The Book

ALFALFA TO IVY
Memoir Of A Harvard Medical School Dean

Joseph B. Martin / David Hubel, Foreword / Ed Benz, Afterword

The human story of Joseph Martin’s journey from rural origins to highly regarded leader makes Alfalfa to Ivy a compelling read. His deep-seated Mennonite values guided him with humility and optimism through tumultuous changes in modern medicine – changes that he helped guide while serving as Dean of Medicine and Chancellor of the University of California, San Francisco Medical School and, later, Dean of Harvard Medical School. His in-dept experience leaves Martin perfectly poised to evaluate academic politics and health care in Canada and the United States. — University of Alberta Press

Martin shares his insights on:

Challenges Facing Academic Institutions
“This perch provides a remarkable opportunity to view and reflect on the issues that continue to challenge the mission of our academic institutions. Of the many issues large and small, three remain important to me: diversity and affirmative action; challenges of academic-commercial relationships, particularly with respect to conflicts of interest; and the question of the citizen’s right to health care, most recently coming to the fore with US health care reform. In this chapter, I offer some of my personal experiences with these issues, together with some perspectives gained over time.”

Affirmative Action and the UC Regents
“Later that fall, I found myself attending obligatory meetings of the UC Regents, where Regent Connerly was systematically unraveling the decades-long support of affirmative action that had been effectively used to increase minority enrollment. His efforts continued until California state law was changed through a public referendum, Proposition 209, which notoriously, in my view, set new barriers for admission, with much of the effects lingering to this day. Enrollment of underrepresented minorities has tumbled.”

Patient-Centered Care
“So what will we do to deliver the quality of care expected, and deserved, by our patients? How will we increase our focus on the importance of prevention and public health measures-encouraging parents to vaccinate their children, supporting major initiatives to stop smoking and developing regimens for weight control that actually work? I strongly believe that the answer is not to train too many more doctors but to give those we train the right jobs with pay commensurate with the contributions made. Perhaps we need to address the disparity in reimbursement wherein doing procedures pays well but thinking deeply about a patient’s problems has financial limitations. Clearly, the role of primary care has not been a high priority; neither have the new requirements in medical care that will demand new models of health care delivery. For a priority shift to take place, there will need to be a new focus on teamwork, where, for example, doctors, nurses, pharmacists and social workers form efficient groupings to consider patient-centered care. And what of our responsibility to work with our governments, our cities and our health departments to accomplish this?”

Health Care Reform
“I have no doubt that these experiences frame my present bias toward a universal health care system in the US, based upon a single-payer system. However, I recognize this is presently a political impossibility. The current system in the US is broken, not only because of the uninsured but also because health care costs of the traditional fee-for-service reimbursement mechanism are unsustainable, and primary care networks essential for proper delivery of health care and for prevention are simply not in place. I have a sense of outrage at the social injustices that derive from the big business model of insurance and health care administration now extant in the US.”

Transparency Between Academia and Industry
“As we explore the answers to these questions and work together to make these relationships more transparent, we must keep in mind the enormous benefits that these relationships have brought to our nation’s patients, to our institutions and to our economy as a whole. At a time when both our economy and our health care system faces great challenges, we must remember that science and technology have brought us to the forefront of groundbreaking medical discovery, and that the collaborations between academia and industry have, in so many instances, led the way.”

Lessons Learned: Leading by Listening
“… a good leader weaves people of divergent and sometimes conflicting interests – including those who do not necessarily care for each other or for the leader – around a common mission. For the successful leader to “weave” well in our world he or she must have the ability and commitment to lead by listening, hence the final aphorism of this humble “guide.”

IQ and Emotional Quotient (EQ)
“Individual brilliance may result in earth-shaking concepts, discoveries and Nobel prizes, but we expect more of academic leaders: we expect what is commonly called emotional intelligence or EQ. EQ is the ability to understand another’s position, to put oneself in the place and context of the whole, to empathize, to understand the impact of group dynamics on the the outcome of a situation, to be able to reflect on one’s own reactions, to feel and share another’s disappointment and pain, to commiserate, and to initiate planning – bearing in mind the effect your actions will have on others. Simply put, EQ is the ability to listen and to recognize what the other person is really saying.“

A compelling and enticing
story… of family and of
the exhilarating moments
in medicine.

John Dirks, President and Scientific Director,
The Gairdner Foundation

Joseph Martin grew up near the village of Duchess, Alberta. He received his MD from the University of Alberta in 1962. He would go on to serve as the Dean of Medicine and Chancellor of the University of California-San Francisco Medical School, and, later, Dean of Harvard Medical School.