Medical school aiming for top

By Alice Keesing and Beverly Creamer
Advertiser Staff Writers

Two years ago, the University of Hawai'i medical school was nearly dead. Today, it is undergoing a renaissance, generating considerable energy in the medical community and promising to jump-start a new economic engine for the state.

"We've always talked about Hawai'i being a center for health and wellness in the Pacific ... I think it can happen, and it will happen." Bruce Anderson, Hawai'i Department of Health director Advertiser library photo • May 25, 2001

The strategic plan for next four years is simple but weighty: to make the John A. Burns School of Medicine the best in the world with an Asia-Pacific focus.

"It wasn't too many years ago that people were talking about closing the medical school. Now it's being looked at as not only a center for education and outreach, but as a catalyst for a biotechnology development," said state Department of Health Director Bruce Anderson. "So we've come full circle, and I think that's largely a credit to (medical school dean Dr. Edwin Cadman) and the team he has put together."

The strategic plan capitalizes on Hawai'i's location and diverse mix of people, which make it an ideal laboratory for scientists to test and compare diagnoses, treatments and methods. It promises to bring millions of federal research dollars into the state and improve the health and well-being of residents.

"I think the plan is excellent," said Dr. Richard Friedman, vice president for medical affairs for The Queen's Medical Center. "(Cadman) has picked areas that have real potential for growth. Clearly, he has some major challenges before him, but things like alternative medicine and Native Hawaiian health have real opportunity in Hawai'i. They are areas where we have unique experience and we can really do something."

Since his arrival two years ago, Cadman has been bent on winning approval for a new facility. With planning under way for a site in Kaka'ako, the next big step is bringing in top-flight researchers to help carry out the vision. As part of his contract, Cadman was guaranteed 30 new faculty members in addition to the existing 190.

Things are looking brighter on the Manoa campus after decades of declining morale, said Martin Rayner, interim director of the Pacific Biomedical Research Center, which is merging with the medical school.

The university has won grants that build the university's research potential, Rayner said, by supporting junior faculty. In 2000, the medical school and PBRC brought in $25 million. That's projected to double to $50 million this year.

The medical school will continue to build its expertise in AIDS research and in cloning and biogenesis, which resulted in the world-

famous green mice. But the newly defined school also is reaching into the community with a renewed emphasis on public health.

It will focus on infectious diseases that threaten the state and nation. It will help tackle issues related to Hawai'i's rapidly aging population, upgrading an already strong geriatrics division. It will explore the link between a healthy environment and healthy people. And in what many see as a key move, the school will work to improve the health of Native Hawaiians, rated among the poorest in the nation.

Cadman has worked with the Native Hawaiian community to help envision a department that specifically addresses its health needs and brings in the federal research dollars to find answers and apply them.

Hardy Spoehr, executive director of Papa Ola Lokahi, the Native Hawaiian Health Care System, praised the medical school for "recognizing how important Hawaiian health is, and the role the university can play in addressing some of the issues."

Spoehr said he also would like to see the school incorporate traditional Hawaiian healing practices into the curriculum — an idea Cadman embraces.

Dr. Terry Shintani, who runs an alternative health care clinic in Wai'anae and is known for his work treating disease by promoting a traditional Hawaiian diet, also is excited by the potential "to shine some light" on the tremendous health problems in the community.

The danger, he said, is in simply using the Hawaiian community for research, only to have the results end up in reports that never benefit the group who are dying of diabetes, heart disease and cancers at the highest rates in the state.

The medical school's plans for a major initiative in the molecular genetics of disease could revolutionize health care for Native Hawaiians and other ethnic groups.

Tapping into the state's ethnic diversity, researchers will pinpoint which genes predispose people to certain diseases, with a view toward developing blood tests that will signal an individual's likelihood of getting a disease.

Someone diagnosed as likely to get diabetes or heart disease, for example, could be advised on proper diet, Cadman said. "Today the family history is the only predictor, and that's a very crude assessment."

The medical school will renew its efforts in research on infectious diseases, an area where Hawai'i once led the nation.

"UH used to have an outstanding program in infectious disease epidemiology. They actually had some of the foremost experts in the world at the School of Tropical Medicine working on dengue fever, yellow fever," Anderson said. "But because of a lack of attention and perhaps lack of focus — mostly a lack of support at the dean's level — most of them ended up leaving Hawai'i and going elsewhere."

Located at the crossroads of the Pacific, Hawai'i is particularly vulnerable to potentially fatal infectious diseases. The recent dengue fever outbreak is a good example, introduced from other hot spots in the Pacific, Anderson said. Hawai'i also is seeing more imported diseases that once were considered eradicated, such as leprosy and penicillin-resistant tuberculosis.

The state health director has praised revival of the school of public health, which he believes lost touch with the community.

Cadman is "right on" with his focus on core areas such as epidemiology and biostatistics, Anderson said. "I know he's taking some flack from some of the community members on that, because obviously they have their pet interests in different areas and everyone would like to do it all at once. But you can't do that. They need to rebuild the school from the ground up.

"We've always talked about Hawai'i being a center for health and wellness in the Pacific, but it's never happened," Anderson said.

"But I think with some energy and enthusiasm on (Cadman's) part, and support from the community, I think it can happen, and it will happen."

Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014 and Beverly Creamer at bcreamer@honoluluadvertiser.com or 525-8013.