Dean Philip A. Pizzo, M.D.

Letter from the Dean

Dear Readers,

How do we make choices? Are they results of our free will or the consequences of social norms, genetic predisposition and behavioral factors? Or yet other forces and events beyond our control? In War and Peace, Tolstoy opines that the travesty of war — and virtually all human interactions — is determined by thousands of antecedent events impinging on a single moment. Is that what really happens?

This issue of Stanford Medicine focuses on behavior and its impact on change in our good and bad habits. If only the route to change were as simple as taking responsibility for our own actions (e.g., the New Year’s resolution). But science and experience suggest it is more complex. Genetics, ingrained neural pathways and one’s social environment all tend to lock in patterns of behavior, leaving human beings essentially captive to their frailties. This can result in addiction to drugs or other substances, obesity, infectious disease. Indeed, the interaction of the environment and genetics creates a powerful fulcrum for risk and outcome.

Institutions can also make decisions that can influence behavior. For example, as of Sept. 1, the medical school campus became a tobacco-free zone. Our new policy extends the medical school’s indoor ban on tobacco to the outdoors. With more than 400,000 deaths annually in the United States related to tobacco, prohibiting smoking on the medical school’s campus is a move toward improved health for faculty, staff and students. Smoking is the leading preventable cause of death in this country.

For most people, the habit of smoking is fiendishly difficult to break. Nicotine is as addictive as heroin, cocaine or alcohol. Smokers who want to stop need all the help they can get.

I am hoping that our action is read elsewhere as it is intended: a statement that tobacco is dangerous to your health. The medical school’s smoking ban is part of a global trend to restrict tobacco use. Since the 1990 initial citywide ban on indoor smoking by San Luis Obispo, Calif., a tidal wave has been building. Ireland prohibited smoking in all workplaces in 2004. More dramatically, in September, Belmont, Calif., just a few miles north of our campus, became the first city to ban smoking not only in public spaces but also in some private residences: apartments, condominiums and townhouses.

Policies such as these do work. Studies show that creating obstacles to smoking helps smokers quit. And the majority of U.S. smokers (70 percent, according to a 2002 Centers for Disease Control and Prevention report) want to quit. So behavior, even addicted behavior, can be influenced by institutional as well as personal decisions.

We’re just beginning to gain insight into the individual’s power to change behavior. Science is asking some big questions. Is free will really free? As we unravel the mystery, we’ll be probing one of life’s essential questions: what it means to be human. And we will seek a better understanding of how behavior influences choice — or how our choices impact our behaviors, be they good or bad, healthy or unhealthy.

With best regards,

Philip A. Pizzo, MD
Professor of Pediatrics and of Microbiology and Immunology
Carl and Elizabeth Naumann Professor

Dean, Stanford University School of Medicine

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