GREGORIO SINGIAN MEMORIAL LECTURE THE MAN WHO SAW THE INVISIBLE

Dr. Cawilihan T. Zubiri

The year was 1872. The month was May. A baby boy was born in Pampanga, in the town of Santo Tomas. His parents named him Gregorio. Gregorio Singian. This was not an easy time to be born. Just three months before, the three priests -- Fathers Gomez, Burgos and Zamora -- had been executed. The country side was still abuzz with the happenings.

Narinig mo ba? Grabe ano?

The Filipinos -- or at that time we were called the indios --were confused. How did that happen? What had they done? The only crime the priests had committed was to make a simple request: that all priests in training -- Spanish and Filipino alike -- be treated equally. And because the 3 priests had a following, the Spanish authorities were not happy with their clamor. When the Cavite Mutiny took place, the Spaniards found an event in which to implicate the priests and so it was made to appear that they were the leaders behind the mutiny. And they were put to death. And three months after, Gregorio Singian was born. It was a time when people had questions.

longer?

Questions like How much

It was a time when ones spirit was easily stirred by that sense of injustice -- injustice toward ones race, so that there was a moving within the soul that one had to to do something to help ones people. Practically every young man -- more so the man who had the opportunity to have an education -- felt some stirring in his heart. What
1

could he do for his race? What abilities had been placed inside of him that would help move his people forward? And the young Gregorio as he walked the halls of academe -- the halls that would later be known as the University of Sto Tomas must have experienced the same emotions as Jose Rizal, who about 10 years before had also walked the same halls and corridors -- Rizal whose mother had been thrown into prison for a crime which she did not commit. But how could he -- Gregorio Singian -- lift up the lives of his fellow Filipinos? He decided to be a surgeon. To alleviate pain, -- and where he could -to prolong life through surgery. But where would he learn? Who would teach him? He lived in a small town -- Sto Tomas in Pampanga. How did a surgeon train during his time? Training to be a surgeon There was not much in terms of local training. In fact, there were no surgeons as we understood surgeons to be. The earliest records that were written about surgery in the country were records about surgery which had been done by outsiders--foreigners who visited the country for trade among whom sometimes were physicians and surgeons. When one goes back to the early beginnings of our history when we were not yet a nation, when we were simply a disjointed number of kingdoms, how was surgery practiced? If we were to correctly sort out our history prior to our independence, we would divide it into three periods First, the Kingdom Era Second, the Spanish Era Third, the American Era
2

The Kingdom Era In the Kingdom era, we were called Mai at least by the Chinese. At least that part of our land especially around Mindoro was known to the Chinese who came here to trade as the State of Mai. That was our name to the outsider. They even had Chinese characters of our name.

These records were found in the era of the Sung Dynasty around the year 972 A.D. And within what would now be our borders were also other kingdoms. Some historians would call them rajahnates. we will call them kingdoms. For our purposes today,

The Kingdom of Butuan was known for its balangays -- large wooden boats that sailed the open seas, the Southeast Asia Maritime route. In fact, they were the first wooden watercraft ever excavated in Southeast Asia. Then there was the Kingdom of Tondo sometimes also known as the Kingdom of Tundun, mentioned in the Laguna Copperplate Inscription which means it existed as a kingdom in the year 900 A.D. Then there was the Kingdom of Saludong referring to the area now known as Manila. And the Kingdom of Namayan which referred to the area around the upper portion of the Pasig River and the coast of Laguna Lake The kingdoms mentioned were known throughout the known world as the kingdoms of the people with gold -- the people who mastered the art of gold craftsmanship.

Almost everywhere in the country, there have been found pieces of evidence of our workmanship in gold. Belts, ornaments, gold chains, necklaces, bracelets, earrings, other jewelry, bowls, utensils and face masks. The Kingdom of Butuan was a Hindu kingdom at that time and so the discovery of numerous Hindu gods wrought in gold was not surprising. There was a statue of the Goddess Kinari wrought in pure gold. And a gold and silver Tara. There was even a special ceremonial cloth woven entirely out of pure gold fibers -- woven using a technique so advanced that it can no longer be replicated. The fact that our gold jewelry has been found in Egypt, attests to the fact that the craftsmanship was valued and admired by a civilization so advanced as Egypts. When it came to gold and gold craftsmanship, we were one of the best, if not the best in the world. So the question is sometimes asked: if we were skilled in working with gold, and skilled in boat building, perhaps we were then skilled enough to practice surgery? Perhaps, but so far there is no record. There was surgery but the surgery was done by those who traded with us. Mention is made in our writings of Chinese physicians, and of surgeons. Dutch

