Blanket Email from Senior Vice President for Health Sciences
Kudos and Questions for Proposed Medical School

This blog has previously posted on the possible establishment of a new medical school in the Twin Cities by the University of St. Thomas and Allina.

The following blanket email has been sent to BigU AHC faculty. Mr. Bonzo posts it without comment at this time. An earlier blanket email by MedSchoolDean at BigU has also been posted.

Frank B. Cerra	Fri, May 25, 2007 at 12:05 PM
Reply-To: "Frank B. Cerra" To: ALL-AHC-ALL@oris.ahc.umn.edu

Dear Colleague -

May is a remarkably productive month in the Academic Health Center. By the end of last week, we graduated 224 new physicians, 134 new nurses, a record class of 157 new PharmDs, 138 new dentists, 91 new veterinarians, and 187 public health graduates prepared to improve the health of our communities.

All of you deserve a strong pat on the back for the work you've done in preparing this next generation of more than 900 health professionals to care for Minnesotans. This has been our commitment since the University was founded 154 years ago.

For the past couple of weeks, I've been reflecting on that historic commitment as colleagues in the community discuss the feasibility of starting a new medical school. The stated rationale for this fledgling partnership between Allina and the University of St. Thomas is the impending shortage of primary care physicians to care for our aging population.

Much of our work at the University is designed to respond to workforce needs in various health professions. Whether it is a need for pharmacists in rural communities, advanced practice nurses to manage chronic care for patients, training all health professionals to move care upstream into prevention, or modeling new cost effective ways to achieve health, our schools have been responsive with innovative programs and expansions of existing programs to meet workforce needs of Minnesota.

As one who has managed the complexities of this Academic Health Center for more than a decade, I do have some questions that will need to get into the dialogue about this new school.

--Is another medical school truly the solution to the need for access to healthcare for aging Minnesotans?
--Are there other models of care that are more fiscally responsible for the future care of chronic conditions?
--Given the available capacity in our state's training programs, would it be more prudent for the community to work with us to find ways to attract students into health careers who are committed to primary care?

As the state's only public research university, we stand ready to help the community as they pursue the feasibility of starting a new school.

Frank B. Cerra, M.D.
Senior Vice President for Health Sciences
McKnight Presidential Leadership Chair

A public dialog and discussion on this matter is certainly in order. Perhaps some competition from St. Thomas would be good for Bigu? If this dialog does occur, Mr. B. would certainly like to contribute to the conversation.

On this Memorial Day weekend: memento mori.

Bonzo

Gonzo Justice:
Former US Attorney Heffelfinger Publicly Reacts to Monica Goodling Testimony and Kyle Sampson Email

The StarTribune reports today on local effects of the Justice Department's latest disgraceful behavior. Excerpts are posted below. Please see the full article if you are interested as the situation is more complex than the casual reader might wish to know about.

[Addendum: The Desert Beacon does a good job in laying out this situation in all its ugliness:
"Vote fraud more important than rape? Gonzales Department of Justice replaced attorney trying to reduce reservation crime"]


Heffelfinger slams Justice Department

The former U.S. attorney has grown more open in his anger over the fired-attorneys controversy. Thursday that reached a peak.

By Eric Black, Star Tribune

Last update: May 24, 2007 – 11:18 PM

In a blistering attack that won a standing ovation from more than 200 members of the Hennepin County Bar Association, former U.S. Attorney Thomas Heffelfinger on Thursday defended his work on Indian issues and accused Justice Department officials of firing people without knowing the most basic information about their qualifications.

Heffelfinger, who says he had no idea anyone in Washington was thinking of firing him when he resigned his position as U.S. attorney in February 2006, has gradually become more open about his outrage over the controversy around the firing of U.S. attorneys as his name has been more publicly linked to it.

In remarks to the Bar Association in Minneapolis, he reached a new peak, saying among other things that "something is fundamentally broken within the Department of Justice."

And he read aloud from an e-mail, written by Kyle Sampson, then-chief of staff to Attorney General Alberto Gonzales, to other Justice Department officials under pressure to explain how particular U.S. attorneys had become candidates for dismissal.

Sampson suggested the attorneys on the list -- including Heffelfinger -- "had no federal prosecution experience when they took the job."

This elicited a burst of shocked laughter from the audience, many of whom knew Heffelfinger had been a Hennepin County prosecutor, a federal prosecutor, and had served a previous term as U.S. attorney for Minnesota under the first President Bush before the second President Bush appointed him in 2001.

In testimony in Washington on Wednesday, former Justice Department official Monica Goodling said that the complaints she had heard about Heffelfinger were that he spent too much time on American Indian issues. Heffelfinger defended his commitment to issues of Indian law and then called the claim that he was too interested in the issue "outrageous and shameful." That brought the biggest ovation of his luncheon address.

And, he told reporters after the luncheon speech, he also briefed Gonzales on his continuing plans and commitment to the issue, and Gonzales made no complaints about any of it.

Minnesota tribal officials Thursday rejected the idea that Heffelfinger spent too much time on Indian issues.

A general housecleaning is called for at Justice. The old saying about a fish rotting from the head seems appropriate.

Bonzo

Avandia flagged by FDA as a possible heart risk five years ago

Warning apparently buried

From the LA Times via Star-Tribune:

Diabetes drug Avandia caused concern 5 years ago

FDA reviewers flagged it in 2002 as possibly causing heart failure, yet a safety alert went out for it Monday.

By Ricardo Alonso-Zaldivar, Los Angeles Times

Last update: May 22, 2007 – 9:27 PM

WASHINGTON - Federal investigators warned nearly five years ago that the diabetes drug Avandia might be causing heart failure, according to an internal government memo released Tuesday by a consumer group.

Separately, in fast-moving developments in the latest drug safety investigation, a senior Republican senator said he learned that the Food and Drug Administration's safety office recommended the strongest possible warning for Avandia -- only to be overruled.

"The FDA didn't take that advice," said Sen. Charles Grassley, R-Iowa, a critic of the agency. "Instead, the warning about congestive heart failure risks with this drug is currently buried."

FDA spokeswoman Julie Zawisza said debate and disagreement are not unusual within the agency, "particularly when the science is unclear, complex or emerging."We do not have sufficient understanding of the data at this time to make a regulatory decision," she said.

