Our Vision Is Marking a Trail

New England's own Ralph Waldo Emerson wrote: "Do not go where the path may lead; go instead where there is no path, and leave a trail." I believe that HMS and the Harvard Medical community are here to do just that‹not only to excel at whatever we undertake today, but to create, innovate, and lead the way to the realization of tomorrow's dreams.

As I look back at plans we have laid out over the past few years, I am pleased to say we are succeeding. In research, education, and outreach to those around us, we have been innovators of new ways of thinking and have created new opportunities. We are indeed advancing the HMS mission:

To create and nurture a community of the best people committed to leadership in alleviating human suffering caused by disease.

Research Collaborations

We talked about an expanded campus for HMS, one that would span Boston's Longwood Avenue with a North Quad anchored by a new research building. That 550,000-square-foot building is now a reality, fully occupied by scientists from the School's Pathology and Genetics departments who moved across Longwood, as well as HMS faculty from hospital-based departments who are involved in related work. We hoped to spark scientific collaboration via colocation, and indeed, we are already seeing positive results.

An informal review of faculty in Pathology found three significant new collaborations between members of the department and their hospital colleagues who are now often just a floor away or down the hall. Their new research delves into how papillomavirus triggers cancer, the cellular events that lead to neurodegenerative diseases, and the signaling pathways that control telomeres‹the tips of chromosomes thought to hold secrets to aging and cancer.

In the Genetics Department, one young faculty member has already developed three collaborations with hospital colleagues. In less than a year, proximity in that building has helped him create a collaboration on brain development with a team from Beth Israel Deaconess Medical Center located in the adjoining Harvard Institutes of Medicine. He has begun work on a new way to create a mouse model for gene recombination with a researcher from Brigham and Women's Hospital working one floor above him, and he has teamed up with another BWH faculty member working three floors above to better understand the genetics of multiple sclerosis.

Similarly, space opened up by relocating two departments from the South Quad has allowed the remaining departments and our new initiatives to bring in major new recruits. Our year-old Center for Molecular and Cellular Dynamics was able to hire a talented young faculty member to join its team of structural biologists.

The Department of Neurobiology was able to attract one of the most sought-after junior faculty members in the country to join the department and start to bridge traditional neurobiology and the new initiatives in systems neuroscience that are being launched here and across the Charles by the Harvard Faculty of Arts and Sciences.

The newly open space allowed our Department of Microbiology and Molecular Genetics to recruit a top senior faculty member who will help the department advance our new initiative in chemical biology, an initiative that is actively developing four new core facilities that would not have been possible in the "land-locked" single Quad.

The new Department of Systems Biology that we launched in September 2003 moved into new quarters in October 2004, in the former home of our Genetics Department in the Warren Alpert Building. With the promise of this new space, the three founding members of the department have been able to recruit three new senior and two new junior faculty members, one of whom was named a MacArthur fellow and awarded one of this year¹s "genius" grants.

We have consistently predicted that much of the best new science will be interinstitutional, and two such initiatives have shown major progress this year. The Broad Institute, a collaboration of Harvard, MIT, and several of the Harvard hospitals, was launched in 2003 with a $100 million gift from Eli and Edythe Broad. The institute broke ground on a new building this year, but even in temporary quarters it has started to amass impressive scientific results and research contracts, including a $75 million federal grant to sequence the genomes of more than 100 microorganisms.

Early in 2004 we launched the Harvard Stem Cell Institute, and within months, some 300 researchers from Cambridge, the Quad, and our hospitals had attended the institute¹s monthly lab meetings. By the fall of 2004, more than 170 sets of stem cells from the 17 new cell lines isolated at the institute had been shipped to some 70 researchers around the world.

Many HMS faculty members are playing key roles in a truly historic interinstitutional initiative‹the planning for Harvard's new Allston campus on a land footprint in Boston that is larger than Harvard's Cambridge campus. Faculty committees have defined 18 areas of science ripe for investment that could benefit from new facilities in Allston. Of these, 13 currently have active participation from HMS faculty, with four largely developed by our hospital-based faculty. These programs involve metabolism and obesity, creating an engine for translational research, a core of translational immunology, and health systems design.

