Haile Prized

First published June 2003

Universities, like most other organizations, have strata in which workis conducted, decisions made and professional lives led in blissful isolation from the larger system. Occasionally, however, a leader emerges who, by virtue of bringing consciousness and conscience to this organism, makes it aware of its higher and better self. For the last decade, the UCSF School of Medicine has enjoyed such leadership from Haile Debas, dean, surgeon and humanist, who among many other accomplishments will long be remembered for having served in 1997 as both dean and university chancellor simultaneously.

Debas' career reflects his international perspective and scientific acumen: Born in Asmara, Eritrea, he trained as an undergraduate in Addis Ababa, Ethiopia, before receiving his medical degree from McGill University in 1963. He came to UCSF in 1987 as chair of the department of surgery after training at the University of British Columbia (UBC), Scotland and UCLA. He practiced surgery in the Yukon Territories before serving on the faculty at UBC, UCLA and the University of Washington. Over the course of his career, Debas has achieved national recognition as a gastrointestinal investigator and, as stated in his official biography, has "made original contributions to the physiology, biochemistry and pathophysiology of gastrointestinal peptide hormones." He is a member of the Institute of Medicine and the National Academy of Sciences as well as a fellow of the American Academy of Arts and Sciences. He has also served on many boards and associations, often as the president. He is the current chair of the Council of Deans of the Association of e` Medical Colleges.

Yet impressive as these achievements are, they do not exactly capture the spirit of the man, who has employed wit, warmth and no small amount of wizardry to shape the School of Medicine -- not so much in his own image as in service to a single idea: that all people matter. Indeed, if there is a single statement that captures Debas' philosophy, it is his oft-quoted remark that he wanted UCSF to be known as much "for caring as curing."

Now, as he prepares to exit the office of dean to devote time to the study and solution of international public health problems, Debas shares some thoughts about his tenure and his legacy with UCSF Magazine.

What qualities make a good leader?
First, you need a vision. Second, you can't allow yourself to become so consumed with details that you miss the big picture. You also need to accept the fact that you can't know everything, that there are people around you who know more. That helps to build a team spirit. You must be up-front with everyone, too, even when the issues are difficult. Hidden agendas undermine collective wisdom and trust. And you need both to create the kind of fantastic dynamic that we have here at UCSF. Lastly, you must keep your word. This is especially important when you're recruiting someone. It also helps if you're easy to get along with. I think I am.

What constitutes this "fantastic dynamic" at UCSF? Is it something tangible or just self-congratulatory?
It's very real. We like to say that UCSF has an interdisciplinary and collegial culture. I know it sounds hackneyed, but it's true. People really talk to each other here. They work together. Our basic science community is a model of this kind of collaboration; the neighborhoods at Mission Bay [clustered laboratories reflecting common interests] are tangible examples of this thinking. San Francisco itself is also part of the equation. Even with the high cost of almost everything, it is a fantastic place to live. Because people are happy to be here, I think that makes them more productive. It also makes it harder for other institutions to lure away our faculty. But in the end, I think what matters most about the dynamic is how it endures. Some of our competitors make a habit of trying to recruit "big names." We have our share of big names at UCSF, but our recruitment strategy has always been to find young people with great potential and to grow and nurture them. That is how we replenish our leadership from within and ensure innovation.

Have the changes in the health care landscape altered the pace of innovation, and perhaps even eroded the stature of academic health sciences centers such as UCSF?
Yes, there have been great changes. But the pace of discovery has not lessened here, and UCSF remains a premier institution full of hardworking, concerned and brilliant people. The most important change, of course, has been managed care. It was very big on the West Coast first, and particularly in San Francisco. It took control of medicine away from the doctors, hospitals and nurses and put it in the hands of health maintenance organizations. As a consequence, the number of hospital beds and hospitalizations began to decrease significantly even in the early 1990s. That accelerated with the failure of the Clinton health care insurance plan. Health care was left to the markets to manage. We have learned the hard lesson that the market cannot manage health care; it's unbelievable that we allow the health of people to be traded on Wall Street every day. There also is far more paperwork. There are legislative mandates. There is the threat or reality of audits, low reimbursements, dislocation of referral patterns, disruption of teaching…the list is very long.