The FDA issued a safety alert about Avandia on Monday after a study in the New England Journal of Medicine linked the drug to increased risk of heart attacks and death from cardiac disease. The alert underscored less prominent warnings of heart risks in prescribing literature primarily intended to inform doctors.

But a memo from FDA drug safety reviewers -- dated July 16, 2002 -- indicates there were significant concerns much earlier within the agency about Avandia and Actos.

Released by the watchdog group Public Citizen, the memo analyzed 47 early reports to the FDA of patients who went into heart failure and had to be hospitalized while taking one of the drugs. Congestive heart failure, or CHF, is a life-threatening condition that comes about when the heart can't pump enough blood to the rest of the body.

"This case series strongly supports the hypothesis that [these drugs], as a class, may be associated with CHF in diabetics," the memo said.

Peter Agre to Explore Running for US Senate

Would it hurt to have a second smart senator from Minnesota?

From Today's Star-Tribune

Chemist knows a Senate run takes a lot more than smarts

Is there room for brilliance in the United States Senate?

By Doug Grow, Star Tribune

May 21, 2007 – 8:57 PM

Though a graduate of Minneapolis schools -- Roosevelt High and Augsburg College -- it's been years since he's actually called Minnesota home. Secondly, though he has a nice job -- the physician is vice chancellor for science and technology at Duke University's School of Medicine -- he doesn't have access to the amount of money needed to play contemporary politics.

So why's he considering a campaign?

"We live in desperate times," said Agre, citing problems ranging from the health care crisis to the lack of support for public education to the ever-increasing mess in the Middle East.

Agre, 58, doesn't think his address problem is a big one. After all, Al Franken, a DFL Senate candidate, also hasn't had a Minnesota residence until recently.

"I've always been a Minnesotan," Agre said. "Your paper recently had a story with the headline, 'Bob Dylan, Still One of Us.' That's me." He added that though he spent his career at Johns Hopkins University before moving to Duke, he's always made frequent trips "home."

He has deep family roots here. He's Lutheran. He paddles in the Boundary Waters. He skis in the Mora Vasaloppet. He eats hotdish.

That's a lot of Minnesota in a résumé.

The money issue is tougher.

He will spend considerable time in Minnesota in July to find out if he can attract the sort of financial support that would make a Senate race possible.

"I have to be realistic," he said. "This is not about tilting at windmills."

Agre was awarded the Nobel Prize in chemistry in 2003. (He and his colleagues discovered microscopic channels involved in the exchange of water among cells.)

At the time, he vowed that he would become more of a public spokesman for science. He has made good on his pledge, traveling all over the world to speak to science organizations. He's also traveled back to Roosevelt High, where, a couple of years ago, he passed his Nobel medal around a room filled with kids who were amazed at the humility of the man who talked with, not down to, them.

But there is this simple fact: There are no Nobel winners in the Senate. That's because the Senate has become a club for the wealthy or for anyone with a lifelong driving ambition to be a senator.

Let's see:

Show me the money!

In this world, one thing counts, in the bank, large amounts.

or is it:

Money is the root of all evil.

In a state that elected Paul Wellstone anything is possible. If Ciresi and Franken are really interested in retiring Senator BlowDry perhaps they should throw their support and dollars to Peter Agre. The thought of Senator BlowDry staying in office because Al Franken ran is too terrible to contemplate.

Ciao, Bonzo

Comic Relief

"He has done nothing wrong," Bush said in an impassioned defense of his longtime friend and adviser [Attorney General Alberto Gonzales] during a news conference at his Texas ranch.

The sainted Mr. Gonzales has previously graced the pages of the Periodic Table in the post "One Can Only Marvel..."

When Mr. B. suggested to Mrs. B. that BoyGeorge was a chowderhead, she replied that this could not possibly be the case since that would give chowder a bad name.

Of course Wolfowitz recently announced his resignation from the World Bank despite Bush's early support in Wolfie's effort to brazen it out. Mr. B. hopes that the same fate awaits Attorney General Gonzales. Don't worry about Gonzo being out of a job, however. Just think of the money he will be able to make as a Halliburton attorney or in some similar position.

And so it goes. Bonzo

Not a Pretty Sight
Avandia - aka Rosiglitazone - Another Medical Train Wreck?


[Note: NEJM is a subscriber based service. But Mr. B. logged on to the site - as you can, too - and was given access to an important paper. Extracts are posted below in the belief that they are important and that this is permitted under the fair use doctrine. Please consult the whole article if this is a matter of medical importance to you. If the NEJM is too heavy duty for you, here is a link to an article in Time.]

From the New England Journal of Medicine Web Site:

Published at www.nejm.org May 21, 2007 (10.1056/NEJMoa072761)

Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes
Steven E. Nissen, M.D., and Kathy Wolski, M.P.H.

ABSTRACT

Background Rosiglitazone is widely used to treat patients with type 2 diabetes mellitus, but its effect on cardiovascular morbidity and mortality has not been determined.

Methods We conducted searches of the published literature, the Web site of the Food and Drug Administration, and a clinical-trials registry maintained by the drug manufacturer (GlaxoSmithKline). Criteria for inclusion in our meta-analysis included a study duration of more than 24 weeks, the use of a randomized control group not receiving rosiglitazone, and the availability of outcome data for myocardial infarction and death from cardiovascular causes. Of 116 potentially relevant studies, 42 trials met the inclusion criteria. We tabulated all occurrences of myocardial infarction and death from cardiovascular causes.

Results Data were combined by means of a fixed-effects model. In the 42 trials, the mean age of the subjects was approximately 56 years, and the mean baseline glycated hemoglobin level was approximately 8.2%. In the rosiglitazone group, as compared with the control group, the odds ratio for myocardial infarction was 1.43 (95% confidence interval [CI], 1.03 to 1.98; P=0.03), and the odds ratio for death from cardiovascular causes was 1.64 (95% CI, 0.98 to 2.74; P=0.06).

Conclusions Rosiglitazone was associated with a significant increase in the risk of myocardial infarction and with an increase in the risk of death from cardiovascular causes that had borderline significance. Our study was limited by a lack of access to original source data, which would have enabled time-to-event analysis. Despite these limitations, patients and providers should consider the potential for serious adverse cardiovascular effects of treatment with rosiglitazone for type 2 diabetes.