And then came the Spanish era -- the era in which Gregorio Singian was born. The Spanish Era Now, there were written reports of sutured head wounds among the crew of the expeditions sent to colonize the Muslims in the southern islands. And the surgeons were probably Spanish. But we know that
4

there was surgery done because of a requisition form received for lancets and dry cupping glasses dated 1571 at a military hospital in Manila. As early as 1571 we had a hospital? Yes, as early, in fact, as 1565, we had a hospital! In fact, 200 years before America had its first hospital -- the Pennsylvania Hospital built by Benjamin Franklin in Philadelphia -the Philippines already had a functioning hospital. It was built in Cebu. Presumably, a military hospital was priority for Miguel Lopez de Legazpi. That hospital was transferred to Cabildo Street in Intramuros in 1571 and this is when the requisition for lancets was written. The hospital stayed in Intramuros until the year 1893 when it was transferred out to Arroceros and Concepcion Streets, the present location of the Veterans Hospital. All these years the hospital was simply called the military hospital. In 1898 the hospital was renamed the Sternberg Hospital by the Americans. And this was the hospital -- the Sternberg Hospital -where Gregorio Singian saw the first major surgical procedures done. Did he do surgery right after graduation? No. History sometimes has a way of deciding what we do. A few months after his graduation in 1896, the Philippine Revolution erupted. Followed very soon after by the American Era. And the most conspicuous aftermath of the American Era was the Filipino-American War. The American Era Whatever training he was to have to be a surgeon was interrupted by a season of serving as a doctor in the Philippine forces in Pampanga during the Filipino-American War. But whenever time allowed, he trained on his own. How?
5

The hard way. He purchased books -- anatomy books, surgery books, books on surgical techniques, atlases. He read them over and over again. He read and studied them until he became the master of anatomy and could picture the anatomy of a cadaver almost as spontaneously as breathing. They called him the Magician of the Scalpel. How did he reach that echelon of proficiency? He chose to master anatomy by performing animal operations. Where? Not in some sterile, clean laboratory but under his ancestral home in Pampanga, in what today we would call the silong of his house. Not exactly the best facilities, but when one is a pioneer, one does not choose ones facilities. When one is a pioneer one does not choose which road to take because there is no road. One has to blaze ones own trail. But somehow, Gregorio Singian could see something that others could not see. He could see a country which would have its own surgeons, and surgical facilities He could see the invisible. And he chose to build his own road toward that which he could see. If Dr. David Livingstone and Dr. Gregorio Singian had lived in the same space and time of history they would in all likelihood have been great friends. I say that because when David Livingstone was serving in the interior of Africa and men from England would write him asking which was the best road to take to go to him, he was heard to have said,

If you have men who will only come if they know there is a good road, I don't want them. I want men who will come if there is no road at all.
And that sounded very much like Gregorio Singian -- a man who built his own road. A man who blazed his own trail. What does it take to be a man who will blaze his own trail?
6

It begins with courage. Gregorio Singian had couragethe courage to be in the minority. The courage to be in the minority By the year 1904, most sons of ilustrados who had become physicians were being sent to America to train. Was he the son of an ilustrado? Yes, his grandfather was a former gobernadorcillo. But for his own reasons, Gregorio Singian did not leave his country. We may never know his reasons. All we know is that it was a very schizophrenic time for our people. We were being helped to become independent and to have democracy but whenever we had other ideas about how that democracy should be expressed in our own context for our own needs, we were being killed -by the thousands. Until almost a million Filipinos were killed in a span of 15 years , much much more than were killed in the 300 years that we were ruled by Spain. Gregorio Singian had a schoolmate -- Pedro Abad Santos, an older brother of Jose Abad Santos. He was the medical board exam topnotcher of his batch, but Pedro Abad Santos had now become a freedom fighter for his country and had fled to the hills, and was later captured by the Americans and sentenced to 25 years in prison. I wonder sometimes, -- but perhaps this is just me -- if maybe, just maybe, the confusion in the mind of Gregorio Singian caused him to say,

How can I accept an offer to train abroad , when my own people are being killed left and right by those who will train me?

Pampanga at this time of our history was at the center of the fight for justice, by men and women who stood up for principles of truth and lawfulness. But perhaps, thats just me. Perhaps Gregorio Singian had other reasons. Unless old letters and old documents surface in the future, we may never know why he chose to stay.

