The growth of knowledge in a host of fields, from molecular biology to nanotechnology to medicinal chemistry, is accelerating rapidly, creating opportunities for new therapies that promise to transform the nature of medical care. Synthesizing and applying this vast quantity f critical information is an activity beyond the power of any single individual or discipline. The is simply too much to know. Accordingly, partnerships of all sorts - across our departments and among institutions - will be the force driving medical advancements in coming years. 

Cures That May Stem From Fat Having fat, though not necessarily being fat, may one day save your life. Dr. Adam Katz, a plastic surgeon with an interest in regenerative medicine, has found a variety of adult stem cells in the stromal cells associated with fat that retain their capacity to transform themselves into other kinds of tissues. Though more differentiated and less plastic than stem cells found in embryos, adult stem cells could be used to generate heart muscle tissue to treat patients after a heart attack or bone cells to heal complex fractures or to treat osteoporosis. With a gift of $300,000 from former dermatology department chair Dr. Peyton Weary and his family, Dr. Katz and his colleagues are focusing on the use of adult stem cells found in fat to produce and repair skeletal muscle. Other projects in his lab involve efforts to regenerate or repair heart muscle, the central nervous system, and bone cells. He is collaborating with colleagues Roy Ogle, Kevin Lee, and Brent French on these efforts

Dealing with Distress in Nursing The study of ethics crosses many disciplines at the University, among them medicine and nursing. Ann Hamric studies the problem of moral distress in the nursing profession-the conflict that occurs when a nurse knows ethically what ought to be done in a patient-care situation but feels prevented from taking action. Constraints such as lack of time, power, knowledge, and confidence can lead to moral distress. "We have some evidence that the experience of moral distress is increasing and has caused nurses to leave positions and even the nursing profession itself. It is contributing to the national nursing shortage," said Ms. Hamric, who received the Nursing Alumni Association's 2002 Distinguished Professor Award. "Moral distress needs to be recognized and dealt with." With support from a three-year, $554,000 grant from the National Institutes of Health, Ms. Hamric is working with colleagues in the Center for Biomedical Ethics on ethical issues related to clinical research coordinators. She also works with students. In 2001, for example, she supervised a study by Elizabeth Sekinger (Nursing '02), who examined the problem of moral distress among her peers in the School of Nursing. Now an emergency room nurse at Brigham and Women's Hospital in Boston, Ms. Sekinger was one of the school's first Distinguished Majors. "Many ethical issues dramatically affect nurses because they are front-line providers," said Ms. Hamric. "Nurses are interesting, important, and powerful, and if you've been hospitalized, you understand this."

From Discovery to Treatment

The power of collaboration is evident in the consortium of scientists led by University researchers Alan F. "Rick" Horwitz, professor of cell biology, and J. Thomas Parsons, chair of the Department of Microbiology, who were awarded a $38 million grant from 

the National Institutes of Health to study cell migration. They are leading a group of twenty-five top scientists in eight disciplines from fourteen of the world's leading academic medical centers to pursue breakthroughs in cancer, cardiovascular disease, arthritis, and other illnesses.

Other groundbreaking collaborations are also producing impressive results:

• Robin Felder, director of the University's Medical Automation Research Center, and colleagues at Georgetown University published findings that set the stage for developing a medical test-believed to be the first of its kind-to predict whether a person will develop high blood pressure. The test is based on three variants in a kidney gene associated with the most common type of hypertension.

• Collaborative work in the School of Medicine and the Department of Chemistry is paving the way to improved therapies for heart disease, spinal cord injury, kidney transplants, and other conditions. Adenosine analog compounds designed by Joel Linden, professor of medicine, and synthesized by Timothy Macdonald, chair of the Chemistry Department, have been shown to suppress damaging inflammation triggered by the immune response. In February, University researchers received a $1.5 million grant from the Dr. Ralph and Marian Falk Medical Research Trust to expand their investigations of clinical uses for these compounds.