From the Discussion

Our study has important limitations. We pooled the results of a group of trials that were not originally intended to explore cardiovascular outcomes. Most trials did not centrally adjudicate cardiovascular outcomes, and the definitions of myocardial infarction were not available. Many of these trials were small and short-term, resulting in few adverse cardiovascular events or deaths. Accordingly, the confidence intervals for the odds ratios for myocardial infarction and death from cardiovascular causes are wide, resulting in considerable uncertainty about the magnitude of the observed hazard. Furthermore, we did not have access to original source data for any of these trials. Thus, we based the analysis on available data from publicly disclosed summaries of events. The lack of availability of source data did not allow the use of more statistically powerful time-to-event analysis. A meta-analysis is always considered less convincing than a large prospective trial designed to assess the outcome of interest. Although such a dedicated trial has not been completed for rosiglitazone, the ongoing Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes (RECORD) trial may provide useful insights.34

Despite these limitations, our data point to the urgent need for comprehensive evaluations to clarify the cardiovascular risks of rosiglitazone. The manufacturer's public disclosure of summary results for rosiglitazone clinical trials is not sufficient to enable a robust assessment of cardiovascular risks. The manufacturer has all the source data for completed clinical trials and should make these data available to an external academic coordinating center for systematic analysis. The FDA also has access to study reports and other clinical-trial data not within the public domain. Further analyses of data available to the FDA and the manufacturer would enable a more robust assessment of the risks of this drug. Our data suggest a cardiovascular risk associated with the use of rosiglitazone. Until better precision of the estimates of the risks of this treatment on cardiovascular events can be delineated in patients with diabetes, patients and providers should give careful consideration to the risks and benefits of their overall treatment plans.

Dr. Nissen reports receiving research support to perform clinical trials through the Cleveland Clinic Cardiovascular Coordinating Center from Pfizer, AstraZeneca, Daiichi Sankyo, Roche, Takeda, Sanofi-Aventis, and Eli Lilly. Dr. Nissen consults for many pharmaceutical companies but requires them to donate all honoraria or consulting fees directly to charity so that he receives neither income nor a tax deduction. No other potential conflict of interest relevant to this article was reported.

What a novel concept! BigU MedSchool should hire some people like Dr. Nissen. They could then serve as examples to MedSchoolDean and to other like-minded Med School faculty here at BigU.

The general situation does not look good to Mr. Bonzo. Parallels are already being drawn with Vioxx, e.g. the link to Time noted above.

Health Care Myths and Realities

The Journal of the American Medical Association has an interesting opinion piece from which Mr. B. has extracted the following:

What Cannot Be Said on Television About Health Care

Ezekiel J. Emanuel, MD, PhD

JAMA. 2007;297:2131-2133.

There are 3 phrases that should and can no longer be said about the US health care system without qualification, embarrassment, criticism, or even denunciation: "The United States has the best health care system in the world," "Health care is special," and "New is better."

"Best Health Care System in the World"

The United States has the most expensive system, by far. In 2005 health care cost more than $6000 per person or in excess of 16% of the gross domestic product (GDP). The nearest rival, Switzerland, spends $4077 per person per year, or 11.5% of its GDP (in purchasing power parity). Norway spends $3966 (9.7% of GDP); Germany, $3043 (10.6% of GDP); and South Korea, a mere $1149 (8.2% of GDP). However, Americans are increasingly aware that all of this money is not buying very much. Life expectancy in the United States is 78 years, ranking 45th in the world, well behind Switzerland, Norway, Germany, and even Greece, Bosnia, and Jordan. The US infant mortality rate is 6.37 per 1000 live births, higher than almost all other developed countries, as well as Cuba. Even for white individuals, the numbers are not world class—5.7 infant deaths per 1000 live births—more than double the rate in Singapore, Sweden, and Japan. Even at the individual hospital level, Americans are realizing the care they receive is not of the highest quality. The idea put forth in the Institute of Medicine report To Err Is Human that 100 000 Americans die each year from medication errors in the hospital has taken hold in the public consciousness as emblematic of the problems with the quality of health care.

Within the last few years, the tipping point has been passed. Something has radically changed when the New Yorker claims the system is a mess and when UnitedHealthcare, a corporate pillar of the status quo, opens an advertisement in the Wall Street Journal by boldly stating that:

The health system isn't healthy. There's no denying it. A system that was designed to make you feel better often just makes things worse.

The US health care system is considered a dysfunctional mess. Conventional wisdom has been turned on its head. If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative.

"Health Care Is Special"

To many, the specialness of health care meant that cost should not be a consideration in care. Ethical physicians could and should not consider money in deciding what they should do for sick patients. Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life, akin to the economist who knew the price of everything but the value of nothing. Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold costs down.

Today, saying that health care is so special that its cost is irrelevant serves to discredit the source. A New York Times reporter learned this lesson the hard way when he praised a study that claimed by "virtually any commonly cited value of a year of life, we found that if medical care accounts for about half the [6.97 year] gain in life expectancy [since 1960] then the increased spending has, on average, been worth it." In response, the reporter "received about 500 e-mail responses from readers, and the most common reaction was a version of a simple question: ‘Why do Americans spend so much more than folks in most other developed countries while getting worse results?’"

"New Is Better"

Americans are enamored with technology, especially health technology. The US Food and Drug Administration has been urged to use surrogate markers to approve drugs and medical devices faster so they can help sick patients. Not only is the United States an early adopter of new health care technologies, many physicians are early "proliferators" of technological innovations.

Increasingly, Americans are beginning to be skeptical about whether new health care technologies are better. The tipping point probably came with the withdrawal of rofecoxib from the US market. Today, the list of drugs and technologies for which new might not be better (and may be even worse) has expanded rapidly: postmenopausal hormone therapy, bare-metal stents, megadose antioxidants, selective serotonin reuptake inhibitors for adolescents, Swan-Ganz catheters, gabapentin for bipolar disorder, erythropoietin for anemia, and the list goes on.

[Addendum, 4:50 pm: To which list can today be added Avandia, which was hoped to be a breakthrough medication for treating type II diabetes.]

