research and the clinical mission march 16 th, 2009
TRANSCRIPT
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Research and the Clinical Mission
March 16th, 2009
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Why Discuss Research Now?
• Research is absolutely necessary for the UNC HCS
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Neil Hayes, M.D. The Cancer Genome Atlas (TCGA)
• Mission: understand the molecular basis of cancer through the application of genome analysis technologies
• 3 tumors: » glioblastoma » ovarian cancer » lung cancer
• UNC – 1 of 5 NIH Funded Genome Characterization Centers
• $4m over 3 years.
• http://cancergenome.nih.gov
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UNC Palliative Care Program
Palliative Care leads research, clinical service and education to relieve pain and suffering and improve quality of life for seriously ill patients and their families
$2.75 million in current research funding
New interdisciplinary research – Pulmonary Medicine / ICU, Pediatrics, Schools of Social Work and Nursing
Co-Directors Stephen A. Bernard, MD (Hematology Oncology)
Laura C. Hanson, MD, MPH (Geriatric Medicine)
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Cam Patterson, M.D., M.B.A.AHA Established Investigator Award
Burroughs-Wellcome Award in Translational MedicineFounder and President, Dyzen, Inc.
$9 million in grant funding
• Developing new therapies to treat vascular diseases and cancerthrough manipulation of bloodvessel growth•Identifying new mechanisms forreversing abnormal enlargement ofthe heart•Designing new approaches to identify genetic signatures thatpredict risk of cardiovascular disease
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04/18/23 6
ANCA Glomerulonephritis:ANCA Glomerulonephritis:From Molecules to ManFrom Molecules to Man
• NIH Program Project Grant continuously funded since 2000» $9.3 million award
over 10 years• Ron Falk, Charles Jennette
and their collaborators have published produced more than 160 papers on this topic
• UNC is the world leader in autoimmune diseases and kidney failure» Hopkins envies our
program» Implications for Solid
Organ Transplant Programs
Ronald J. Falk, MD
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COPD Clinical and Translational Research
Specialized Center for Clinically Oriented Research:
Using the unique availability of MDs working closely with PhDs to further elucidate the pathophysiologicmechanisms behind decreased mucus clearance in patients with chronic bronchitis
James Donohue Richard Boucher Ashley Henderson
$20 M NIH SCCOR grant to study COPD lung disease
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The Adult AIDS Clinical Trials Unit
Continuously funded since 1987, the UNC ACTU is the leading NIH funded clinical trials units in the country
Faculty in the UNC ACTU have published landmark papers on the treatment of HIV disease and its opportunistic infections
The work accomplished by the UNC ACTU has had a profound impact on the well-being of persons infected with HIV disease
Joseph Eron, Jr, MDPrincipal Investigator
Charles van der Horst, MDCo-Principal Investigator
$2.75 million in grant & contract funding
NPR Reported on UNC’s Malawi Program this morning (3/16/09)
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How UNC’s David Margolis Plans to Eradicate HIV
Less than 1 per million resting CD4 cells are infected
Attacking Persistent HIV Infection:Moving Towards Eradication of HIV Infection
Attacking HIV within the human genome
$3.4 million in funding…NIH and other Federal Sources
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Victor Garcia-Martinez Has Developed a Better Mouse Model for Human Diseases
The next generation mouse model:
The culmination of decades of research on humanized mice is leading to advances in our understanding of innate and adaptive immunity,
autoimmunity, infectious diseases, cancer biology and regenerative medicine.
The development of these new generations of humanized mice will facilitate translational research in several biomedical disciplines.
$5.4 million in NIH grant funds
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Mesenchymal STEM CELLS
FAT cells
BONE cells
βcatenin
+
Janet Rubin MD Division of EndocrinologyProfessor of Medicine
1. Stem cells can become FAT or BONE
2. Exercise:• decreases stem cell
choice of fat lineage• stimulates choice of
bone lineage
3. This involves mechanical stimulation of beta-catenin in stem cells
4. Exercise does the same thing in whole animals
5. Long term goal – can we reproduce exercise in patients with mechanical simulators?
Funding: NIH, 2 RO1 grants
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Division of Gastroenterology & Hepatology
This is a photo of the faculty and fellows in the GI Division. The size of the division would be reduced by more than 60% without the $16 million dollars in research grants that we receive each year. We provide a much richer experience for patients because of our large size, diversity and national reputation. We also offer some of the most advanced treatments because they are developed by our researchers.
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Is Research Really Critical For Our Clinical Mission?
• Reputation • Rankings• Cutting edge patient care• Research can drive profitable clinical programs and our
strategic plan (Cancer, CV Disease, SOT)• The cost/efficacy of advertising:
– All regional advertising campaigns on Cancer and Cardiovascular Disease focus on research and cutting edge patient care (UNC, Duke, WakeMed)
– We get incremental high profile PR with each major research advance at no additional cost
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Is Research Really Critical For Our Clinical Mission?
