Stanford Report, April 5, 2006

Transforming a medical center: Pizzo’s first term ushers in new approaches to research, education

Dean has won kudos for interdisciplinary approach to research and education, but work remains to realize his vision

Steve Fisch Photography

Philip Pizzo this month marks the five-year anniversary of his becoming dean of the medical school, where he has strengthened efforts to translate basic research findings into effective treatments for patients.

Dean Philip Pizzo, MD, had several hours before he would appeal to the university’s trustees on a matter that was critical to his vision of transforming medical education at Stanford. On that morning of Oct. 10, 2005, the trustees would decide whether to approve the next phase of development of the school’s centerpiece building, the Learning and Knowledge Center. Pizzo had been preparing for this moment months before his first day on the job five years ago—in April 2001. He had learned then the details of the school’s history with the Liaison Committee on Medical Education, the powerful national group that had repeatedly cited the school for its “inadequate” facilities and nearly withdrawn its accreditation. The LCME reviewers were scheduled to return to the campus several days after the trustees meeting, and Pizzo was under pressure to prove there was progress on the facilities front. He had come to work at his usual 6:30 a.m., even though the day before he had walked his eldest daughter down the aisle and helped preside over a wedding party for 160 guests. A man known for his relentless energy, he was unusually tired. He pumped himself up for the meeting. The presentation was vintage Pizzo—meticulously thorough, thoughtful and forward-looking. The trustees unanimously endorsed the project. “It was in essence through his leadership and his vision that turned what was an enormous problem into a big opportunity with the LKC project—that was all Phil,” said John Freidenrich, former chair of the board. “He had to get a lot of people to buy in, but he was the one pushing for it and working with the accreditation group.” It was yet another step in Pizzo’s effort during his first five years at Stanford to bring about what he routinely refers to as “transformation” of the medical school.

Pizzo has been the catalyst for curriculum reform and provided unprecedented support to education. He's organized the school's research enterprise around five major institutes, all with a focus on getting therapies quickly to patients. And he's created a collegial climate among the faculty that encourages cross-disciplinary efforts, both within and outside the school. In the process, he's strengthened the school's reputation among its peers, giving it a greater national presence.

University officials, aware of his impact, recently asked him to stay on for another five-year term.

AN UNLIKELY RECRUIT

Pizzo, 61, the Carl and Elizabeth Naumann Professor of Pediatrics and of Microbiology and Immunology, officially arrived at Stanford on April 2, 2001, from Children's Hospital in Boston, where he had served as physician-in-chief as well as chair of pediatrics at Harvard Medical School.

He said he'd been surprised when Stanford officials first called him about the top medical school job, for he had spent most of his career as an investigator and never envisioned himself as a dean. He grew up in New York, the son of Italian immigrants, and was the first member of his family to graduate from high school. After receiving his medical degree from the University of Rochester, he trained in pediatrics at the Children's Hospital Boston/Harvard Medical School and then went to the National Institutes of Health, where he was on the ground floor of developing new approaches to treatment of childhood cancer and treatment and prevention of pediatric AIDS.

He's the classic pediatrician, with the comforting hand you'd want at your child's bedside in a crisis. But with his dean's hat on, he can be tough, able to make decisions that aren't always popular, colleagues say. He has a thin, wiry frame, largely due to his penchant for marathons and PowerBar lunches, and his five years here have put more gray on his head.

Pizzo arrived at Stanford at a difficult time, as the medical center was still reeling from the failed merger with UC-San Francisco. There were financial challenges, a demoralized faculty and strained relationships with the university. At the national level, the health-care system was collapsing, and the NIH was falling behind in funding research at a time when knowledge was exploding.

Moreover, the LCME's past criticism of the school and its facilities loomed large in the background. So from the day Pizzo accepted the dean's job in December 2000, he had the school's education program—and the facilities to house it—uppermost in his mind. As the concept for the new education building gradually took shape, he lobbied to get it in front of the trustees in time for the LCME visit. He was greatly relieved to have the trustees' endorsement in hand.

