On the corner of 38th and Chestnut stands a couple of affordable neighborhood restaurants that will shutter by the summer of 2022. In their place will rise a 13-story privately developed lab building, the latest of a trend in recent years to turn Philadelphia into the next hub for “life science innovation.” 3.0 University Place, another lab building, is under construction on 42nd and Market. uCity Square is a planned “innovation district” on 38th and Market that already boasts multiple towers of leasable lab spaces. Office tower owners in Center City have even been converting their properties to laboratories, anticipating an influx of life science start-ups hungry for a few feet of benches to bring their ideas to fruition.
The discourse of “innovation” has not just pervaded medicine; it has also seeped into urban development and prompted gentrification of a new variety. Medicine’s “cutting-edge” is not just a metaphor. It is literally cutting into the urban fabric, changing the city’s skyline, justified by a horizon of progress.
The flourishing of private laboratory spaces for rent is a recent phenomenon. In the 20th century, only established research institutions such as government entities, pharmaceutical companies, and universities had the capital and need to build these costly spaces. However, the increasing clamor for “health innovation” is attracting the attention of real estate investors looking to turn a profit from biomedical startups seeking a place for their science. It’s a perfect blend of business and “saving lives.”
Medicine takes place in specific locations. These laboratories occupy space, yet we so rarely acknowledge where they are rooted. Philadelphia does not appear in the mission statement of the Perelman School of Medicine: “to advance knowledge and improve health through research, patient care, and the education of trainees in an inclusive culture that embraces diversity, fosters innovation, stimulates critical thinking, supports lifelong learning, and sustains our legacy of excellence.” The statement is placeless, unmoored from the city’s physicality. But what is our relationship to Philadelphia? How much do we know about the place where we are supposed to learn medicine, embrace diversity, and foster innovation? What does this silence say about our participation in a medical institution that only looks forward to a self-declared innovation that abstractly “saves lives,” but never looks back at the local harm and destruction that follows the wake of its progress?
Indeed, the horizon of the “future of medicine” shines so brightly that it blinds us to the gentrification that innovation heralds. Laboratories are displacing families from their homes. But this is not new. Over half a decade ago in 1963, the University City Science Center on 37th and Market–the first urban research park in the United States–was built by demolishing the Black Bottom neighborhood of Philadelphia. As I sit in the beautifully appointed “Quorum” of the Science Center, a free co-working space open to the public, I wonder about how they sanitized this history of displacement. Like the medical school’s mission statement with its appearance of placelessness, it is easy to omit the inconvenient truth that people and communities were, and are, actively erased to make way for medical and scientific progress. “Science” was the banner used by predominantly white institutions, including Penn and Drexel, to “redevelop” Black Bottom into oblivion, displacing thousands of Black Philadelphians. Half a century later, the “science” has yet to yield commensurate benefits for those forced out of their homes through eminent domain or financial muscle. If any life-saving therapies, opportunities, or permanent livelihoods came out of the oldest urban research park, they can not make up for the loss of people’s homes.
Even the memory of this history is threatened by erasure. “University City High School,” a science and math magnet high school built as part of the University City Science Center development, never succeeded and was demolished in 2015. Destroyed with it was a student-made mural that commemorated this history of scientific gentrification. UC Townhomes on 40th and Market, an affordable development built to house some of the displaced residents, is now slated for demolition and redevelopment. Senior citizens who were forcibly moved in 1963 when they were young are once again kicked to the curb to make way for scientific progress. The primary beneficiary of all of this “Penntrification” has been university students and the institutions that feed off of their tuition dollars.
What is our role as students who benefit from this history–whose future role as physicians may bring us face to face with the very people who were displaced? What can we do about this cycle of medical-scientific gentrification?
One sunny Saturday afternoon in March 2022, I stood with a crowd of protestors in front of UC Townhomes, listening to community leaders discuss the impending sale of their homes. We marched on Chestnut and Market past Penn students enjoying the sun with their family. The few who paid attention to us cocked their heads in confusion. They didn’t seem to know the reason for our gathering, the messy history of their university. Their ignorance is understandable. Their class assignments rarely prompt them to think critically about the place in which they study.
Medical students face a similar challenge. Medicine is an endless horizon that sucks us ever forward, to clerkships, to residency, to fellowship, to some job of prestige and financial security. It’s difficult to slow down and pay attention. It took seven years of living in Philadelphia before I found myself amidst the people who have lived here for decades, slowed down enough to feel for my place. I feel the community’s decades-long struggle for their dignity and their homes, fights that many transplants are just beginning to appreciate. Among those brought to Philadelphia for Penn, I feel their anger at the landlords, their frustration with the city, their sense of injustice against gentrification. For them, these are the immediate agents that need to be held responsible, but the landlords and developers eye us as potential tenants and customers. When we are the upstream cause of gentrification, the more difficult question is what we do with ourselves. What do we do with our participation in the medical vocation when the enterprise is the reason why laboratories displace homes? Would we ever relinquish control over the speed and direction of “innovation” if the displaced communities demanded it?
