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Research and the Clinical Mission

Research and the Clinical Mission. March 16 th , 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

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Research and the Clinical Mission

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  1. Research and the Clinical Mission March 16th, 2009

  2. Why Discuss Research Now? Research is absolutely necessary for the UNC HCS

  3. 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

  4. 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)

  5. • Developing new therapies to treat vascular diseases and cancer through manipulation of blood vessel growth •Identifying new mechanisms for reversing abnormal enlargement of the heart •Designing new approaches to identify genetic signatures that predict risk of cardiovascular disease Cam Patterson, M.D., M.B.A. AHA Established Investigator Award Burroughs-Wellcome Award in Translational Medicine Founder and President, Dyzen, Inc. $9 million in grant funding

  6. ANCA Glomerulonephritis:From 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

  7. 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 pathophysiologic mechanisms 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

  8. 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, MD Principal Investigator Charles van der Horst, MD Co-Principal Investigator $2.75 million in grant & contract funding NPR Reported on UNC’s Malawi Program this morning (3/16/09)

  9. 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

  10. 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

  11. FAT cells βcatenin + Janet Rubin MD Division of Endocrinology Professor of Medicine • Stem cells can become FAT or BONE • Exercise: • decreases stem cell choice of fat lineage • stimulates choice of bone lineage • This involves mechanical stimulation of beta-catenin in stem cells • Exercise does the same thing in whole animals • Long term goal – can we reproduce exercise in patients with mechanical simulators? • Funding: NIH, 2 RO1 grants Mesenchymal STEM CELLS BONE cells

  12. 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.

  13. 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

  14. 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

  15. Why Discuss Research Now? Doesn’t research cost money?

  16. 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

  17. 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

  18. 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

  19. 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

  20. Department of Medicine NIH Performance

  21. Departments of Medicine: NIH Rankings 2008

  22. Comparative NIH Grants: DOM and SOM

  23. Department of Medicine: Funding Sources

  24. 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

  25. NIH Indirect Dollars: Where Do they Go?

  26. 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

  27. 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)

  28. 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

  29. 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 infrastructure Many of these dollars can fund programs currently funded by state dollars These dollars will fund programs necessarily funded by clinical dollars at most medical schools

  30. 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

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