Former CDC director on what new docs, scientists need to know

On Monday, May 12, former CDC Director Rochelle Walensky delivered the below commencement address at the WashU School of Medicine.

One of my first tasks even before my tenure began as director of the Centers for Disease Control and Prevention was to pen an op-ed for the New York Times. It said, “I will lead with facts, science and integrity.” In retrospect, I would have refined that point and added, “and that science will change.” Why?

Because science, by its very nature, is a self-correcting process. New science emerges, and previous blind spots are exposed. And with each answer, new questions arise. This may be obvious to you, but it is worth saying clearly. Science is provisional. It is designed to be open to challenge, to revision, and to refinement. That is not apparent to everyone.

What, then, is the difference between science and fact? How does it cross the line from open inquiry to dogma? How does it become shielded by authority and protected from question?

Facts stand alone. They are treated as fixed, resistant to change until and unless overwhelming new evidence forces us to rethink them. Facts are usually stated without qualification. For example, if you throw a ball into the air, it will fall back down. You do not bother adding, “unless a tornado sweeps through” because the fact holds in all expected conditions.

What am I supposed to say to this generation of young scientists?

But when does science become fact? And more importantly, who gets to decide?

The answer is not in titles, nor in appointments or votes. Science morphs to fact when the evidence is strong, independent, and repeatable and when predictions hold up over time; when challenges fail; and when broad consensus emerges among trained professionals. People, like you.

Facts are not declared. They are earned by surviving challenge after challenge, earned by withstanding time and scrutiny, and earned when broad, careful consensus forms among those best positioned to judge. Experts, like you.

If facts anchor one end of the spectrum, the other end is anchored by something much harder to live with: uncertainty. In decision science, one of the field’s leading textbooks is “Decision Making in Health and Medicine.” Chapter 2, titled “Managing Uncertainty,” opens with:

“Much of clinical medicine and health care involves uncertainties: some reducible, but some irreducible despite our best efforts and tests. Better decisions will be made if we are open and honest about these uncertainties, and develop skills in estimating, communicating, and working with such uncertainties.”

What do we do with uncertainty? What do we do with the gray? Especially in an age when technology, Google, and artificial intelligence can offer instantaneous, comprehensive answers to almost any question. What do we do, when our boards demand the right answer; when our medical training rewards exactness; when our field embraces “precision medicine”; and when the world expects certainty? But when the future, the diagnosis, the management plan, and even the path forward are, in reality, gray?

The truth is uncertainty creates vulnerability. Uncertainty provokes fear. So, human nature invites us to suppress it. The scientific literature demonstrates that uncertainty does not just make us uncomfortable; it also affects our mental health. Uncertainty is linked to anxiety, to stress, to burnout, and to paralyzing indecision. When uncertainty becomes chronic, it can fuel hopelessness, helplessness, and even depression. I suspect this sounds familiar to both you and your patients alike. Let us consider approaching it differently. Instead of resisting uncertainty, acknowledge it. Even, accept it. It is not easy, and it takes practice. We need to become better at saying, “I don’t know” to each other and to our patients and to recognize the value in that admission.

At this time of year, we honor the new graduates in medicine and welcome them to the field. We celebrate the knowledge you have gained, the people you have touched, and the gateway you have built to your future. This new degree comes with more than just the new title of Doctor. It comes with responsibility. You are now stewards of truth: both seekers and tellers. You are defenders of reason and champions of intellectual honesty. Perhaps most importantly, you are the communicators of uncertainty. And we need you.

Because in today’s world, the lines between fact, science, and uncertainty are increasingly blurred. Things once treated as dogma are being questioned. Things that were once uncertain are too often handed out as fact.

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Your starched white coat is not the mark of mastery, but the threads that bind you to a lifelong pursuit of knowledge. Knowledge gathered at the bedside, forged at the bench, tested in populations and returned, always, to the hands of patients who need it most.

It is at the bedside, too, where science meets its truest reckoning; where elegant hypotheses bend beneath the weight of human complexity; where diseases refuse to follow the neat patterns of textbooks; and where the standards we write in guidelines remain, for far too many, painfully out of reach.

Empathy may, in fact, be one of the most profound forms of scientific observation — a reminder that we often learn the most not when we speak, read, or investigate, but when we simply listen. Our patients, though generally unschooled in medicine, carry with them a lifetime of experience — lessons embedded in their stories and symptoms — if we have the wisdom to ask, and the patience to hear.

You are embarking into an incredible career at a fragile and uncertain time. Facts are being attacked, and science is being distorted. And the most vulnerable — your patients — are the ones who will pay the price.

Today, the map ends and true discovery begins. You will write the next great chapters in medicine. You will help move the world forward: from sickness to healing; from pain to comfort; from science to fact; from uncertainty to understanding, and back again, as only honest inquiry can.

Healing will reach beyond the limits of medicine because it will not be knowledge alone that restores your patient, but rather, the care you offer, the questions you ask. You will weave together story and knowledge, symptoms and science. The needs you meet are those that no prescription can fill.

The title you have earned — Doctor — is not the end of your learning, but the beginning of your responsibility. You are now both the seekers and the stewards of truth. It will be your voice that must defend the integrity of facts, and the power of science. Your voice will matter. Your choices will shape lives. And your willingness to face both facts and uncertainty — with humility, with curiosity, and with courage — will be what defines you.

Because the world and the people in it need more than answers.

They need you.

Rochelle P. Walensky, M.D., M.P.H., is the Bayer fellow in health and biotech at the American Academy of Berlin. At the Harvard Kennedy School, she is a senior fellow at the Women and Public Policy Program, Hauser leader at the Center for Public Leadership, and senior fellow at the Belfer Center for Science and International Affairs. She is also former director of the CDC.

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