Four years ago, Roberto Bolli, M.D., a rising star in the world of cardiology research, got an offer he couldn't refuse.
The University of Louisville asked him to head its cardiology division. Bolli, whose heart attack research at Houston's Baylor College of Medicine gained him international attention, would hold a chair endowed by Louisville's Jewish Hospital Foundation for $1 million.
University and hospital executives pulled out all the stops to lure the 46-year-old scholar. Among other perks, they delivered a fully equipped laboratory, renovated to his liking at a cost of $2 million. Jewish Hospital Foundation acquired the building and paid for renovations and equipment, and the university agreed to provide staffing and maintenance.
Bolli won't discuss the total value of the package but says the offer was so good he stopped looking elsewhere.
"They gave me an outstanding opportunity," says Bolli. He sees a bright future for Louisville's biomedical research effort. "The university is now investing very heavily in research," he says. "They are in a very rapid growth mode."
Bolli doesn't see patients, but his National Institutes of Health-sponsored research has immediate implications for patient care. And Jewish Hospital, the nation's eighth-largest heart hospital by open-heart-surgery volume, is counting on Bolli to build the program. Its goal: to move into the top three.
Poised to join the fray. It takes big bucks to fund cutting-edge research programs. But thanks to an extraordinary $33 million windfall from the state and unparalleled cooperation among local business, government and healthcare leaders, this city is poised to leap ahead in the cutthroat competition for biomedical research dollars. Key leaders-from Kentucky Gov. Paul Patton and Louisville Mayor Jerry Abramson to University President John Shumaker and Douglas Cobb, the president of Greater Louisville Inc. (the local chamber of commerce)-have made it their goal to rev up Louisville's plodding biomedical engine.
Rarely in the nation has a healthcare endeavor aligned so many powerful public and private interests. Rarer still is the level of investment being made by the state to attract and retain some of the brightest minds available. Experts say such public-private partnerships will be the wave of the future.
For downtown teaching hospitals, the current environment represents an opportunity of a lifetime. Their futures depend on the transfer of basic science to the bedside.
"For my hospital to stay in a leading-edge position, I've got to have a medical school that's committed to research to help drive that," says Henry Wagner, president and chief executive officer of 442-bed Jewish Hospital's parent corporation, Jewish Hospital HealthCare Services.
By coupling research and state-of-the-art clinical services, "we're going to be able to advance the level of care that's available to patients in this region," adds Stephen Williams, president and CEO of two-hospital Alliant Health System in Louisville.
Can Louisville deliver on its promise? If past is prologue, the answer might be no. Louisville-based Humana tried to carve out a niche in heart replacement in the mid-1980s. Its Audubon Hospital performed the world's second implantation of the Jarvik-7, putting this polite Southern city on the healthcare map.
It was, at least for a while, a source of community pride, says Greater Louisville Inc.'s Cobb. "I think we'd like to get back there."
But the Jarvik heart program unraveled amid questions of efficacy and quality of life. This time, civic leaders promise, Louisville's success in the biomedical arena will not be so fleeting. "The state, the city, the hospitals and the university are solidly behind this agenda," says Shumaker.
Louisville's academic medical community may never go head to head with the likes of Baltimore's Johns Hopkins Health System or Rochester, Minn.-based Mayo Clinic, whose numerous clinical specialties draw patients from across the nation. But there's no reason why Louisville can't enhance its local and regional appeal.
"We're not going to try to be all things to all people," Shumaker acknowledges. "We'll be able to carve out an agenda that is unique and distinct to Louisville."
Bucks for brains. That agenda got a jump-start this spring when Patton endorsed a measure now called "Bucks for Brains." The Democrat, intent on lifting the state's higher education record and growing the state economy, sees investment in post-secondary education as a long-term solution. The legislative measure he pushed for enables the state to invest $110 million of its budget surplus to endow university-based research positions.