Systems for Education

Just as we have pushed the boundaries of new research, we have pushed equally hard to make changes in our education systems. We have launched three new degree programs, made significant leadership changes, and after two years of study, launched the opening phases of the most dramatic curriculum reform of our MD program in 20 years.

This year we will enroll the first students in a five-year MD­MBA program that is innovative in its focus on leadership. Also this year, we will be enrolling students in two new PhD programs. One, in chemical biology, is intended to give students trained as undergrads in biology or chemistry a firmer grounding in the other discipline and in the new ways we are using chemistry as a tool for biological discovery. The second degree, in systems biology, will seek to take biologists and steep them in the more quantitative sciences of math, computer science, and the physics of imaging, as well as taking students from those physical sciences and helping them embrace biological experimentation.

We have also named new leadership for four of our five existing PhD programs. David Knipe now leads the Program in Virology; Gary Yellen, the Program in Neuroscience; Christopher A. Walsh, the MD­PhD program; and Robert Kingston, the Biological and Biomedical Sciences Program. Hidde Ploegh continues to head the PhD Program in Immunology.

In our MD program, Associate Dean for Student Affairs Nancy Oriol has been promoted to Dean for Students with a greatly expanded portfolio, and Peabody Society Master Ron Arky has been named to the newly created position of Dean for Curriculum. In addition, we have undertaken major administrative restructuring throughout our Program in Medical Education to accommodate the changes that we expect to come from our curriculum reform initiative. The reforms envisioned now could have a greater impact on medical education than the New Pathway reforms of 1985.

The various medical education reform committees produced a blueprint for a new curriculum that was distributed to faculty for review in October 2004. We encourage and look forward to their suggestions of ways to improve this blueprint and to implement it effectively. Some of the reforms outlined so far are being tested as pilots, and more extensive pilots will begin in the fall of 2005. Many will begin to be implemented in the fall of 2006.

The reform initiative will examine the feasibility of maintaining the best components of the case-based, small-group system of the New Pathway while seeking to better integrate the preclinical and clinical years. The current proposal starts for the first time with two weeks or more of immersion in the full scope of medicine, shortens to a year and a half the time allotted for preclinical study of basic science, but keeps some time for basic science during clinical training. Clinical training will start earlier and include more longitudinal experiences that will mix inpatient and ambulatory care. Throughout the four years there is built-in time for "areas of concentration" to allow in-depth coursework as well as in-depth independent work in areas ranging from basic biomedical research to patient-oriented research, social medicine, and global health.

One pilot program that began in July 2004 combines all the third-year core clerkships into one year-long longitudinal clerkship. Initially, eight students are spending their year at Cambridge and Mount Auburn hospitals and their affiliated clinics and community health centers, following a designated set of patients through all of the care they receive

In the Community

While these innovations in research and education are central to our mission, this mission would not be fulfilled if we did not remain true to our commitment to the community around us. I am proud that Harvard Medical faculty, students, and staff continue to be actively involved in the many extensive and broad-based programs in our local community and around the world. In October of 2004, we published a directory of programs that we provide to area residents. I am pleased to say there are more than 270 efforts listed, ranging from after-school and youth-mentoring programs to health education and direct care for underserved populations.

We are using the new technology of the World Wide Web to reach out to people everywhere with a new consumer information site on our home page and via new online continuing medical education classes that are being offered to physicians in developing countries.

Our Department of Social Medicine and our Division of AIDS are helping local providers deliver therapy for HIV, TB, and other intractable illnesses around the globe. In Vietnam alone, the Division of AIDS has trained more than 300 physicians in the contemporary use of antiretroviral therapy. Harvard Medical International is working in 26 countries on 42 programs, ranging from HIV education and broad continuing medical education to health system quality control initiatives.

It is gratifying to look back and see how our community has come together, created a vision of things that could be done, and developed strategies for making them happen. Now we are seeing the efforts begin to bear tangible results. We have marked some new trails and should be proud of what we have accomplished together. --Joseph B. Martin, MD, PhD