The change in language suggests Americans now recognize that the system has deep structural problems. While this recognition is no guarantee of change, it does constitute a critical precondition for comprehensive reform of the system. Reform cannot occur without acknowledging that there is a problem. The next step is for the public to see a solution that they think offers a realistic chance of making the system better.

Now here is language that one would not see in JAMA back in the good old days of rants about the evils of socialized medicine...

Mr. B.

See no evil, speak no evil, hear no evil

Could there be a conflict of interest at BigU?

Not according to AD Maturi; according to Associate AD Wistrcill it is just the appearance of a conflict of interest.

Sometimes it is hard to keep up with the wily administrators and athletaestheticians at BigU.

Jay Weiner of the Strib has an excellent piece today on the academic equivalent of the revolving door at the military-industrial complex.

From the article:

This marriage of commercial interests and college sports is creating cozy bedfellows. For instance, the U athletic department's lead representative in negotiations with Learfield for rights to TCF Bank Stadium is associate athletic director Tom Wistrcill.

Just 13 months ago, Wistrcill was a Learfield employee.

Gophers athletic director Joel Maturi says there's no conflict of interest.

University Chief Financial Officer Richard Pfutzenreuter said before he signs off on any Learfield-TCF Stadium deal he wants to be assured "we're getting full market value."

One issue is the negotiating role of Wistrcill, who was hired by Maturi.

"I haven't seen any conflict myself," said Pfutzenreuter. "I think Wistrcill knows exactly who he's working for. It's the University of Minnesota."

Said Wistrcill: "There could be the appearance of [a conflict] ... Others could say, 'Hey, here's a former Learfield employee negotiating a deal with Learfield. What's going on?' That's why other people [in the central administration] are involved. ... I'm going to do what's best for the university."

But Pfutzenreuter said that, if a tentative deal is struck with Learfield to market the new stadium, "I'm likely to say I want an independent assessment."

UD does justice to this subject in the larger context of academics and sports. See part III of her post. - Three Ways of Looking At A Sports Fiasco


As Mr. B. has noted in the past, ethical standards are apparently rather low here at BigU.

Ciao,

Bonzo

Will Peter Agre Run for Senator in Minnesota?

Mr. B. has written previously about Peter’s wonderful letter to the Strib about his early life experiences, including having attended Roosevelt High School and Augsburg College in Minneapolis. Peter is a Nobel prize winning scientist. Jonathan Turley is the Shapiro Professor of Public Interest Law at George Washington University, a member of USA TODAY's board of contributors, and writes:

The land of $9 million

Anyone can run for public office, right? Not quite. A closer look at Minnesota’s U.S. Senate race shows how our fractured, money-soaked system can effectively eliminate most citizens — even a Nobel Prize winner — regardless of résumés.

By Jonathan Turley

For those who believe that American democracy is at a crisis point, there is no more vivid example than Minnesota, where comedian Al Franken has launched a full-throated effort to unseat Republican Sen. Norm Coleman. It is fast-food politics at its artery-clogging worst: instant gratification and no nutritional value. Yet, Franken has both personal wealth and a host of wealthy donors at his call — pushing out virtually all competitors.

While Minnesota has long prided itself on favoring underdogs, the day may have passed when an idea-rich, cash-poor candidate can secure a major office. The threshold barriers to new voices entering our political process were evident during a recent conversation that I had with Nobel Prize winner Peter Agre.

A Minnesota native, Agre revealed his interest in running but said he was told by state politicos that, in opposing Franken, he is a day late and a dollar short — well, $9 million to be specific. That was the amount that he would need to be "credible." Despite a lack of money, Agre still intends to run as either a Democrat or independent.

In the 2000 Senate race in Minnesota, lawyer Mike Ceresi (who is also running in 2008) put up $5 million of his own money in his losing bid. To win, a candidate needs buzz and bucks, and Franken — who has raised $1.4 million as mere seed money — has an endless supply of both. He thrilled bored voters by calling Coleman "one of the administration's leading butt boys."

Conversely, Agre does not have much to put on the table beyond a Nobel Prize for chemistry and global work on behalf of academic freedom. In today's politics, that gives him about the same odds as Albert Schweitzer running against Arnold Schwarzenegger.

Nonetheless, there is something fundamentally wrong when a man such as Agre is considered political roadkill. Even in a state that once embraced underdog candidates such as professional wrestler Jesse Ventura (who became governor) and college professor Paul Wellstone (the late U.S. senator), money now confines politics to the ranks of rich personalities and robotic functionaries.

Except for his lack of money, Agre would appear the perfect candidate. Besides instantly doubling the IQ of the Senate, Agre would be the first Nobel Prize winner for science to be elected to Congress. While the Senate has been Nobel-free for more than six decades, he would join three prior senators and one vice president (the president of the Senate) who received Nobel Peace Prizes.

Born in Minnesota and a former Eagle Scout to boot, Agre seems to have walked off the set of A Prairie Home Companion: milking cows in the summer and eating lutefisk in the winter — a vile codfish soaked in lye that only a snow-crazed Norwegian can swallow with success.

Part of a large farming and working-class family, Agre went to Theodore Roosevelt High School in Minneapolis (with another student named James Janos — later known as Jesse Ventura). His father was the chairman of the chemistry department at St. Olaf College. Growing up, Linus Pauling — two-time Nobel laureate for chemistry and peace — stayed at their home, unaware that the gangly kid running around would inherit his Nobel Prize 49 years later.

Agre's announcement would create a wild contrast for Minnesota voters. On one side, there is Franken, whose contributions to humanity include such books as Lies and the Lying Liars Who Tell Them: A Fair and Balanced Look at the Right and Rush Limbaugh is a Big Fat Idiot.

On the other side is Agre, who has quietly served medicine and human rights for decades around the world. His published works include scientific breakthroughs credited for having "ushered in a golden age of biochemical, physiological and genetic studies at the molecular level."

Agre could present an equally sharp contrast with Coleman on issues such as stem cells. Coleman has often discussed his tragic loss of two children to a rare genetic disorder as shaping his opposition to most stem cell research. Agre's loss of his 3-month-old daughter, Lydia, to cerebral palsy helped shape his views in favor of such research.

