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Dean Cadman of Hawaii s John Burns School of Medicine on Biotech, Doctors

HONOLULU, Hawaii — Before Ed Cadman accepted the position of dean of the John A. Burns School of Medicine of the University of Hawaii five years ago, two faculty committees had recommended that the university close the school.

Cadman came to Hawaii after 14 years at Yale-New Haven Hospital, where he was senior vice president for medical affairs and chief of staff. Previously, the oncologist was director of the cancer center at the University of California, San Francisco.

Last week, instead of witnessing the closing of the medical school, Cadman Cadman presided over the Hawaii Bioscience Conference, a two-day symposium held at the Hawaii Convention Center that culminated with the school’s cultural advisor chanting a blessing at the entrance to a new four-story education building

Cadman and others on the island hope the facility will spawn a biotechnology cluster on the Honolulu waterfront.

The education center, a 100,000-square-foot facility, will open to students in the spring, and a nearby 200,000-square-foot research facility will open in September.

BioCommerce Week spoke with Cadman to find out his goals for the revitalized medical school.

How did this facility come about?

I arrived here in November of 1999 and they were talking about closing the medical school. At the same time, they were talking about diversifying the economy here, too, and one of the sectors they were discussing was biotechnology. I reminded the community and legislative folks that you need to support a research-intensive medical school because that is where the biotech industry is clustered. Take for example, San Diego, San Francisco, Boston, Seattle, and New York. If they don’t support a research-intensive medical school, it won’t happen here. The entrepreneurial faculty of a medical school basically starts biotech companies. That is why Genentech is in San Francisco; and that’s why Amgen is in Southern California. Faculty members at the respective institutions in those areas established those small companies.

This is a 10-acre site on a 100-acre peninsula, right across the street from downtown. What a wonderful opportunity this is for the state. The community, state, governor, share a common vision. We want biotech to be successful here. They are supporting the medical school research to do that.

How is this being funded?

It’s a $150 million project with interest and principal coming out of the tobacco settlement money — $40 million comes annually to the state and we get from $10 million up to $11 million of that money.

We will have a state-of-the-art animal and research facility combined and that will accommodate the biotechnology industry in this region. We will have DNA analyzers, synthesizers, protein analyzers, and synthesizers.

What was the process of technology selection?

It was a committee decision. The building will have common core facilities. The laboratories are not individualized. They are open labs on the outside part of the building and the core facilities will be on the internal parts of the building. The lab workers, PIs, and research associates will look out on the ocean and a park. But it is not going to be individual laboratories. It’s a collaborative effort. We need to get researchers involved in collaboration, working together.

What type of computational facilities will it have?

We are connecting to the Maui Supercomputer, which is probably the 10th fastest in the world and will have the computer science department at the University of Hawaii working with us on the computation facilities of the campus and we are going to recruit bioinformatics researchers.

How is the school staffed?

We have 69 PhD scientists, 160 physician scientists, and 1,221 volunteer physicians. We don’t have a university hospital; we work with private hospitals in town. The revenue for the school in 2004 was $112 million, of which $54 million went to supporting research. The state contributes $21 million, and the allied hospitals contribute $23 million and the rest of it comes from clinical income. We have a unified faculty practice plan, with 37 physicians participating, and we anticipate 100 physicians in the next year. The faculty has received $61 million from the NIH to support programs in preterm labor, infectious diseases, and functional MRI.

How many physicians in Hawaii are trained here?

There are 2,500 practicing physicians in Hawaii and 50 percent of them are graduates of our medical school or our residency-training program. We have a unified residency-training program and 80 percent of residents come from the mainland.

Is Hawaii a draw for recruitment?

We have a faculty member, Duane Gubler. He was at the CDC and he had opportunities to go everywhere in the world and he came here last January. He wants to develop an outstanding tropical disease center. The emerging infectious diseases are primarily in Asia.

Hawaii is halfway across the Pacific from the US to Asia. What are the economic development possibilities that you see?

We are taking advantage of our geographic location and we have relationships with China, Vietnam, Indonesia, Singapore, the Philippines, and Korea. On my most recent trip, to Japan at the end of November, I spoke with several pharmaceutical companies. They have a consortium and are interested in coming here because of the ethnic diversity in the local population to do clinical trials. They are leasing 13,000 square feet of space to establish a proteomics and genomics program and they will move into a research facility in a couple of years to take up 50,000 to 60,000 square feet of space. VCs from the Bay area and San Diego are sniffing around here, and they are raising money for research opportunities here.

What kind of capital do you need to raise now?

The state contributes and we don’t need that kind of money now. We do need VC money and angel money to develop biotech companies.

Do you see commercial possibilities arising from new compounds or technology tools?

Research tools, compounds, great ideas, vaccines, medical instruments, medical technology — any of the above. The markets in life sciences are diversified. It’s not just about drugs, it’s about diagnostic equipment, diagnosis, genomics, proteomics, predicting disease, and nanotechnology.

Hawaii has a diverse population. Is that an advantage in the type of research you plan here?

The Japanese [pharmaceutical] consortium wants to profile normal people and sell that [information] to pharmaceutical companies elsewhere and provide opportunities to compare that with diabetic heart disease in ethnic groups. There is no majority here — Japanese are 25 percent of the population; 30 percent are Caucasians, 10 percent are Philippinos. There [are] only 10,000 pureblooded native Hawaiians remaining.

How do you train doctors for the future of medicine?

We have a problem-based training program. We separate students out into several groups, with five or six student per group. We have 84 cases in the first two years, and we have a seminar program twice a week in that two-year period. That is where we train the students. They have to search the literature and have the responsibility to educate themselves. The tutors give them broad assignments. For example, diabetic cases. They will have an assignment to do the molecular biology of insulin and the anatomy of the pancreas and how to examine and treat a patient. The majority of medical schools have lectures and a student doesn’t see a patient. The students don’t get a chance to synthesize what they have learned. I was disappointed in my two years of medical school. I didn’t see what the relevance was until I got to the third and fourth years. These students learn, in the context of a clinical case, the basic science and medicine and the retain more.

Will your students know how a microarray works, or how to do gene-expression profiling?

The students will presumably know about microarrays, but they don’t have the time to get into the labs. That is for a fellowship. The medical students have to go into an internship and residency clinical programs before they get a license.

If a test has value in diagnostics, they will know that. If the test has value in therapeutics, they will know that. We teach contemporary medicine, diagnostics and therapeutics.


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