The University of Louisville's $33 million share goes a long way toward helping Shumaker achieve his vision of national pre-eminence. Shumaker's 1997 "Challenge for Excellence" calls for significantly increasing business start-ups from university research activity, having at least 20 nationally ranked research and graduate programs, maintaining 75 endowed chairs and professorships in key areas and increasing the university's endowment to $750 million from $320 million.
The state's only quid pro quo: The university must match each state dollar with a dollar of private funding, creating a $66 million pool and funding as many as 33 new endowed chairs. State funds will be dispersed from a trust fund maintained by the state's Council of Postsecondary Education. Alliant and Jewish already have agreed to help raise matching money through their own fund-raising arms.
When invested at, say, 6% interest, the endowment will generate $120,000 annually to pay salaries. That provides only a base on which to build. Top-name researchers can command much more.
Kentucky's academic medical community says Patton's program is a model public-private partnership. In fact, the Association of American Medical Colleges knew of no other state that has provided such a large endowment for university-based medical research. Although Patton tapped surplus funds, his original proposal called for issuing bonds to attract brainpower to the state. That, too, was considered a unique approach.
University of Louisville officials say they'll invest about $24 million in healthcare science research positions. The windfall more than doubles existing chairs, of which the university now has 28.
New research positions will be added in six fields of medicine: cardiovascular disease, molecular medicine, neuroscience, oncology, organ transplantation and visual sciences. Each builds on the clinical strengths of Alliant, Jewish and University of Louisville Hospital.
On the cutting edge. Louisville's high-tech medical achievements already are grabbing headlines. Jewish is participating in the final testing of a new artificial heart developed by Danvers, Mass.-based Abiomed. The first implantation of the 2-pound wireless device could occur in less than two years.
Another miraculous leap of technology is expected here by year-end. University researchers have perfected a method for delivering immunosuppressive drugs that will allow surgeons at Jewish to perform the world's first human hand transplant.
Meanwhile, Alliant's Norton Hospital is experimenting with spinal cord regeneration and new surgical techniques.
Ultimately, it's hoped that the state's investment will help spur meaningful research results, new technologies and even spinoff companies and medical manufacturing.
If the economics pan out as expected, Louisville has a lot to gain.
"Our hope is that each of the 33 endowed professorships will, in turn, leverage our initial investment upward by fivefold so that the $66 million becomes $330 million," Wagner says. "That's where the power of this idea starts to take hold."
Wagner's math assumes that the initial investment will multiply over five years as researchers recruited to Louisville attract their own federal and private research grants. It's estimated that as many as 100 new jobs could be created as each chair assembles a staff.
Most of the nation's endowed professorships are filled, Wagner says. That's where he thinks Louisville has an edge. "We're going to be recruiting the 40-year-old who has a pot of money and some demonstrated track record."
A crowded field. Louisville is making its push at a time when competition for funding is tighter than ever. That doesn't seem to worry the local academic medicine establishment, which trails far behind cities like Boston and New York in NIH funding and whose research budgets are dwarfed by places like Mayo and Hopkins.
"Leveraging is the key," says Shumaker.
Jewish and Alliant operate facilities in a multiblock swath of downtown Louisville hugging the university campus known as the Louisville Medical Center. All three institutions are partners in 269-bed University of Louisville Hospital, which Alliant and Jewish operate under a 15-year management contract with the university. Although bitter rivals, Jewish and Alliant were driven by a shared not-for-profit motive. Previously, the university hospital was managed by Columbia/HCA Healthcare Corp. and before that, Humana. But only recently have the not-for-profit partners begun to realize their collective power.
Greater Louisville Inc. helped spark that realization by identifying biomedical research as one of two major economic drivers of the city. The other is distribution services.
By targeting biomedicine, the local business community hopes to bring jobs to the city, create more wealth and instill civic pride.
"I think that there is a general feeling that this is a growth industry and we have some competitive advantage in it," says Cobb, president of the 2,500-member association.
Cobb works closely with the Louisville Medical Center Development Corp., a not-for-profit partnership created by the university and the downtown teaching hospitals.