Of course, the very notion of a Nobel laureate joining the less-than-cerebral ranks of the U.S. Senate is something too much to hope for. It would be a scene reminiscent of when John F. Kennedy welcomed Nobel Prize winners to the White House in 1962 and observed, "Never has there been so much collective intelligence in this room, since Jefferson dined here alone."

Mr. B. looks forward to Peter Agre running for Senate in Minnesota. He needs to lose the Mensa label, though. This will not be hard once people get to know him a little better.

Wolfowitz Resigns

Mr. B. has previously posted on this matter. "Wolfie, we hardly knew you...
(Or, you've done a heckuva job, Wolfie)"

Today CNN reports that Wolfowitz has resigned as of the end of June with all the requisite face-saving blather:

WASHINGTON (CNN) -- Embattled World Bank President Paul Wolfowitz agreed to resign Thursday after weeks of controversy over his handling of a pay package for his girlfriend, a bank employee, the institution's board of directors announced Thursday.

In a statement announcing the decision, the bank said "a number of mistakes were made by a number of individuals" in the matter.

Wolfowitz said the bank board accepted his contention that he acted "ethically and in good faith."

In a statement from Wolfowitz, he said it is "necessary to find a way to move forward. To do that, I have concluded that it is in the best interests of those whom this institution serves for that mission to be carried forward under new leadership."

"Change should not be feared, it is something to welcome. It is the key to keeping this important institution relevant and effective in the future and meeting the needs of the world's poor, and of humanity as a whole," the statement said.

Sic transit gloria

BigU’s MedSchoolDean Comments on St. Thomas/Allina
Feasibility Study for New Medical School

Mr. Bonzo has previously posted on this topic.

A blanket email was sent to faculty yesterday that is quoted below in full and without any editorial comments.

Mon, May 14, 2007 at 11:13 AM

To: MED-ALL@oris.ahc.umn.edu
Dear Medical School Faculty and Staff,

You may have noted with interest – as did I – that Allina and the University of St. Thomas have formally announced their intention to study the feasibility of starting a third medical school in the state of Minnesota. Like many of you, I had heard that there were discussions in the community as long as six to eight months ago. Now that the two institutions have made their goals public, I wanted to share with you my thoughts on this development.

This medical school was founded before the establishment of the state of Minnesota, and we have significant experience providing medical education to generations of physicians. We have a solid record of ensuring physicians are interested in practicing in communities throughout the state with our Rural Physician Associate Program, and our residency programs have provided generations of leading care to the families of the state. We were recently named one of the top 10 medical schools in the nation for training family medicine physicians.

We educate students from the state of Minnesota to become physicians for the state of Minnesota.

Although I haven’t been asked, I’d be happy to speak with leaders of this fledgling effort. Having spent my professional career in academic medicine in universities across the nation, I have worked with colleagues at the Association of American Medical Colleges to transform medical education for the next generation. Our Flexible M.D. program and the evolving MED 2010 are but two examples. More importantly, I’ve had the opportunity to work with our national educational accrediting programs, providing an opportunity to witness firsthand what leads to success or failure in the current environment.

Do I have concerns? Certainly. Medical education is an expensive undertaking that requires significant resources to drive its success. This medical school today is an $800 million enterprise and many of its sources of revenue are shrinking, including federal Medicaid dollars dedicated to education and many state programs.

Medical education is not simple. In our Medical School, however, we collectively have a large amount of experience. We have been educating physicians for the state of Minnesota for more than 150 years. The University of Minnesota Medical School was mentioned in the Flexner Report of 1910, which called for reform of medical education, as a school that was doing it right. We still are doing it right.

Deborah E. Powell, M.D.
Dean of the Medical School
Assistant Vice President for Clinical Sciences
McKnight Presidential Leadership Chair

The Bonzos Are Off to New Orleans

Mr. B.'s nephew, JonS, is graduating from law school this week. He had a tough time of it, and due to hurricane Katrina had to leave the city of his birth for a term to travel North to attend school in DC.

Because JonS has been through a lot in getting to this point, the Bonzos look forward to celebrating his achievements. Thus, blogging will be slow, if at all, until next week. Mr. B. has not been in NO since Katrina, and expects to be pretty depressed by the situation there. Two of his academic chemist friends also had to go through the flooding of their house and temporary relocation elsewhere.

But some people, JonS included, love NO and still hope to make a life there. More power to 'em!

Ciao,

Bonzo

University of St. Thomas to Establish New Med School?

"Yond Cassius has a lean and hungry look.
He thinks too much; such men are dangerous."

From the StarTribune:

State's 3rd med school in the works

Allina and the University of St. Thomas are in talks about an effort to train primary-care doctors.

By David Phelps, Star Tribune

Last update: May 07, 2007 – 11:42 PM

Allina Hospitals & Clinics and the University of St. Thomas are exploring the establishment of a back-to-basics medical school in Minneapolis to train primary-care physicians.

The two organizations are in the talking stage at the moment but plan to present the concept of a 40-student-per-class school to their respective boards of directors later this week.

A statement from St. Thomas and Allina on Monday said additional doctors are needed "given population growth in the Upper Midwest and the increasing number of retirees who will need health care."

Allina is the second-largest nonprofit health care services provider in Minnesota. St. Thomas is the state's largest private university, with a large graduate business school and a new law school.

St. Thomas already offers a health care MBA, and the business school houses the university's Center for Health and Medical Affairs.

The two organizations would use clinics and hospitals in the Allina system, with a likely focus on Abbott Northwestern, as classrooms, and doctors and other clinicians would serve as faculty members.

The emphasis would be on primary care, much along the lines of the old-fashioned family doctor practice.

Minnesota currently has two medical schools: the University of Minnesota Academic Health Center in combination with the University of Minnesota Duluth, and the Mayo Clinic. The university is the largest, and last week graduated 220 doctors. Mayo graduates about 40 doctors a year.

Minnesota can use an additional medical school because the state proportionately graduates fewer doctors than its neighboring states, according to Allina's analysis of the market. Minnesota has a ratio of one doctor graduated for every 20,000 residents. Wisconsin's ratio is one doctor to 15,000 residents and Iowa's is one doctor for every 9,000 residents, Allina said.

