The University of Texas Southwestern Medical Center at Dallas

Thank you very much, Charlie, for such an overly generous introduction. Charlie Sprague is my mentor, and he's taught me many things. When he retired and I was named to his former job, he gave me one piece of advice which is noteworthy in light of the remarks he just made. He said, "If somebody gives you credit that you don't deserve, take it . . . because somebody else will damn sure give you the blame for something you don't deserve." So, Charlie, thank you for your kind words, even if I don't deserve them.

When Charlie first told me that the Philosophical Society would be meeting in Dallas and that the topic would be biomedical, he said that the meeting would provide an opportunity to have a little advertising for UT Southwestern Medical School. So that's what my remarks will be, in part, before I introduce Glen Evans. I would like to give you some general information about our institution as a way of introducing the specific research effort that you'll be hearing about from Dr. Evans.

We are "the University of Texas Southwestern Medical Center at Dallas," one of fifteen branches of the University of Texas System. We were originally created not as a branch of the University of Texas, but as a private medical school called Southwestern Medical College.
It was war time, the country needed more doctors, and Dallas didn't have a medical school. The only two medical schools in the state were the University of Texas Medical Branch at Galveston, the sole state school, and the private Baylor Medical College, which recently had moved to Houston from Dallas.

The business and medical leaders of Dallas felt that North Texas needed a medical school and started one as a private enterprise. It was owned and operated by Southwestern Medical Foundation and had an annual budget of $250,000.

In 1949 the trustees of the Foundation realized that if they were ever to develop this fledgling school into a great institution, it would need better financial support. They offered all of the assets of the little medical school to the State of Texas if it would become the second University of Texas medical school. The state accepted the offer and established the University of Texas Southwestern Medical School, with a state appropriation beginning in 1950 of $500,000 per year.

The first permanent building was completed in 1955, and growth was slow but steady through the l950s and 1960s. In the mid-1960s, the State of Texas made a major long-term commitment to expand and improve its system of higher education, including medical centers. Between 1965 and 1985, general revenue appropriations to UT Southwestern increased from less than $3 million per year to over $60 million, and the physical plant grew from 300,000 sq. ft. to 3,000,000 sq. ft. Similar changes were occurring at all the state's medical and general academic campuses. It was the golden age of Texas's public support of higher education.

The recession of 1986 precipitated a 14% across-the-board cut in appropriations to all of Texas's institutions of higher education. Since then, our funds from the state have grown in step with inflation but not in excess of inflation. Nevertheless, total growth at UT Southwestern has continued far more rapidly than inflation or state funding-but the increased funding for our continued expansion and enhancement of programs has to come now not from the state but from the private sector.

Between 1985 and 1996, UT Southwestern's total budget grew from $180 million to $450 million, with the state's contribution falling from over 40% to less than 20%. The physical plant has grown to 4 1/2 million sq. ft., again with the bulk of the new funds coming from non-state sources.

Growth in buildings and budgets is important, but facilities and funds, alone, don't make a great institution, of course. It is people who make a great institution. We at UT Southwestern are fortunate to have a faculty and staff composed of exceptional people. For example, we have four Nobel Prize winners on the faculty--more than any other medical school in the world. But, needless to say, it takes many more than four individuals to make a great institution, and we're fortunate to have a faculty now numbering almost 1,000 truly outstanding teachers, clinicians, and researchers.

Most people assume that medical schools have one mission, and that is to educate medical students so they can be awarded the M.D. degree. That is, of course, a central mission of medical schools, but it's only one of many.

We do indeed educate enrolled students, but not just M.D. candidates. In addition to our 800 medical students (200 per year), we educate 500 Ph.D. candidates and 400 Bachelor's degree and Master's degree candidates. The Ph.D. students are learning to do medical research. The Bachelor's and Master's degree students are learning allied health professions, such as laboratory technology, physical therapy, dietetics, and rehabilitation and counseling.