"The goal is to capture the economic development benefits associated with a strong downtown medical center," says Steven Spaulding, the development corporation's executive director. "We had this economic development engine that was running at half speed," he says.
Mayor Abramson, who spearheaded formation of the development corporation, now serves as its chairman and as cheerleader of a plan to develop a health-related business park on prime downtown real estate. Spanning three blocks at completion, the park will house biomedical companies and support services such as equipment repair. It also could serve as an incubator for new technologies invented by university researchers. Spaulding is lining up initial tenants in biomedical instrumentation, computer systems and healthcare research but has yet to sign contracts.
Ideally, Spaulding would like to have the first phase of the park under way in six months. Initial land acquisition-the biggest obstacle-and development could cost $6 million. Medical center hospitals, the university and the city will participate in the project's financing, and the corporation will seek federal and state grants to help defray the cost.
Is it overreaching? Louisville's high ambitions may outstrip its ability to deliver.
Plans to convert a $66 million investment into $330 million over five years may not be realistic.
"It seems to me awfully aggressive," says Richard Tannen, M.D., senior vice dean at the University of Pennsylvania School of Medicine. Tannen's venerable research program drew roughly $270 million in funding in the fiscal year ended June 30.
To support the salary and research of an assistant professor in the basic sciences, an academic medical center might spend nearly $750,000 over two to three years until that researcher is able to compete for research grants, Tannen says. Even then, it takes years to build momentum. A researcher who generates $500,000 a year after a seven- or eight-year period is considered quite successful, he says.
Also, a dearth of NIH funding for infrastructure needs, like laboratory space and equipment, makes it difficult to launch new research projects, Tannen adds. Some programs can't compete for funding until the infrastructure is in place.
The NIH funded a mere $47.4 million of clinical research in Kentucky last year. That puts the state's research funding capacity on a par with states like Rhode Island ($53.2 million) and New Hampshire ($42.1 million). Contiguous states like Indiana and Tennessee do much better, raking in $104.2 million and $166.9 million, respectively. Louisville doesn't even make the list of the top 50 cities with the highest concentration of NIH awards.
If Kentucky wants to play in the big leagues, it will have to match wits with California ($1.6 billion) and Massachusetts ($1.1 billion).
Louisville's $66 million endowment begins to look like a drop in the bucket. Even the governor realizes it's not enough. Patton will recommend another round of funding when the General Assembly convenes again in 2000, state finances permitting.
But Patton may not be around to resume his education crusade. He's expected to face a tough re-election bid in 1999.
So far, there's been no backlash against the governor's bucks-for-brains initiative. Louisville's community hospitals seem generally supportive.
"Healthcare will be improved by continued research," says Sue Stout Tamme, president of 407-bed Baptist Hospital East.
Creating new professorships will "raise the caliber of talent in the community," notes Peter Bernard, president and CEO of Caritas Health Services, which runs 331-bed Caritas Medical Center in the city. Research outcomes could lower healthcare costs, he adds.
Although teaching and research institutions are notoriously more expensive than community hospitals, payers say the jury's still out.
"We're just going to have to wait and see how this plays out," says Dick Brown, executive director of the Kentucky Association of Health Plans. He'd like to see a concentration of research on certain prevalent, preventable diseases, like diabetes and cardiovascular disease. "Any initiative that's going to assist this region in building better centers of excellence and focusing on quality healthcare issues is welcome."
That, of course, is exactly what Louisville's academic community promises.
And it was part of what attracted Joel Kaplan, M.D., the university's new medical school dean, to the job. Kaplan, the former head of the faculty practice plan at New York's Mount Sinai Medical Center, joined the university July 1.
From his office window in downtown Louisville, the former New Yorker watches a $28 million biomedical research building rise from a lot on Chestnut Street. Jointly funded by Jewish, Alliant, the university and the state, the construction project is another reminder of Louisville's biomedical mission.
"Everybody feels it's a new day here," says Kaplan. "The world will know about it soon."