The shortage of primary-care physicians can be attributed, in part, to the lure of higher-paid specialties such as cardiology and orthopedics. The median income for doctors in family practice is about $150,000 a year, about half of what specialists can earn.

It's difficult to lure primary care physicians to inner-city neighborhoods where a disproportionately high number of patients lack insurance, their medical problems are compounded by poverty or violence and where doctors are reimbursed through government programs that pay less than private insurance for standard procedures.

"We anticipate there will be a shortage of primary-care physicians, but we haven't yet concluded that adding another medical school will solve a problem created by very low reimbursement rates from Medicare, which drives the overall compensation package for primary care doctors," said Mary Brainerd, HealthPartners CEO.

And potential sources for financing medical education are dwindling largely because of federal cutbacks, said Mary Koppel, spokeswoman for the U's Academic Health Center.

"We have 154 years of experience we'd be more than happy to share. But the margins are small in all aspects of health care, and every source of funding in medical education is at stress. We're here as a resource for everyone, and I'm sure we can be of help during that [feasibility] phase of discussion."

The University of St. Thomas is an interesting institution. They recently started a Law School, that is already accredited, and have persuaded a very strong BigU law school faculty member to join them:

Paulsen leaving University of Minnesota:

After 16 years on the faculty of the law school, Mike Paulsen has announced he's joining the University of St. Thomas law faculty in Minneapolis starting this fall. He is a scholar of the first order, an irreplaceable colleague, and a personal friend. He will be greatly missed.

Michael S. Paulsen

McKnight Presidential Professor of Law and Public Policy, Briggs & Morgan Professor of Law, Associate Dean for Research and Scholarship
Northwestern University, B.A.
Yale University, M.A., J.D.

Perhaps BigU, even with 154 years of experience, can learn some things from the University of St. Thomas?

Ciao,

Bonzo

Oh Lord, It’s Hard to be Humble,
When You Have Ambitious Aspirations

By executive fiat Mr. Bonzo, as everyone at BigU, is driven to discover. His most recent discovery is the US News & World Report Rankings of America’s Best Colleges, version 2007. Alas, the rankings for public national universities are disturbing news for a BigU in the third year of our ten year march to greatness.

America’s Best Colleges 2007

1 Harvard University (MA)
1 Princeton University (NJ)
3 Yale University (CT).
4 University of Pennsylvania
5 Duke University (NC)
5 Stanford University (CA)
7 California Institute of Technology
7 Massachusetts Inst. of Technology
9 Columbia University (NY)
9 Dartmouth College (NH)
11 Washington University in St. Louis
12 Northwestern University (IL)
13 Cornell University (NY)
13 Johns Hopkins University (MD)
15 Brown University (RI)
15 University of Chicago
17 Rice University (TX)
18 University of Notre Dame (IN)
18 Vanderbilt University (TN)
20 Emory University (GA)
20 University of California – Berkeley *
22 Carnegie Mellon University (PA)
23 Georgetown University (DC)
23 University of Virginia *
25 Univ. of California – Los Angeles *
25 University of Michigan – Ann Arbor *
27 Tufts University (MA)
27 U. of North Carolina – Chapel Hill *
27 Wake Forest University (NC)
30 Univ. of Southern California
31 College of William and Mary (VA)*
32 Lehigh University (PA)
32 Univ. of California – San Diego *
34 Brandeis University (MA)
34 University of Rochester (NY)
34 Univ. of Wisconsin – Madison *
37 Case Western Reserve Univ. (OH)
37 Georgia Institute of Technology *
37 New York University
40 Boston College
40 University of California – Irvine *
42 U. of Illinois – Urbana - Champaign *
43 Rensselaer Polytechnic Inst. (NY)
43 Tulane University (LA)
45 Univ. of California – Santa Barbara *
45 University of Washington *
45 Yeshiva University (NY)
48 Pennsylvania State U. – University Park *
48 University of California – Davis *
50 Syracuse University (NY)
50 University of Florida *
52 University of Texas – Austin *
53 George Washington University (DC)
53 Worcester Polytechnic Inst. (MA)
55 Pepperdine University (CA)
55 Univ. of Maryland – College Park *
55 University of Miami (FL)
58 University of Georgia *
58 University of Pittsburgh *
60 Boston University
60 Ohio State University – Columbus *
60 Purdue Univ. – West Lafayette (IN)*
60 Rutgers – New Brunswick (NJ)*
60 Texas A&M Univ. – College Station *
60 University of Iowa *
66 Miami University – Oxford (OH)*
66 University of Delaware *
68 Fordham University (NY)
68 Univ. of California – Santa Cruz *
68 University of Connecticut *
71 Brigham Young Univ. – Provo (UT)
71 Southern Methodist University (TX)
71 Stevens Institute of Technology (NJ)
74 Indiana University – Bloomington *
74 Michigan State University *
74 SUNY – Binghamton *
74 Univ. of Minnesota – Twin Cities *
78 Baylor University (TX)
78 Clemson University (SC)*
78 North Carolina State U. – Raleigh *
78 St. Louis University
78 University of Colorado – Boulder *
78 Virginia Tech *
84 Clark University (MA)
85 American University (DC)
85 Auburn University (AL)*
85 Iowa State University *
85 Marquette University (WI)

Public Universities that are ahead of BigU are bolded*. Wisconsin has dropped one spot from last year and Minnesota has dropped several spots to be tied for 33rd in the public university category. The eleven BigTen schools, including Penn State and Northwestern, are in green. BigU is tied for last place in the BigTen with Indiana and Michigan State.

Now OurLeader and other BigU administrators can cry that the criteria used for these rankings is suspect and that their own numbers are a better method of ranking. But looking at the criteria used in the US News rankings, they don't seem particularly unusual or unfair to Mr. B. Somehow, using them, Wisconsin is 40 [sic] positions above us. And the majority of our competition in the BigTen beat us. With the exception of Northwestern, they all bear the same burden of being a state supported institution. How can this be? And let's face it - if a prospective student is going to be looking for ways to evaluate potential places to attend college, he or she would be foolish not to consider these rankings. They are readily available to prospective students - just google college rankings and see what pops up.