But perhaps surprisingly, enrolled students make up only half of our total number of trainees. We teach over 1,600 post-doctoral students, as well-individuals who have completed their M.D. or Ph.D. and come to UT Southwestern for additional clinical or research training.

Our educational responsibility for over 3,000 trainees is a primary mission, but like all other major academic medical centers, UT Southwestern also has other important missions as well, namely clinical care and research.

In the clinical arena, UT Southwestern's faculty physicians provide care for over 1.4 million patient visits each year. Over half of those are indigent patients at Parkland Memorial Hospital, Dallas County's public hospital, and the indigent care provided free by our faculty is currently valued at $150 million per year.

Until fairly recently, essentially all of our clinical activity was at Parkland, which lacked the space or facilities to care for the large number of elective referral patients who might want access to the expertise of our faculty specialists. Since the construction of Children's Medical Center of Dallas in the 1970s, the James W. Aston Ambulatory Care Center in the 1980s, and Zale Lipshy University Hospital in late 1989, however, we have been able to offer referral care on a broad basis, and the number of patients choosing to come to our faculty physicians has increased significantly. For example, the Aston Center had 50,000 out-patient visits in 1985 and 270,000 in 1996.
We've also had remarkable progress in the research arena over the past several years. You'll be seeing examples of that today in Dr. Evans's talk and on the tours.

Texas is fortunate in the strength of its medical research, but this is a fairly recent development. The late 1970s was the period when our state began becoming a major research force on the national scene, and I would attribute that to the major investment in its higher education institutions that Texas began making in the 1960s. It takes a little while to build up momentum.

For example, prior to 1979 scientists working in Texas were rarely elected to the National Academy of Sciences. We occasionally recruited some people who already had been elected, but the research being done in Texas was not leading to election to the National Academy.

Election to the National Academy of Sciences is probably the ultimate honor for American scientists, short of the Nobel Prize. Sixty American scientists are elected each year in all branches of science, including astronomy, chemistry, physics, agriculture, engineering, mathematics, and so on, as well as medicine. Nationally, about one-fifth of those elected each year are from medical institutions. Texas's first medical scientist in the Academy was elected in 1979 and it is interesting that since that time, one-half of all the Texans elected have been from medical institutions-a pattern quite different from the country-at-large. During that time, sixteen scientists have been elected from Texas's general academic campuses-two from Rice, one from SMU, two from the University of Houston, two from Texas A&M, and nine from UT-Austin. Sixteen medical scientists have been elected over the same period-three from Baylor College of Medicine, one from UT-Houston, one from M.D. Anderson, and eleven from UT Southwestern.

These numbers are something that Texans should be proud of. They serve as strong evidence that our investment in higher education has resulted not just in better education for students but also is providing the infrastructure to allow Texas universities to become research powerhouses.

UT Southwestern is fortunate in that having a large number of national and international research leaders has led to beneficial ripple effects. People of National Academy caliber attract grants competitively. They also attract other people who want to collaborate with them, both senior and junior, who, in turn, attract still other grants. They also attract the best students from across the country, who often stay on in Texas and in their own turn attract yet more grants.

So there becomes an upward spiral of increasing research activity, increasing research funding, and increasing numbers of leading researchers. The sharp rise in UT Southwestern's research activities is illustrated in Figure 1. In 1980, our faculty was awarded $25 million in competitive research grants. By 1996 that number had increased six-fold to $150 million per year.

I should point out that $150 million is not a larger total than several other medical schools in the country. However, we are also far from the largest medical school in the country. The average faculty size of the top twenty-five medical schools in the country (as ranked by U.S. News and World Report) is over 1,400, compared to UT Southwestern's 1,000. In terms of research grants per faculty member, we consistently rank in the nation's top ten, and our rate of increase is one of the fastest in the country.

Research productivity has important economic implications for Texas. UT Southwestern's ability to attract $150 million in research grants to Texas results in thousands of new jobs. Research also provides an opportunity for Texas to attract biotechnology companies, and thereby for our state to be part of one of the country's fastest growing new industries. And, when our research discoveries result in new products, Texas's medical schools can share in the proceeds of bringing the products to the marketplace.