But destiny meant for him to stay here -- with his people -- a hurting people whom he wished to help. What else does it take to blaze a new trail? It also needs times of silence. The determination to have times of silence They tell us that Gregorio Singian was a man of few words which was sometimes difficult for those who made him their teacher. But it also means that he knew the value of silence. The purpose of silence is to be able to hear -- to hear the voice in ones soul saying, This is what you ought to do. Or to hear ones God say This is why I created you. And the mark of silence is not so much the absence of noise. The mark of silence is control. The person with control is the person who can do what needs to be done when it needs to be done. What else does it take to blaze a new trail? It also takes daring, the audacity to be different. The daring to be different Sometimes, to do things differently can mean the loss of approval or the loss of acceptance or of the sense of belonging, but Gregorio Singian did not mind. No one accepted surgery at that time. To think of ones flesh being opened so that ones insides could be poked at and manipulated was not normal in his time. And the news about him cutting dogs open--they must have laughed!

Did you hear? doctor!

Gorio is operating on dogs!

He wants to be a dog

But it comes to each one of us -- that time when we have to choose.

Will it matter to us what our colleagues say? Do we want to be illustrious? Or do we want to have integrity? Do we want to have the title or do we want to walk in truth? When we accept an offer, are we after the benefits or do we do it out of a genuine burden for others? Are we interested in position or would we rather that our soul have that sense of peace from within? The choice comes to us in different forms. We are offered a position as head of the department. Or head of a policy-making body for the government. What are the things that are really at stake? Two decades ago, two doctors had to make a choice. In 1965 a substance called Aspartame was serendipitously discovered as having a sweetness 180 times that of table sugar but without its calories. It began to be marketed under a number of trade names. One company manufactured it as EQUAL. Another manufactured it as NUTRASWEET. NutraSweet was then owned by G. D. Searle. And so on its discovery, Aspartame began to be used as a sweetener. But within a few years, questions arose over the safety of aspartame as a sweetener. Observations began to arise. People having severe headaches, later memory loss, later reports of brain tumors. Biochemically there were questions surrounding Aspartame because first, 1. aspartame breaks down into methanol and methanol formaldehyde into

Formaldehyde has been classified as a human carcinogen by the International Agency for Research on Cancer (IARC) and by the US Environmental Protection Agency (USEPA) Research studies on workers exposed to formaldehyde have suggested an association with brain tumors, cancer of the nasal sinuses, and possibly leukemia. So the first problem with aspartame was its breakdown to formaldehyde, a known carcinogen. The second problem that arose with aspartame is that 2. aspartame also breaks down into aspartic acid Aspartic acid is known to produce damage on the brain and nerve cells. But those who advocated the use of Aspartame showed studies claiming that Aspartame was safe. But no one was telling the true story. The studies calling Aspartame safe were all funded by NutraSweet. One hundred percent of the studies done on aspartame which were funded by NutraSweet said aspartame was safe. Ninety two percent of the studied funded independently said aspartame had problems. When we review the timeline, this is what we find. Timeline 1965 Aspartame discovered. From the time Aspartame was discovered and for 16 years thereafter, Aspartame could not get approval as a sweetener for use in heated and baked products. G.D. Searle, its manufacturer, wanted to get this approval. 1976 An investigation by independent scientists finds G.D.Searle's testing procedures substandard, shoddy,

10

full of "manipulated" test data. The investigators report they "had never seen anything as bad as G.D.Searle's testing." 1977 The FDA formally requests that the U.S. Attorney's office begin grand jury proceedings to investigate G.D. Searle for knowingly misrepresenting findings and "concealing material facts and making false statements" in aspartame safety tests. Donald Rumsfeld is hired by G.D. Searle to become its CEO Enter a man by the name of Dr. Jere Goyan. 1979 October 21 Dr. Commissioner. Jere Goyan appointed FDA

1977

Dr. Goyan begins to review all the material available to him on studies documenting the effect of Aspartame on rats and other experimental animals on brain tumor appearance. He feels the studies are overwhelming. Study after study show the danger with the use of aspartame in experimental animals. In one particular study, an experiment cited by Russell L. Blaylock, M.D. in Excitotoxins in 2005, showed that aspartame-fed rats developed two tumors by 60 weeks of age and five tumors by 70 weeks." Dr. Jere Goyan refuses to approve the use of aspartame. 1979 FDA Board of Inquiry composed of three independent scientists confirms that aspartame might induce brain tumors. Ronald Reagan is elected president Donald Rumsfeld is included as part of Ronald Reagans transition team

1980

11

Donald Rumsfeld is recorded as having made this statement.

