The public good of science for health.

April 22, 2017, was the date of the 132nd annual meeting of the Association of American Physicians (AAP). April 22nd was also the date of the March for Science, which was held in 600 cities globally. AAP was a formal sponsor of the march, with 84% of its members endorsing it. Apart from the march, the trisociety AAP-ASCI and American Physician Scientists Association (APSA) meeting offered its usual evidence of why the March for Science is relevant: that science both represents some of the best of the human condition — of curiosity, knowledge, and exploration of the meaning of being human — and is a basis for securing a better future. The premise that science will serve better health futures goes back to the founding of the AAP in 1885. Established “for the advancement of scientific and practical medicine,” it was formed and led by the — then — young Turks, who were forceful leaders in bringing science to medicine in the US. Their expectation was that scientifically based medicine would transform the physician’s ability to improve the health of patients. We now can look back on the results: more than 130 years of advances in science have been critical to the US and to the world, creating dramatic improvements in health, wellbeing, life expectancy, and prosperity. One summary metric demonstrates an increase in life expectancy by over 30 years in the last 100 years (1), largely due to the scientific contributions of public health and medicine, improved education,and poverty alleviation. Further, Robert Solow’s Nobel Prize–winning attribution is that over half of all economic growth in the US since World War II is due to technological progress and our underlying investments in education, basic science, research and development, and infrastructure (2). At the same time, improved health status of the US, and of all nations, is fundamental to our productivity as well as our wellbeing and longevity. I have had the opportunity to review the archives of the AAP and find that it offers a history of the roots and the trajectory of these achievements in terms of the US origins of medical and public health science and then the evolution of medical science in particular. I would like to reflect on this trajectory and accomplishments and suggest how I think this offers a lens to both understand the impact of science on health and the impact of health on well-being and our future and suggest a redefined status for science for health as a public good. AAP was organized in 1885 to be a society of “American physicians and pathologists” — initially limited to 100 members — who would meet annually to discuss subjects of “general interest for the advancement of scientific and practical medicine” (Table 1). The first council of AAP included seven physicians from the east coast, Chicago, and Montreal, including several who were at the forefront of the move to make science the basis for advancing medicine. The members are listed in Table 1. Two in the table, Doctors William Osler and William Henry Welch, are preeminent figures in medicine and science. Figure 1 shows a photo of William Osler, who became AAP president in 1895, while he was writing The Principles and Practice of Medicine. Osler was the creator of the medical residency, bedside rounds, and clinical clerkships and was the author of “Aequanimitas.” He was one of the “fab four” who started the Johns Hopkins School of Medicine, the first US medical school committed to science as the foundation to medicine. Figure 2 shows a photo of the AAP president’s gavel. It is made from the wood from Dr. Osler’s birthplace in Bond Head, Canada. The other member from the first AAP council meeting who I would like to particularly honor is William Henry Welch (Figure 3), the impresario of US scientific medicine who started the Johns Hopkins School of Medicine, recruited all of its initial faculty, and served as founding dean from 1893 to 1898 — with the goal of creating the first scientifically based school of medicine in the US. Welch was president of AAP in 1901. He subsequently served as founding dean of the first school of public health, at Johns Hopkins, from 1916 to 1926. In fact, Welch proposed that a school of public health be developed at the same time as the school of medicine, but that ultimately happened sequentially. Welch also served Reference information: J Clin Invest. 2017;127(10):3561–3567. https://doi.org/10.1172/JCI96941. This article is adapted from a presentation at the 2017 AAP/ASCI/APSA Joint Meeting, April 22, 2017, in Chicago, Illinois, USA. Table 1. AAP: First Council, 1885