Medicine moves fast, charged by its desire for technical innovation. I am in awe of the richness of medical conversations around computation, modeling, and genetic engineering that seem to effortlessly receive institutional sponsorship and financial capital. Investors, real estate and otherwise, eye this energy with hunger, moving heaven and earth to sustain the medical-scientific enterprise with its promise of financial rewards. Simultaneously, the conversations around history, geography, and social justice seem to move at a glacial pace, sustained by a minority (and minorities) whose efforts secure only small concessions. What would happen if we slowed down technical innovation and accelerated justice instead?
Something interesting happened when I marched with UC Townhome residents and fellow protestors. As we walked, time paradoxically seemed to slow. My brain registered every bodily movement. Every chant felt deliberate. I sensed the stakes of our presence and purpose in our action. By taking myself out of the rush of medical school, I felt grounded in the community. Taking the time to slow down, I felt liberated from the demand of medicine to move ever-forward. I forced myself to seek an understanding of the community in their own words, to dwell in the difficult question of my place in Philadelphia and my responsibility to it. This deceleration may offer a first step toward addressing something as large as gentrification. We must take time to remember, to bear witness to the stories and lives of the communities that surround us. We must also take time to realign the horizons of medical innovation with those of the communities that they threaten to displace.
The stories of University City Science Center and Black Bottom–including how things are playing out again today at UC Townhomes and the neighborhood restaurants on 38th and Chestnut–tell us that the demand for innovation fuels inequity. Developers cannot magically conjure new spaces for innovation; they can only take from someone else. This, incidentally, is also the model of “manifest destiny,” of American settler-colonialism. While we cannot control developers, we can take the time to reassess our priorities, to take ourselves out of their equation, to refuse profit-driven progress. We can ground ourselves in Philadelphia.
We might slow down to read the stories of our own institution: “Governance of Teaching Hospitals: Turmoil at Penn and Hopkins” by John A. Kastor M.D., and “Pushing Back the Gates: Neighborhood Perspectives on University-Driven Revitalization in West Philadelphia” by Harley F. Etienne. The former describes the University of Pennsylvania Healthcare System’s reorganization in the late 1900s, turning it from a regional institution coasting on its colonial heritage to a medical-industrial powerhouse. The latter describes the relationship of the larger University to West Philadelphia, delving into the University’s impact in the community beyond the glossy brochures issued by its marketing department. As peer-reviewed academic monographs, these books show the rigor that is needed to understand the raced and classed history of where we are. They slow us down to pay attention to structural details, the making of a “system” that is opaque to most of us who are cogs in the complex machinery of scientific progress. Slowing down allows us to remember the violent acts of powerful institutions, acts that these institutions would rather fade into forgotten history.
Medical training is by nature itinerant. Students and residents are like Medieval apprentices and journeymen who travel from one city and one master craftsmen to another. Even as we move from city to city, we might slow down to ground ourselves in our future places of training to learn both their official history and their sordid undersides. We must arm ourselves with the knowledge of place to make less harmful decisions on how we live and work. If we have the energy and time to establish new organizations, found “innovative” start-ups, create satirical performances, and publish groundbreaking research, we also have the energy and time to decelerate and consider whether these ventures align with the needs of the people with whom we live. Knowing that our decisions have downstream consequences on developers, we can bend the arc of our actions to meet the needs and demands of those that may be displaced by innovation.
From where we live to what we eat, from the friends we make to the politics in which we participate, the decisions we make in our lives and at work influence one another. In this way, gentrification is not wholly beyond our power, especially when we control its demand. Protest is one answer, but there are many others. What would it look like if our curriculum centered on the community and not just touched upon it as the “service” extracurricular or an afternoon plenary? How do we connect our conversations on medical entrepreneurship with those on anti-racism and gentrification in Philadelphia? How do we leverage our networks to amplify neighborhood demands, such as “Payments in Lieu of Taxes” to support neglected public services?
These questions require deliberate answers. As the demand for laboratories ushers in displacement, we must reassess our demand for medical innovation. If we feel the injustice of gentrification, then we should take time to reconsider what we do in medicine and the demands we place on time and space. Slowing down, getting to know where we are in Philadelphia or wherever our careers take us, is the first step in cultivating not only a sense of responsibility, but also the ability to respond–to identify the actions we must take to advance a more just horizon for medicine.
Alex Chen is a CDY5 at the Perelman School of Medicine.
Image by Yvonne Su, an MS1 at the Perelman School of Medicine.