• Faculty Recruitment/Retention• We recruit and retain at the highest level regionally and
nationally, despite low salaries– We pay “market (50th percentile)” for all non-faculty health
care providers– Our “average” clinical faculty salary is between the 35-40th
percentile of all benchmarks and far below private practice salaries
• Faculty cite: research opportunities/working at a top-tier institution/collaborative culture as reasons they stay at UNC
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Why Discuss Research Now?
• Doesn’t research cost money?
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Why Discuss Research Now?
• Doesn’t research cost money?
• Yes. It is estimated that for every “direct” $1.00 of NIH funding, it costs between $1.10 and $1.20 to perform that research
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Why Discuss Research Now?
• Research is absolutely necessary for the UNC HCS
• The finances of our research programs are overwhelmingly positive for the UNC SOM, UNC HCS and UNC-CH
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The Financial Case for Research
• The Department of Medicine research portfolio • Reflects the overall SOM portfolio• Shows the financial importance of both research and
clinical programs
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The Financial Case for Research
• The Department of Medicine research portfolio • Reflects the overall SOM portfolio• Shows the financial importance of both research and
clinical programs
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Department of Medicine NIH Performance
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DOM NIH Performance
0
2
4
6
8
10
12
14
16
18
2000 2001 2002 2003 2004 2005 2006 2007 2008
$0.00
$10.00
$20.00
$30.00
$40.00
$50.00
$60.00
$70.00
$80.00
$90.00
NIH Rank
NIH $$ (M)
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Departments of Medicine: NIH Rankings 2008
$ Rank
$ Per Capita Rank Institution $ Internal Medicine
Full Time Faculty
Research $ Per Capita
9 1 Yale University $ 90,512,627 200 $ 452,563
1 2 Univ of California San Francisco $ 160,571,880 504 $ 318,595
11 3 Univ of North Carolina $ 81,780,274 278 $ 294,174
18 4 Stanford University $ 55,062,505 194 $ 283,827
12 5 Univ of Chicago $ 79,805,281 286 $ 279,039
3 6 Duke University $ 129,035,686 469 $ 275,129
13 7 Univ of California San Diego $ 79,373,137 293 $ 270,898
4 8 University of Michigan $ 121,010,404 456 $ 265,374
2 9 Johns Hopkins $ 144,643,278 600 $ 241,072
8 10 Washington University $ 99,291,220 424 $ 234,177
7 11 Vanderbilt $ 103,331,327 493 $ 209,597
23 12 University of Iowa $ 44,293,038 214 $ 206,977
10 13 Univ of Pittsburgh $ 90,023,897 438 $ 205,534
6 14 University of Pennsylvania $ 104,341,280 522 $ 199,888
17 15 University of Alabama Birmingham $ 59,458,688 309 $ 192,423
5 16 University of Washington $ 109,490,169 578 $ 189,429
24 17 University of Maryland $ 44,016,183 241 $ 182,640
26 18 University of Wisconsin $ 42,503,709 235 $ 180,867
27 19 Univ of Virginia $ 39,109,129 225 $ 173,818
16 20 Mount Sinai University $ 68,000,915 437 $ 155,609
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Comparative NIH Grants: DOM and SOM
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Department of Medicine: Funding Sources
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The Financial Case for Research
• The Department of Medicine research portfolio • Reflects the overall SOM portfolio• Shows the financial importance of both research and clinical
programs
• NIH (and other funding agencies) pay both “direct” and “indirect” research costs
• The calculation of research “losing money” is based on “direct” costs• For every $1.00 of “direct” NIH research funding, UNC-CH receives an
additional $0.465 for “indirect” costs• Much of our budget depends on current NIH indirect costs and there
is a great opportunity right now
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NIH Indirect Dollars: Where Do they Go?
04/18/23 25
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New NIH Dollars
• The Obama economic stimulus package contains an additional $8 B of NIH funds to be spent over the next two years
• Had we not built and maintained a vibrant research faculty we would be unable to compete for these dollars
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How much of the NIH Stimulus Funding Can We get?
Assume ~ $6 B will go toward medical school research
Assume that UNC SOM receives stimulus dollars in the same proportion as current funding (2.1% of total funding to medical schools)
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The Calculation
Institution Direct NIH Funds “New Indirects”
UNC-SOM (14) $224 M (2.1%) $58.6 M/year
U of Arizona (74) $ 36 M (.34%) $ 9.49 M/year
ECU (115) $ 4.5 M (.04%) $ 1.12 M/year
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The Calculation If the SOM brings in an additional $58.6 M in Indirect Costs from NIH:
UNC-CH will get $35.2 M/year UNC-SOM will get $23.4 M/year
Some of these dollars are needed for infrastructureMany of these dollars can fund programs currently funded by state
dollarsThese dollars will fund programs necessarily funded by clinical dollars
at most medical schools
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Why Discuss Research Now?
• Research brings prestige to the UNC HCS• It distinguishes the UNC HCS from local competition• With the shrinking clinical dollar, research dollars are
important but often overlooked as a contributor to the “business” of health care
• We have opportunities to obtain additional research funding – the indirect component of which will “fund” our overall operations and contribute to the clinical mission