The success of these and other collaborations rests on the quality of individual researchers whose work bridges numerous disciplines. This year, we were fortunate in attracting outstanding new faculty such as Barry Gumbiner, one of the nation's leading cell biologists, who now chairs the Department of Cell Biology and is working with colleagues across the Grounds to organize the new Morphogenesis and Regenerative Medicine Institute.

H. Mario Geysen, the new Alfred Burger Professor of Biological and Medicinal Chemistry, has come to the University from GlaxoSmithKline and holds joint appointments in the School of Medicine and the College of Arts and Sciences.

Called the father of combinatorial chemistry, he has revolutionized the pharmaceutical industry with an approach to identifying and synthesizing chemical agents that involves not only chemistry, but also robotics, instrumentation, computer science, and engineering.

By using automated systems, combinatorial techniques enable chemists to address multiple problems in parallel rather than in sequence. As a result, numerous drug candidates can be screened simultaneously, vastly accelerating the pace of drug testing and discovery. To advance this work, Glaxo has provided Mr. Geysen with some $10 million in equipment and technology, which has been installed in four renovated laboratories in the Chemistry Building.

By using automated systems, combinatorial techniques enable chemists to address multiple problems in parallel rather than in sequence. As a result, numerous drug candidates can be screened simultaneously, vastly accelerating the pace of drug testing and discovery. 

Our collaborative partnerships include generous benefactors, who are fueling medical advances with remarkable support. This past year, Alice Goodwin and William H. Goodwin, Jr. (Darden '66), a member of the Board of Visitors, provided $3.9 million to hasten clinical trials of a promising vaccine for melanoma and to support the development of new vaccines for lung, ovarian, breast, and colon cancer. In May, the couple made an additional $6 million commitment to the University's Cancer Center to accelerate trials of promising new therapies for cancers of the pancreas, head and neck, brain, and lungs.

Creating a Genetic Switch Culminating eight years of experimentation, Heidi Scrable, an associate professor of neuroscience, has developed a genetic switch that provides a precise and reversible way to control gene expression in mammals. To reach this breakthrough, Ms. Scrable turned to the simple, well-known mechanism that bacteria use to metabolize lactose, a sugar found in milk and other sources, and adapted this genetic code for mice. To demonstrate the concept, she created a transgenic mouse that produces pigment and turns brown after drinking milk. Replace the milk with water, and the mouse reverts to its original white coloring. Ms. Scrable's switch can be applied to a host of experimental situations and can help us understand the temporal dimensions of genetic diseases.

A Remarkable Record of Achievement During his sixteen-year tenure as dean of the School of Medicine, Dr. Robert M. Carey created five new medical departments and sixteen interdisciplinary centers, built four research buildings, and substantially raised the quality of the medical faculty through strategic recruitment and collaboration with other schools at the University. Basic research programs climbed into the top echelon, and NIH support quintupled, elevating the school to the top thirty in NIH funding last year. Three departments were in the top five. An internationally recognized endocrinologist and recipient of the American Heart Association's Irving Page Award for Hypertension Research, Dr. Carey will return to full-time teaching and research on the Medical School faculty. In the meantime, he is taking a year's sabbatical to develop a proposal for a groundbreaking new center to advance his ongoing study of hormonal control of blood pressure.

Providing the Best Medical Care 

Confronting the challenges of an increasingly rigorous health care environment, the Medical Center has taken a number of steps to control costs, increase revenues, and improve management while upholding the quality of care. R. Edward Howell, the new vice president and chief executive officer of the University Medical Center, has provided invaluable leadership over these developments. Formerly with the University of Iowa Hospitals and Clinics, he joined the University Health System in February.

While instituting administrative changes, the Medical Center also has moved forward with innovative patient care. Among the new diagnostic procedures and therapies introduced this year:

• The Digestive Health Center of Excellence began offering a DNA test to identify patients with increased risk for colorectal cancer.

• Orthopedic surgeons now offer a wider range of graft choices for knee surgery patients.

• Using a portable ventricular assist device, patients awaiting heart transplantation can remain at home until a heart is available.