"I literally recall the air going out of my emotional balloon right after the vote, so I was just about able to get myself home," Pizzo recalled recently. "But I was happy on all accounts." He was even more elated months later when the LCME gave Stanford stellar marks. [See accreditation story, page 10.]

University Provost John Etchemendy, PhD, noted the difficult circumstances under which Pizzo arrived at Stanford and said he has brought about "remarkable" change.

"Now the school has developed an exciting vision endorsed by the vast majority of the faculty," Etchemendy said. "The school's new medical curriculum is leading the way in the nation and the recent visit by the LCME resulted in the highest assessment given by that board. These changes are the result of a great deal of work by many people, but they would not have happened without Dean Pizzo's energetic leadership."

In his first year, Pizzo set about crafting a strategic plan that would provide clear direction and serve as a rallying point. It would help create stability and alleviate some of the uncertainties while uniting faculty members on both sides of the aisle, clinical and basic research, who had become estranged.

The theme of the strategic plan, "Translating Discoveries," would become a thread for many of the school's activities, and translational medicine—the process of quickly turning discoveries into therapies—became the school's mantra.

RETHINKING RESEARCH

Pizzo said he believes strongly in the value of research, for in his years as a scientist and clinician, he had seen children cured of cancer and other diseases, all because of research advances. He also is a champion of basic research recognizing that it both creates knowledge in its own right while serving as the underpinning of innovations that can improve human health.

But to take research from bench to bedside requires a proactive approach. Accordingly, Pizzo organized the school's research program around five interdisciplinary institutes, all with a translational focus—stem cells, neuroscience, cardiology, immunology/transplantation and, in the near future, cancer.

He chose the translational theme in part with the NIH in mind, as the agency would later emphasize it in its so-called "roadmap." The map wasn't written when Pizzo came to Stanford, but he shared the Stanford strategic plan with NIH officials and they incorporated some of his ideas, he said.

"Part of our mutual job is to anticipate where research directions are going so we don't miss opportunities. And I think creating the institutes, creating the banner of translating discoveries, allows us to be more competitive," Pizzo said.

In fashioning the institutes, Pizzo said he also believed that the school needed big, bold ideas if it were to attract needed funding through sponsored research or private philanthropy. "With stem cells and cancer, donors are stepping forward because they see that we're doing something different," he noted.

He also chose to push a project that had been talked about Stanford for some 35 years but never seriously pursued—the creation of a Comprehensive Cancer Center that would have the official imprimatur of the National Cancer Institute. The school submitted its application to the NCI in early February and hopes to hear back this summer. The cancer center is expected to evolve into the fifth research institute, Pizzo said.

In creating the institutes, however, Pizzo challenged the traditional system of department-based medicine, leading to resistance from some faculty who want to maintain the status quo and believe the institutes aren't well-defined. Despite his natural tendency to move on fast-forward, Pizzo said he recognizes the need to take a measured pace when it comes to institutional change.

"I'm a person who loves to live on the free end of change and who is comfortable with the uncertainty that it brings. But I also recognize that too much of it too soon can also be very difficult," he said.

In bringing diverse faculty together through the institutes, a positive side effect has been a meshing of the clinical and basic research scientists, who had previously gone their separate ways.

"One of the most important things he has done is bring together the pre-clinical and clinical faculties in a way that was groundbreaking for Stanford," said Lucy Shapiro, PhD, the Virginia and D. K. Ludwig Professor of Developmental Biology.

Pizzo himself noted the shift at the annual retreats—how faculty who in the first year choose separate seats according to their clinical or basic science allegiances were, by the second year, intermingling at the dinner table.

BUILDING BRIDGES

Pizzo also set about to repair relationships with the university through a number of interdisciplinary, cross-campus efforts. University relations had been strained in the aftermath of a failed attempt to merge Stanford and UCSF hospitals that preceded Pizzo's arrival. In its wake were serious financial ills at the hospital that left some university officials feeling the medical center was a liability.