I will call in all my markers and no matter what I will see to it that Aspartame is approved this year.
1981 1981 1981 January 20 Ronald Reagan is sworn in as new president January 21 Dr. Jere Goyan is removed from office January 22 G. D. Searle re-applies for approval for use of Aspartame as sweetener in heated and baked products April 13 Dr. Arthur Hull-Hayes is appointed as new FDA Commissioner

1981

It soon became clear that the panel would uphold the ban by a 3-2 decision, but Dr. Hull Hayes installed a sixth member on the commission, and the vote became deadlocked. Dr. Hull Hayes then personally broke the tie in Aspartame's favor. 1981 April 20 Dr. Hayes over-rules an FDA Board of Inquiry decision July Aspartame is approved as a sweetener for use in heated and baked products

1983

And today, we still have an assortment of products with Aspartame available in the market, the most popular being the soft drinks: Coke Zero, Coke Light, Pepsi Zero, Fanta Zero, Dr. Pepper Zero, Sprite Zero as well as many cookies and candies. When the decision was made, the Senior FDA toxicologist was so devastated that he made this statement, recorded in the annals of the U.S. Congress.

Beyond a shadow of a doubt, aspartame triggers brain tumors and, therefore, by allowing aspartame to be placed on the market,

12

the FDA has violated the Delaney Amendment. if the FDA violates its own law, who is left to protect the public?
DR. M. ADRIAN GROSS Senior FDA Toxicologist The Congressional Record August 1, l985 Was it politics or was it not? You decide. I tell this story, not to convince you to stop taking soft drinks with aspartame, but for us to appreciate a man like Gregorio Singian who would have agreed with the man with wisdom who said,

Right is right, even when everyone is against it. Wrong is wrong even when everyone is for it.
William Penn There are times when we are given options. The option to hold on to the truth or to compromise. The option to say No or to give in to powerful people and let them have what they want because of the prestige or the money that comes along with it. The option to give the credit to a colleague or to take for ourselves the credit that rightfully belongs to another. Are we going to be an Arthur Hull Hayes? Or are we going to be a Jere Goyan? What else was it about Dr. Gregorio Singian? He had the consistency of excellence and hard work The consistency of excellence and hard work Dr. Gregorio Singian often chose a staff of young medical graduates but not all his assistants stayed with him long.
13

Why? Because his expectations of excellence from those who worked with him were extremely high. One had to come up to his standards if one were to get along with him. If you trained with him, he expected you to know your anatomy. And friends, people of excellence will not always be popular with those who work for them. Today, what is the number one name in Asia for Oriental furniture design? Its a Filipino name -- Kenneth Cobonpue. His furniture win the best design awards in many of the most prestigious furniture shows throughout the world. His furniture are used on the sets of the popular TV series CSI, Miami and the movie Oceans Thirteen? His furniture grace Nobu Japanese restaurants the world over. Does he have a high turn-over rate when it comes to his carpenters? Yes! Why? Because many people would rather have a mentor who is easily impressed even if it means they themselves turn out to be mediocre. They would rather not be asked to do the task again and again and again until it reaches the touchstone of the master. It is an unusual surgical resident who looks for a mentor who is exacting and tough and demanding, who pushes him toward reaching the meridian of his career! Kenneth Cobonpue, Gregorio Singian. They belong to the same ilk, the same breed.

14

But in the final test, people of excellence will look for others of the same kind. And so on December 10, 1900 when the first deliberate laparotomy was performed in the Philippines, on a patient with a 19 pound uterine myoma, Gregorio Singian was on that team. And the rest is history. Friends, what did it take for you to be here today? For surgery in the Philippines to reach the level that we have it in the present day? Alfred P. Sloan, who helped support the construction of the world respected Memorial Sloan-Kettering Cancer Center in New York would have said this.

There has to be this pioneer, the individual who has the courage, to overcome the obstacles that always develop when one tries to do something worthwhile, especially when it is new and different.
Alfred P. Sloan But I would like to summarize it in a simple phrase.

Only he who can see the invisible, can do the impossible.

Frank Gaines

Friends, you are physicians. You are surgeons. You have been called to bring healing to peoples lives. More than that, if the Bible is to be believed, then God has appointed you to this country.

From one man he made every nation of men, that they should inhabit the whole earth; and God determined the times set for them and the exact places where they should live. Acts 17:26
THE BIBLE

15

If we believe that, then you have been appointed and called by God to this nation whose health and physical wellbeing he has placed in your hands. Rise up to that call. Be the Gregorio Singians of this century. Take care of your country--for no one else will. Regardless of where you go, its the only country you will really ever have. Thank you and God go with you.

16