• Cancer patients will benefit from a new intensity-modulated radiation therapy, which adjusts radiation beams to the size, shape, and location of a tumor, reducing side effects by minimizing the impact on surrounding healthy tissue.

• A new therapy that kills cancer cells by freezing them is now available for prostate cancer patients.

Our commitment to serving the people of the Commonwealth was demonstrated by the eighty doctors, nurses, and medical students who volunteered at a free medical clinic in southwest Virginia this year. The University Health System also has taken the lead in establishing the Center for Clinical Toxicology, the only one in Virginia. The center offers twenty-four-hour physician coverage to communities where toxicological emergency care is not available.

The quality of care in our hospitals and clinics continues to be confirmed in national surveys and rankings. Among the results this year:

• Ten of the University's medical specialties were listed in U.S. News & World Report's 2002 edition of "America's Best Hospitals." Clinical departments specializing in hormonal disorders, neurology and neurosurgery, urology, orthopedics, cancer, gynecology, and otolaryngology were ranked in the top twenty-five.

• Forty-three physicians from the Health System were included in the 2002 edition of America's Top Doctors. More than 250,000 doctors were surveyed to create this roster.

• Drs. Maria Kelly, Maureen Ross, and Peyton Taylor, Jr., were named among the top oncologists in the ten-state Southeast region of the United States in a Ladies Home Journal list of "The Best Doctors for Women-Coast to Coast."

As with medical research, private support is critical to maintaining such standards in our Medical Center. This year, the Neonatal Intensive Care Unit received a $1 million gift from Food Lion, the Salisbury, N.C.-based grocery store chain. To go toward a $3.1 million renovation of the NICU facilities, the gift was announced during the annual Children's Miracle Network telethon, which raised an additional $1.58 million for the Children's Medical Center.

As we prepare nurses and doctors for twenty-first century practice, we must blend clinical training with education in the basic sciences, mastery of new information technologies, and the human dimension of health care. 

Our hospitals and clinics will benefit in perpetuity from an extraordinary endowment created by the late Ward Buchanan, a 1914 graduate of the University's law school. A retired Procter & Gamble executive who died in 1942, Mr. Buchanan stipulated in his will that a trust be created to provide income for his close and extended family and, after the death of his last surviving heir, to establish the Ward Buchanan Fund for "hospital purposes" at the University. By the time this fund reached the University this past year, it had grown to $52.6 million, making it one of the largest gifts in the University's history. Initially it will produce approximately $2.5 million a year for the Medical Center.

Preparing the Next Generation of Health Care Providers

This year, Dr. Arthur "Tim" Garson, Jr., was named vice president and dean of the School of Medicine. Formerly senior vice president and academic dean for operations at Baylor College of Medicine in Houston, he sees challenges and opportunities in a number of areas of medical education and is particularly interested in exposing medical students to new ways of caring for patients. Building on the extraordinary achievements of Dean Robert M. Carey, M.D., Dr. Garson takes the helm of a school ranked twenty-seventh in research and in primary care in U.S. News & World Report's annual graduate school ranking.

As we prepare nurses and doctors for twenty-first-century practice, we must blend clinical training with education in the basic sciences, mastery of new information technologies, and understanding of the human dimension of health care. Recent gifts and grants will help sustain these efforts. The School of Medicine was one of only seven medical schools in the nation to receive an educational grant from Pfizer, Inc., to develop and implement an innovative, multidisciplinary curriculum in sexual health medicine. The school also benefited from an estate gift from David A. Harrison III to fund new professorships and to recognize excellence in teaching. In the School of Nursing, a new graduate curriculum for geriatric nurse practitioners will be established with a grant from the John A. Hartford Foundation Geriatric Nursing Project of the American Association of Colleges of Nursing.

The arrival of Dr. Garson and Mr. Howell marks the beginning of a new partnership. Working in coordination with Leonard W. Sandridge, the University's executive vice president and chief operating officer, and Jeanette Lancaster, dean of the School of Nursing, they are creating an organizational and planning structure aimed at maximizing resources and improving education and care even in these difficult economic times.