Research and the Clinical Mission

March 16th, 2009

Why Discuss Research Now?

• Research is absolutely necessary for the UNC HCS

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

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)

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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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

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

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)

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

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

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

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.

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

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

Why Discuss Research Now?

• Doesn’t research cost money?

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

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

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

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

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)

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

Comparative NIH Grants: DOM and SOM

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Department of Medicine: Funding Sources

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

NIH Indirect Dollars: Where Do they Go?

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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

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)

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

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

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