So Mr. B. concludes with his usual request to OurLeader and his functionaries. Please drop this "one of the top three public research universities in the world" stuff. You destroy all credibility when you speak this way. "In the world" reeks of hubris. We have a lot of important work at BigU that should have priority. You would be surprised at what will happen if you can come up with a scheme that the faculty can buy. Let's fix things that are obviously broken. Going on a Children's Crusade at this point is foolish.

"We're number 74!" Now that is a rallying cry. Or, perhaps "Tied for last in the Big Ten - Nowhere to go but up!"

There is obviously plenty we have to do before we worry about becoming one of the top three public research universities in the world. This ambitious aspirations business is a smokescreen. To even mention it, given the sad current state of affairs, is disgraceful.

Mr. Bonzo

How Do We Reward the Great Work of Geriatricians at BigU?
(We close the geriatrics division and they move to Johns Hopkins...)

From a recent New Yorker:

Annals of Medicine

The Way We Age Now
Medicine has increased the ranks of the elderly. Can it make old age any easier?

Atul Gawande in The New Yorker

April 30, 2007

Several years ago, researchers in St. Paul, Minnesota, identified five hundred and sixty-eight men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric specialists. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, ten per cent of the patients in both groups had died. But the patients who had seen a geriatrics team were a third less likely to become disabled and half as likely to develop depression. They were forty per cent less likely to require home health services.

Little of what the geriatricians had done was high-tech medicine: they didn’t do lung biopsies or back surgery or PET scans. Instead, they simplified medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe.

How do we reward this kind of work? Chad Boult, who was the lead investigator of the St. Paul study and a geriatrician at the University of Minnesota, can tell you. A few months after he published his study, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

“The university said that it simply could not sustain the financial losses,” Boult said from Baltimore, where he is now a professor at the Johns Hopkins Bloomberg School of Public Health.

And we compete with Hopkins?

As OurLeader said in this year's state of the university address:

"The inscription on Northrop captures this beautifully: It expresses the spirit of a great University, its commitment to excellence, and its service to the greater good."

Walking the talk is long overdue at BigU.

Bonzo

A Less Than Enthusiastic Response to BigU’s Becoming GreatBigU?

Mr. B. has commented before on the lack of faculty enthusiasm concerning the ambitious aspirations of OurLeader for BigU to become one of the top three public research universities in the world [sic]...

A recent Daily article indicates that a large percentage of the faculty are not drinking the Kool-Aid. The reaction of the Daily and of the university’s spokesperson are quite instructive. See the quotes below in red font. This University spinmeister clearly has what it takes to move on to a place where his extraordinary skills would have an even greater impact. Since there has been such a rapid turnover of spinmeisters lately in the White House, how about a job there?

Note also the enthusiastic rate of participation in this survey: “for an overall survey response rate of 17.35 percent.” This number is telling because the overwhelming majority of people apparently don’t even feel strongly enough about what is going on (or are simply too disgusted) to even bother to respond.

From the Daily:

May 2, 2007


Survey denotes divided campus
A Daily poll showed mixed opinions on the University's strategic positioning progress.

By Conrad Wilson, Tiff Clements

Two years after the Board of Regents unanimously approved a revamp of the University, students and faculty say they are skeptical of the progress made.

The University administration's goal to be one of the top-three public research institutions in the world has divided support, according to a poll conducted by The Minnesota Daily.

Overall, students were more confident than faculty about the likelihood of the administration to implement the strategic plan in the next decade. Where nearly 50 percent of students polled said they were certain the goal would be met, calling it extremely or very likely, only 36 percent of faculty responded with such optimism.

University spokesman Dan Wolter said he sees the numbers as positive, grouping together respondents who said it was extremely, very and somewhat likely the University would reach its goal in 10 years.

"I think having more than 70 percent think this top-three goal is realistic and doable is a very positive sign," he said.

Hmm, and the US is winning the war in Iraq. There MUST be a place in the White House for this creative spinmeister.

Support from faculty, staff and students will be crucial to achieving this goal, Wolter said.

"Continued engagement and interest in this is going to be very critical."

Regent Patricia Simmons said faculty skepticism might stem from variables outside the University's control, like state funding and competition with other universities.

"I don't think this reflects support as much as caution," she said. "The faculty would and should respect the fact that this is an aspirational goal and there are a lot of factors involved that all have to come together."

Once again Mr. B. implores a member of the Board of Regents to understand that some faculty consider this top three business to be an insult to anyone at BigU who actually knows what a "top three university" is. Some of us have been educated at such an institution or done sabbaticals there. Crying that it is just "aspirational" doesn't help matters. Please stop doing this. The old Ken Keller phrase "commitment to focus" comes to mind and OurLeader and the Board of Regents should start thinking about it. Please fix what is broken, then let's talk.

Minnesota Student Association President Max Page said strategic positioning isn't a huge priority for the organization.

"I know the administration has been working on implementing some of the strategies," Page said. "It's harder to fit students into what they are doing."

Opinion is divided over whether faculty's focus on teaching would change under the plan, according to the Daily poll. Although 25 percent of respondents anticipate no change, 38 percent said they expect faculty focus on teaching to decrease, while 36 percent indicated an increase. Ninety-six percent expect faculty focus on research to increase.

The quality of undergraduate education was also divided. Forty-seven percent said the quality of undergraduate education would increase, while 28 percent predicted a decrease, according to the poll. Twenty-five percent said there would be no change.

The University Futures Survey was conducted from Feb. 23 to Feb. 27, 2007. 347 students, faculty and staff responded to the surveys for an overall survey response rate of 17.35 percent. The margin of error associated with this sample is plus or minus 4.78 percent with a 95 percent confidence interval (reported as 5 percent for simplicity).

Communication studies associate professor Kirt Wilson, who sits on the strategic positioning Academic Task Force for Faculty Culture, said as the University moves forward with its process, it will need to make sure it hires faculty with strong research and teaching potential.

"People always seem to think that to focus more on research means to take away from teaching," he said. "I think that is a false dichotomy."

As a mere 'umble scientist, let me try to communicate this way:

There is a finite amount of time that faculty can work per day. Let us call this 1 for simplicity. Let T be the fraction devoted to teaching and R be the fraction devoted to research:

R + T = 1

Therefore, if R increases, then T decreases. At least on the planets in my universe.

