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Dr. Lee Goldman, Columbia University’s executive vice president for health and biomedical sciences and dean of the faculties of health sciences and medicine. PHOTO: Mike Fitelson
Dr. Lee Goldman is Columbia University's executive vice president for health and biomedical sciences and dean of the faculties of health sciences and medicine. Among his responsibilities is overseeing the campus’ biomedical research budget, which has grown from $324 million ten years ago to $638 million in the last fiscal year. In looking to the future, Dr. Goldman sees a very clear role for the university to play in the community as a partner, economic engine, and ambassador.
Questions and answers have been condensed and edited based on an interview between Dr. Lee Goldman and Mike Fitelson on Thu., Oct. 28, 2010.
Manhattan Times: At the Chamber of Commerce breakfast [in January 2010], you outlined plans to transform the Medical Campus around W. 168th Street and Haven Avenue into more of a plaza setting.
Dr. Goldman: We’re still in the very early phases, but we just had a major donation for a new a medical education building which we hope to build on Haven Avenue on property we already own. It’s as of right, so we’re not looking for exceptions or variances.
The concept is that if I put in a medical education building near where the [university apartment] towers are, we would then be creating more foot traffic. It’s my view that the more people that we have walking around the neighborhood, the safer the neighborhood becomes and the more vibrant it becomes.
As you know many of our buildings look like fortresses. They’re not welcoming to the neighborhood; they don’t make our patients, students and faculty feel as much a part of the neighborhood as we would like them to be. We’re hoping to look at ways that some of these buildings could be more open to the neighborhood and feel more a part of all the foot traffic, which includes people who live in the neighborhood, patients and families who come visit here.
Manhattan Times: Do you have a sense of how employment at the medical center will change over the next 10 years?
Dr. Goldman: We’re growing and I hope we’ll continue to grow and as long as we continue to grow, we create more jobs of all sorts. Without getting into all the details, of course we create jobs with full benefits. This is not like McDonald’s, no offense. The more we are able to continue to upgrade our facilities, grow our research programs, grow our clinical programs: that brings people to the neighborhood. It creates jobs for us, but also if we increase the number of people who get off the subway and walk down the street, it’s more business for every store here in the neighborhood.
Manhattan Times: Do you have a sense of the types of jobs that will be created at the medical center?
Dr. Goldman: If we grow we will need more people from custodians to security guards. But the kinds of jobs we create are also jobs with technical requirements; people who’ve got a high school degree, have some kind of technical training. If we’re growing our research programs for example, which is one of the major ways that we do grow, we need people who can interview patients, people who can serve as research technicians and assistants in the laboratory, people who can enter data into the computer; all those sorts of things. If we continue to grow our clinical programs, we expect to need people who can serve as nurses, patient aides, receptionists, etc. So I think there is a range of jobs, but we are a university and so the jobs tilt toward the technical.
We’ve been growing at a rate of three to five percent per year overall. We’re really tied into two major national trends. One is health care and health insurance and the second is research budgets, especially the National Institutes of Health (NIH). If the NIH budget continues to grow, by definition we continue to grow because we get a little over one percent [of the total budget].
Manhattan Times: Do you see the role of the university in Northern Manhattan changing in the next ten years?
Dr. Goldman: I see us doing more of the same, hopefully continuing to do it better.
I don’t see our student population growing tremendously in size. I do see a student population that increasingly is interested in the neighborhood, doesn’t see itself as locked up in dormitories, likes the fact the neighborhood is becoming increasingly vibrant and would like it to be even more so. Some of those people live in dorms that we have; others are here during the day; others would like to rent apartments in the neighborhood. In terms of the vibrancy of the neighborhood, these are all graduate students. They bring a lot of energy.
Part of our commitment to the neighborhood is we want young women to feel safe in the neighborhood. We want this to be a place where parents don’t worry that their 20-somethings are walking around the neighborhood at night. This is where we and the neighborhood are very much in sync. The more life, vibrancy, street traffic, safety, things we have the better it is for everyone. I was coming back from somewhere downtown once and when we were at 110th or 112th [Street] and Amsterdam [Avenue] and I saw – this was about 10 o’clock at night – there was a woman pushing a baby carriage across the street. I said “I want Washington Heights to be a place where people can feel safe pushing a baby carriage down the street at 10:30 at night.”
It’s a wonderful neighborhood with a lot of history and a lot of potential energy and I think whatever we can, we’ll do to help make it even better.
I don’t want to diminish any of the clinical components of what we do. All the doctors who are here [on the medical campus] are actually employed by the university. So when we admit patients to the hospital, the doctors are actually Columbia doctors. Caring for people in this community – our faculty takes great pride in that. I always talk about it. The line I use repeatedly is that our doctors are proud to take care of people who are vulnerable and have no other options as well as people who could afford every option in the world. Our doctors really like being in a setting where they do both. People choose to come here from all over the world and they get care side-by-side with people from the neighborhood, some of whom, because of their circumstances, really have no other option.
Manhattan Times: Is research the medical campus’ fasted growing segment?
Dr. Goldman: Yes. Ten years ago our research funding across the medical center, all sources, was $324 million dollars. In FY10, which just finished for us July 1, it was $638 million dollars – roughly slightly less than 100 percent growth over ten years. Not every dollar is spent here [on the Washington Heights campus].
Columbia is a great research university and the College of Physicians & Surgeons, The Mailman School of Public Health, School of Nursing, and the College of Dental Medicine are all great research schools. We train students today, but we are different than many other hospitals or even medical schools who see themselves primarily living in the present; we’re always trying to create the future. So research is a critical part of what we do. The kinds of students we attract come here because they want to learn from people who are pushing the envelope.
