our unversty days. Our real value to socety does not le merely n our store of factual knowledge and our ablty to recall facts. Of course, facts are necessary snce they are the buldng blocks of our knowledge and wthout them judgment s mpossble. However, facts change: a significant proportion of facts that was dogma when I graduated n medcne thrty seven years ago are now obsolete. But then, change s part of lfe, a fact recognsed over two thousand years ago by the Greek phlosopher Heracltus when he sad that ‘there s nothng permanent except change’. Educaton, lke lfe, s a journey, not a destnaton; t s a habt of mnd, a phlosophy of lfe, a way of beng. The purpose of unversty educaton s to make you learn to learn, to contnue to queston, to challenge establshed deas and to test new ones. A quotaton from Sr Wllam Osler, consdered by many as the deal medcal practtoner, s approprate – ‘The kllng vce of the young doctor s ntellectual lazness.’ Within a short time you will be receiving your diplomas which are officially valdated by our Unversty. By vrtue of ths conferment, socety assumes that ii you are beng transformed from a lay person to a young, though nexperenced, professonal. In the case of medcal doctors, patents you wll encounter wll bestow you wth power, trustng you wth ther well-beng and wth ther lves. Professonalsm does not mean gettng more prvleges n socety, but rather more dutes over and above the dutes of beng a ctzen. The dploma does not bestow upon us the attrbutes of professonalsm – most of us keep learnng how to be better ‘’professonals’’ throughout our lves, but we are constantly buldng on a foundaton that was developed at Unversty or Medcal School. Change s also evdent n the evoluton of the practce of medcne. Socologcal and technologcal advances are occurrng at an unprecedented pace. It s true to say that the medcal breakthroughs of the last sxty years have probably saved more lves than those of any era snce medcne began. A century ago, our predecessors graduated wth lttle else but a large amount of medcal facts and clncal sklls to face the challenges of the day, whch ncluded tuberculoss, polo, typhod, pneumona, rheumatc fever and brucelloss. Ther therapeutc armamentarum was hopelessly nadequate; no wonder lfe expectancy was low and nfant mortalty so hgh. Thanks to the dscovery of antbotcs and newer vaccnes, mprovement n socal condtons, hygene and santaton, these major nfectons have been brought under control and n some nstances, such as smallpox and polomyelts, eradcated. Brucelloss, so ntmately lnked to Maltese medcne, has not been reported n Malta for over 10 years. Other major advances have been recorded n all other spheres of medcne and surgery, both in investigative as well as in therapeutic fields. The challenges facing the medcal professon today are qute dfferent and nclude several chronc and degeneratve dseases such as heart dsease, stroke, arthrts, cancer and dementa, all due to multple causes whch may nclude both genetc and envronmental factors, as well as new nfectons such as AIDS. Unfortunately, we shall be contnung to face an ever-ncreasng exploson of dseases caused by an ntemperate lfestyle – obesty, smokng, alcohol and drug abuse A major pharmacologcal development has been the ablty to produce drugs aimed at specific receptors on cell surfaces. Such targeted pharmacological therapes are already a realty today, and have resulted n major therapeutc benefits in a number of diseases. Prospects for the development of other such drugs n the near future are very promsng and wll mpact many areas ncludng oncology, haematology, rheumatology and psychatry. As we learn more about the chemstry of mental functon, dseases such as Alzhemer’s could become manageable. The mappng of the human genome has set the stage n whch doctors use gene tests to determne whch patents are most likely to benefit from a particular treatment. It may also be that some time in the future stem cells may help our alng bodes produce whatever protens they lack. The changing medical scene has resulted in significant changes in the nature of our servce and the way we practse medcne. Our predecessors used to practse medcne mostly as solo practtoners, and were dagnostcans, therapsts and pharmacsts all wrapped n one. Unlke them, we now ncreasngly practse medcne as part of an ever-enlargng team of health professonals that may nclude admnstrators whose tranng s more n the lne of economcs and fiscal management rather than medicine and health care. While administrators and doctors share many attrbutes, not least among whch s the desre to create an excellent health system, ther perspectves sometmes clash. Resource constrants may threaten what the doctor sees as the proper dscharge of hs or her professonal dutes. Despte the changng scene, our prme concern should stll be the same as t was centures ago, namely the health and well- beng of our patents. Patents themselves stll expect ther doctor to do what s n ther best nterest, they stll expect ther doctor to be ther advocate and expect ther advocate to be the leader of ther management team. We must not betray that trust – although t s no easy task. Modern medcne s more effectve but s becomng ncreasngly expensve; patent expectatons are hgh and every new development moves quckly from somethng that would be nice to have to something that is definitely needed. There is no shortage of current and future medcal, socal and ethcal questons to tackle and we have to ensure that our ethcs keep pace wth our scence. How can we ensure that socety can contnue to afford qualty health care for all? How can we ensure that access to health servces s far, just and based on real need? What about genetc testng – how are we to ensure that the nformaton that s ganed from these tests wll not cause patents to lose ther jobs or to be dened nsurance? What about the ethcs of stem cell research? We are lvng n an exctng tme, wth medcal scence promsng better prospects for mprovng human lfe. Challenges abound, but we must never forget the fact that t s the patent who s the centre of our attenton. Irrespectve of how technologcal medcne becomes, t wll always reman iv a human enterprse. Indeed, the legtmacy of medcne s based on our personal and ntmate relatonshp wth the patent and secured by the ethcs of confidentiality. It has been said that the doctor’s most compassionate act s to make the rght dagnoss. Knowledge and ablty to use ths nformaton are essental, but are ncomplete unless we apply them wth genune regard to the patent, another human beng, and ensure that we deal wth each and every one of them wth ntegrty, respect and compasson. Dr. Francs Peabody was an Amercan physcan who practsed n the begnnng of the 20th century. He was a clncal scentst and an authorty on typhod fever and polomyelts who was descrbed by hs contemporares as a model physcan and a beloved teacher wth an nner symmetry of ntellgence and heart. He ded of cancer at the age of 45, but hs compasson and wsdom n patent care have made hs short lfe an essental message for anyone who practses medcne. In 1927 he delvered what s consdered to be hs most famous lecture on “The Care of the Patent”. In t he expressed concern that rapidly-growing scientific technology was crowding out human values in the management of patents. The need today to pay attenton to the person as well as to the dsease s even greater than n 1927. Ths s what Dr. Peabody had to say: “The essence of the practice of medicine is that it is an intensely personal matter …the treatment of a disease may be entirely impersonal; the care of a patient must be entirely personal.