"When people say (University of California) Berkeley, University of Michigan," he said, "will the University of Minnesota be the next thing that comes out of people's mouths?"

I assume this is a rhetorical question. Here's another one. Where are Cambridge and Oxford in this list of three, since we are talking about "the whole world?"

Ciao,

Bonzo

If You Build It, Grants Will Come?

Or, Could Someone at BigU Please Be Honest and Responsible About Expansion of Biomedical Research?

It’s nice to see that the direct phone line between Morrill Hall and the Strib is still working. Mr. B. has previously commented on the attention that should be paid to claims of millions of dollars in research funding that will be dropping like manna from heaven if only BigU will throw up multiple buildings and hire new faculty, even though we can’t keep the ones we’ve got...

See: Trees Do Not Grow to the Sky or, Why the State Legislature Should Not Write a Blank Check to BigU for Biomedical Research Buildings

From the StarTribune

Last update: May 01, 2007 – 6:04 PM

Editorial: Put research buildings on separate track
For new industry's sake, let go of legislative control.

Minnesota has the ingredients to be a biomedical science leader -- world-class medicine, innovative agriculture and a major research university. What's needed is a way to bring those ingredients together ASAP for some creative synergy.

That's what Frank Cerra aims to accomplish as senior vice president of the University of Minnesota's Academic Health Center. He has a solid plan: Create a biosciences zone on the Twin Cities campus, build state-of-the art facilities, hire 200 top faculty and set out to win upwards of $100 million a year in grants for research that cures disease -- and creates jobs.

Uh, huh… And just exactly how much is it going to cost to hire those 200 faculty and provide them with start up packages? Let’s see a real analysis here, please. It is not just the buildings - it is the money to make them functional. You can just see how this is going to work. Oh, state legislature, you gave us the money for the buildings and now we need the money to hire the people to put in them. And what if that doesn’t happen?

It's ambitious but achievable [sic] -- provided Gov. Tim Pawlenty and the Legislature get behind it. Authorizing one building every few years, as the political tides permit, won't turn the heads of the high-caliber faculty Cerra is courting. An upfront commitment for five new buildings will.

My goodness, "ambitious but achievable" - that phrase seems familiar to Mr. B. Let's see what a little googling will do. Would you believe: " The plan is ambitious but achievable because the momentum for change is ... " taken directly from OurLeaders UM2005 Annual Report. Surely this must be a coincidence? Have the Strib editorial writers become Kool-Aid drinkers?

Cerra explains: "Recruiting every one of these faculty is a three- or four-year effort. We compete with Harvard, [Johns] Hopkins, Michigan, the California schools. It's a seller's market. These faculty want the best facilities to do their work in. That's very important to them. What do I show them?"

Excuse me, sir, we compete with Harvard, Johns Hopkins, Michigan, the California schools? Have you been sampling the Kool-Aid, too? Sorry Dr. Cerra, let’s get real here. Have a look at the latest rankings in US News & World Report and see what institutions are actually our competitors. See: "Speaking of Rankings." As far as I can tell the traffic between BigU and the above institutions has only been one way. (Chip Bolman -> Harvard, David Sherman -> Michigan, Chad Boult -> Hopkins...) Fortunately for BigU the California schools have a little problem with the cost of real estate. Californians can sell their houses, move to Minnesota, and buy a McMansion - there are a few examples of this type known to Mr. Bonzo.

The state ought to show them a new, fast-track process to authorize bond issues for four new buildings (a fifth is already under construction), for a total of $235 million from the state and $60 million from the university. The university's proposal would bypass the Legislature's usual bonding process. It would create a separate governing board, empowered to issue those bonds as needed to open one major building every two years.

Sorry, but there is a lot more at the U than biomedical research. Why can’t the biomedical researchers compete with the rest of the campus programs and if their needs are legitimate and overwhelming AND the money is available to fund the faculty to go in the building without crippling the rest of the university, then maybe we can talk about it. A blank check for this purpose is not appropriate.

This idea is making its second appearance at the Legislature. This year, as last, it has Senate support. But it has run into resistance in the House from legislators reluctant to let go of their grip on the bonding purse strings. They need a gubernatorial push.

Perhaps it is not just the bonding purse strings. Might it be fiscal responsibility? I realize that to some BigU administrators this may be a novel concept... Some responsible people in the state legislature may have realized that new buildings will also require additional funds to fill them with faculty and equipment. Sort of like a new stadium will require expensive new coaches to fill the stadium. The march to greatness has required an expensive advertising campaign, Driven to Discover, and the road to GreatBigU will need to be paved with gold. Do you really believe that OurGov TeePaw, Republican vice presidential candidate wannabe, is going to allow taxes to be raised so that BigU will have enough money in the future for ambitious aspirations? If so, then I have a nice maroon and gold Yugo I'd like to sell to you.

On Monday, the Legislature sent a $334 million building projects bill to the governor that did not include the Biomedical Sciences Research Facility Authority. Pawlenty vetoed that bill yesterday, saying it was too large. But he also called the idea of a streamlined bonding process for biosciences buildings "a good idea" that "either this year or next year should go ahead." States including Arizona, New York, Texas and Wisconsin have recently announced similar biosciences building plans. If Pawlenty wants to keep Minnesota in the running for this new industry, next year may be too late.

Uh, huh… Mr. B. suggests an honest conversation about the building plans AND the additional money that is going to be required to hire the faculty and buy the equipment to fill them as well as an honest estimate of how much money this spending-spree will net, particularly because of the currently disastrous NIH funding situation. NIH is the source of the bulk of funding for biomedical research. If a case is to be made then let’s be responsible and honest about it, at least.

An amazed Bonzo is disappointed with the Strib for having taken a position that does not seem to be in the best interest of BigU or ColdState. Rather than cribbing from the University for this editorial, perhaps they should do an independent analysis of the real cost of hiring hundreds of new faculty and a realistic estimate of the amount of NIH funds that could reasonably be expected from the proposed building spree.

It is time for BigU's administration to start walking the talk of responsible leadership and frank discussion.

Mr. Bonzo

ps: If we run out of Coke and Pepsi at BigU, at least there is apparently still a lot of Kool-Aid.