An example of that is a big population-based study that Richard Mayeaux has in dementia, following people here in the community with serial examinations and tests to see who develops mental decline, to look at the predictors of that, genetics of that. He’s had very good relations with the community.
When people are part of a study like this it also brings them medical care. An important thing to emphasize for the community is that there is a remarkable amount of medical data showing that if you are in a longitudinal study or in the placebo arm of a clinical trial, you do better than the rest of the people who aren’t part of the study because you’re getting regular care.
That connection to medical care, even though the study itself may not do anything for you, just the fact that you’re connected leads to clearly better outcomes then people who aren’t connected.
They find things that otherwise wouldn’t be found and give you advice you otherwise wouldn’t get.
Manhattan Times: What are the university’s primary areas of research?
Dr. Goldman: We do everything. We do children, we do adults, we do cancer, we do heart disease, we do orthopedics, we do eye. So in the city, there’s Sloan Kettering, which only does cancer. In some cities, the children’s hospital only does children. But we do everything. We do everything on a national-class level.
Manhattan Times: What have been the biggest medical breakthroughs in the last 10 years due to research?
Dr. Goldman: The biggest improvements over the last ten years, 20 years, have been in stroke and heart disease. So your age-adjusted risk for dying from stroke is about 20 percent of what it was 30 years ago. The age-adjusted risk of dying from heart disease is down by about 70 percent. And that’s in part because of blood pressure control, but also because of lower cholesterol levels.
The third [area of improvement] would be the difference in neo-natal care. You may or may not be old enough to remember the birth of Patrick Kennedy, the second son of President John F. and Jackie Kennedy, who was born while he was in the White House and then died of what was called Hyaline Membrane Disease. He was born prematurely, his lungs weren’t fully developed and he died on the third day. The likelihood that a baby like that would die today is almost zero.
Manhattan Times: Where will the biggest impact be made going forward?
Dr. Goldman: The biggest challenges going forward would be less in the longevity than in improving function and quality of life in people with chronic diseases. If you look at what happens to us as we get old, we get chronic diseases, and we become less mobile. A whole bunch of things that kill elderly people may be a normal function of that gradual increase in frailty. In the future we will be able to continue to maintain function as we get older. And we are already seeing this. We’ve seen 80 year olds who jog and we’ve seen 80 year olds who can’t walk.
Will we have a cure for Alzheimer’s Disease [in the next 10 years]? I don’t know. Will we have a cure for various forms of cancer? I don’t know. Those are all things on the horizon. But from my perspective, we can continue to push the envelope on healthy aging.
I tell a story. My grandfather was a dentist. When he turned 65, he closed his practice and mailed his driver’s license back to the state of Pennsylvania. He declared himself an old man. Now he did live into his mid 80s, but he lived the next 20 some odd years as an old man. By definition, he was alive, but gave up his practice. That’s not the way we think of turning 65 anymore. The more we can do things in medicine, which range from orthopedics to physical therapy to psychiatry to all these things, the more we can continue to push that envelope. I don’t think most people at age 65 would mail their driver’s license into the state anymore. I see the tremendous progress to be made here.
The motto of the diabetes center is “Care Until the Cure.” It’s very important to emphasize that there are lots of things we can do to make people’s lives better in the reality and terms of their adaptation to it, even as we try to cure things. We know the cures come at unpredictable times in ways that we might not be able to foresee. So who would have thought that ulcers would be caused by bacteria and cured by antibiotics? You just know no one ever would have dreamed that. Twenty years ago we did not think that most neurological diseases were caused by misfolded proteins in our brains. Things like that that come along and change the way we understand health and disease. We’ll be at the forefront, but I think we have to be careful about too much hype.
Manhattan Times: What is the biggest problem facing research now?
Dr. Goldman: The biggest problem in all honesty is that the NIH has grown at less than the rate of inflation over the past seven or eight years. It’s very hard to sustain a vibrant research enterprise when each year is unpredictable in terms of national funding. We don’t have trouble recruiting top talent; we don’t have trouble, problems with their energy and enthusiasm. The main issue here really is one of the funding. The stimulus package provided additional resources. We actually did extremely well in those competitions and we got more than our usual 1.1 percent. That’s what keeps me up at night, worrying about the future of that budget.
I understand that from a societal perspective, [our funding] is competing with other ways we can spend our tax dollars. Obviously I’m biased in that I think in terms of the kinds of jobs created and also in terms of the knowledge and the health benefits [of investing in biomedical research] is really extraordinary. There are other good investments as well. But research really is creating a public good. I think the U.S. has benefited enormously in a variety of ways by being on the leading edge in terms of medical research, which brings recognition from all over the world.
Manhattan Times: A lot of people who are not familiar with our community ask: “Is Washington Heights safe?” The Columbia staff, faculty, and students who are here every day know that Washington Heights is on an upswing. To some degree they are community ambassadors, educating outsiders – who come from all over the world for all kinds of reasons – about what’s happening here.
Dr. Goldman: As we said earlier it goes back to what we started talking about at the Chamber of Commerce; we see ourselves as partners with a wide range of people who will make this a nicer neighborhood.
We can also say that making this a nicer neighborhood doesn’t mean we move in new people and move out old people. It means that it would be really wonderful if, as the people who live here become more prosperous, this is the kind of neighborhood they want to stay in. Not everyone will want to stay here, but one of the histories of Washington Heights has been the periodic turnover of new ethnic groups. In some ways that’s wonderful and in other ways you would like it to be a neighborhood that retains people, [so that] it’s not seen as simply a stepping stone to a better neighborhood.
You want a neighborhood that, as your lot improves, the neighborhood gets better, grows with you. And that’s the kind of neighborhood we want to be.
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