In the mid-1980s, UT Southwestern established a technology transfer office, seeking to improve our ability to act in partnership with industry to bring research breakthroughs to the public (and, needless to say, to share in any profits). As illustrated in Figure 2, UT Southwestern's inventions in 1986 resulted in royalty payments and licensing fees from industry totaling a grand sum of $70,000. By 1996, that had risen to almost $3 million. This figure ranks seventeenth among all institutions of higher education in the country, including general academic campuses and medical centers.

Now, $3 million in the grand scheme of things is not an enormous amount, but the rapid rate of increase is encouraging. I am confident that, for all of Texas's universities and medical centers over the next decade, the numbers will continue to rise. Technology transfer efforts in universities will be an important source of revenue, and also an important means for making sure that talented faculty stay in academia and aren't forced to abandon their universities in order to see their inventions reach fruition.

But candidly, funds generated from royalties will never be sufficient to generate the revenues Texas universities and academic medical centers need to achieve and maintain excellence. So, where will the funds come from?

Clinical income is an essential and growing part of all academic medical centers' revenues. This income is vitally important to sustain the clinical enterprise and to fund charity care, but in an era of managed care it will never be a major source of funds to underwrite research and education. There are only two potential sources of sufficient funds to maintain and enhance the needed quality and scope of Texas's universities and medical schools: general revenue appropriations from the state, and private philanthropy.

As mentioned earlier, Texas led the nation in its public-sector commitment to higher education and research from 1965 to 1985. After a pause for the past decade, it is essential that we re-commit ourselves as a state-not just to maintain our current level of quality, but to provide the tax dollars necessary to build true excellence and national leadership. At the same time, we must realize that tax dollars, alone, will never suffice. We must rely on the private sector as well, if Texas is to match and surpass California, Massachusetts, etc., in terms of educational and research excellence.

We at UT Southwestern have been extraordinarily fortunate that, over this past decade of special need, the private philanthropic community has stepped forward to help us achieve our goals. Until the mid-1980s, we looked almost exclusively to state government for the provision of seed dollars for growth and improvement. Since that time we have had to look also to private donors-and they have responded magnificently. As shown in Figure 3 , UT Southwestern received $11 million from philanthropy in 1986 ($8 million from competitively-awarded grants from national foundations such as the American Heart Association and $3 million in gifts from local contributors); by 1996, that number had risen to $62 million ($22 million from national sources and $40 million from local donors). It is this remarkable outpouring of philanthropic support that has enabled UT Southwestern to continue growing and improving.
The story of UT Southwestern's rise to prominence is mirrored in many regards in a number of Texas's other leading universities and medical centers. In each, there has been an initial major boost from state appropriations, followed by a further boost from philanthropists. Both will be essential in the future if Texas is to rise to the ultimate level of achievement.

And now it is my pleasure to introduce the last speaker of our meeting. He is fairly new to Texas. His recruitment here and his success since arriving serve as excellent examples of how the investment of a combination of state and philanthropic funds in outstanding research leaders can propel Texas into worldwide prominence-and in the process, bring many more dollars into Texas than the initial investment.

Dr. Glen Evans is one of the world's research leaders in the Human Genome Project, about which so much has been said during this meeting. A few years ago, Glen was working at the Salk Institute in California. Thanks to major endowment gifts from the McDermott Foundation and the Biological Humanics Foundation (which also was founded by Eugene McDermott), plus matching gifts from anonymous donors along with core state funding, UT Southwestern was able to recruit him and his research team to Dallas. Since arriving here, his program has grown to become one of the ten largest Human Genome Centers in the country, and he and his colleagues have been awarded multi-year grants totaling over $20,000,000.

Glen serves as professor of internal medicine and of biochemistry at UT Southwestern, holds the Eugene McDermott Distinguished Chair, and is director of the Eugene McDermott Center for Human Growth and Development and the Center for Human Genome Research. It is a pleasure to introduce him to the Philosophical Society of Texas.