Pizzo worked with the two hospital CEOs to ensure that plans for the school were in line with those for the hospitals, which gradually returned to financial health. On the research side, he worked to build new collaborations with colleagues across Campus Drive.

One example was the formation of the Bioengineering Department, the first university department run by two schools. The idea had been floated for a number of years, but there was little movement until Pizzo took over and partnered with Jim Plummer, PhD, dean of the School of Engineering. They faced obstacles, as the schools have completely different funding mechanisms and systems for recruiting and paying faculty, as well as different cultures. But the two deans were determined to see it through and, in Plummer's words, to try "something unprecedented."

Plummer noted, "One of the things Pizzo will be remembered for is that he took the medical school and made it an integral part of the university by building all kinds of bridges—not just with engineering but with other parts of the university."

University President John Hennessy has made interdisciplinary projects one of the hallmarks of his tenure, and the medical school has been on the front lines of that effort. Pizzo is a big supporter of the Bio-X program, a major multidisciplinary program that marries medicine and biology with engineering and the physical sciences. His influence also led to the inclusion of global health as one of the themes of the university's International Initiative, announced in 2005.

A NEW GENERATION OF LEADERS

Pizzo has been equally dogged on the education front. His first public act as dean, even before he arrived here, was to scrap a proposal for an education building, known as GALE, because he felt it didn't meet the school's needs. It meant he had to summon the courage to call up the LCME and explain that the school would build a suitable project, but that this wasn't it.

He began to consider what the education program should look like, then to devise a state-of-the-art building that would serve as a focal point for the school's "transformative" efforts. At his initiative, the school overhauled the medical student curriculum to create a program that is less flexible but better integrates clinical and research training and includes in-depth study in a specific area, all designed to produce multidimensional physicians who will become leaders in their fields.

With the new curriculum, developed under the guidance of Julie Parsonnet, Pizzo also engineered a new formula for financing education, which reinforced the value of teaching by paying academic units directly for faculty contributions in the classroom.

Parsonnet, MD, senior associate dean for medical education, said Pizzo has given unprecedented support to education. "He's put himself out there as the education dean, and he is. He wants students to love medicine, as he does."

Pizzo attends almost every student function, always making the rounds and rarely sitting down, asking questions of students with a keen interest in what they have to say. When students talk to each other about him, they often refer to him as Phil.

FIVE MORE YEARS

Through his efforts, the medical school has gained a stronger reputation among its peers, said Edward Benz Jr., president of the Dana Farber Cancer Institute and chair of Pizzo's external advisory board.

"I do think there's a sense of ferment in the good sense of the word—of an organization on the move," Benz said.

He added that Pizzo has been "willing to put the greatness of the school ahead of his own personal ambitions. . . . However skeptically people may take the vision or the components of the strategic plan, everybody has to take it seriously because there's no doubt what his agenda is. His agenda is what's good for the school."

Pizzo has helped put the medical school on the national stage through his work with major organizations, such as the Institute of Medicine of the National Academy of Sciences, where he's been chair of the Health Policies Science Board, and the NIH, where he's been a member of a panel on conflict of interest. He also serves on the Independent Oversight Committee for the California Institute of Regenerative Medicine, the state's stem cell agency.

"Phil has a national presence, and I think that's different from the past," said Harry Greenberg, MD, senior associate dean for research. "He has done a lot to give the school far greater national visibility."

Pizzo said he plans to become even more of an advocate on national issues, continuing to press for a "revolution" in health care, for more funding for research and better defined academic relationships with private industry. He's never been afraid to speak out on issues, saying he believes that in key areas, it would be "wrong for Stanford to be silent."

But he recognizes that there is still much work left to do at the medical school. He has an ambitious agenda ahead for his next five years. He plans to continue to grow the institutes, see the Learning and Knowledge Center through to completion and actively raise funds for major capital projects to house the institutes, among other things. And he'll persevere where he feels it's the right thing to do.

"I push hard for issues and am willing to take risks," Pizzo said. "It may take longer than I initially would have liked or wanted, but if I am committed to something I will see it to the end."