Have these changes resulted in any positive consequences?
There is more accountability and more interest in following outcomes, which are both important. Managed care also contributed to the rise of the outpatient setting as both a teaching and a care site. This has been beneficial in some ways, not so helpful in others. But in reality, we are already living in and adapting to a post-managed care world.

How so?
We used to make clinical decisions based solely upon our experience. That was followed by a period when we made decisions based upon experience and managed care regulations. Now we are starting to use the evidence from evidence-based outcomes to guide us. Having all this information available in databases -- including those about medical mistakes and the proven benefits of interdisciplinary teams -- for the first time will be the initial step. As we do more evidence-controlled clinical trials with statistical rigor and incorporate more information technology into our health care system, standards of care will shift. Doctors will be judged on the comparative outcome of their work, and not on the reimbursement decisions of insurance providers.

The human genome project will also eventually make it possible to create 5- to 10-year patient plans. There are about 20 illnesses -- cancer, diabetes, cardiovascular disease, for example -- that consume about 80 percent of every health care dollar. We now know genetic predisposition factors, so why wait 20 to 30 years until a patient gets sick? We can review genetic factors and project a person's health. The future of health care will be prospective. That is a very different kind of "managed care" from today's managed care.

There have been many changes in the School of Medicine during your decade as dean. What are the most significant?
The word "School" is key. When I came to UCSF 16 years ago, there was very little in the educational portfolio of the School. After I became dean, we made a strategic decision to create new medical education positions and to support them with a real budget. As a result, over the last 10 years, there has been a resurgence in curricular reform and a recognition that the UCSF School of Medicine is one of the most innovative education centers in the country. My role has been to lead this reform, to champion it and to make it an absolute priority. Not everyone in the School was happy about it, of course; there are a lot of people who don't like change. I always spoke to them truthfully about my intentions so that there were no surprises.

That's true about my interest in social and behavioral sciences. UCSF has always been basic- science intensive. But we also have a remarkable group of social scientists whose work in areas like policy, economics and behavior has led to an evolution in how scientific expertise should be brought to bear against disease. That's why I am so enthusiastic about the four-year-old Center for Health and Community, which brings all these scientists together under a single umbrella. I'm always reminded of what the director of the Center, Nancy Adler, says: no matter how much we spend on high- tech medicine, 60 percent of all deaths are caused by social, behavioral or environmental factors.

The AIDS Research Institute is another umbrella organization that has brought together cutting-edge scientists of all kinds and really restored our primacy in the AIDS research arena. I hope for the same kind of leadership from the Institute for Global Health (IGH), started by Richard Feachem, who is now on leave as an Undersecretary General at the United Nations and the executive director of the Global Fund to Fight AIDS, Malaria and Tuberculosis. It made sense for the IGH to take root at a place like UCSF because universities like this one have a responsibility for advancing public health in the broadest definition of the term. That's also true for the Wheeler Center for the Neurobiology of Addiction. Addiction is an enormous medical and social problem and finding a solution requires bringing together researchers who are looking at unique parts of the addictive process. That is the essence of the Wheeler Center.

Your interest in complementary medicine was a break with UCSF tradition. Does your African heritage make you more willing to accept alternative approaches to medical problems?
Despite what some might want to believe, there were no African shamans in my family; in fact, I am the exact opposite of that tradition. I'm a surgeon. But I'm also a listener, and I think we have to listen when the public is telling us something. When it comes to complementary medicine, the message is very clear. We -- and by that I mean the medical profession -- are missing something. We're not giving the public what they want. We're too self-absorbed, too interested in our own science. Why else would the American people be spending $27 billion out of pocket on complementary medicine every year?

That's why I have such high hopes for the Osher Center for Integrative Medicine. Its goal is to examine different complementary approaches with an open mind and to apply scientific rigor to the examination of their efficacy.

We also have recruited fantastic people. In particular, with the arrival of Abul Abbas and Jeffrey Bluestone, together with the superb scientists already here, I think our immunology program is now about the best in the country.

Are the low points of your tenure as easy to list?
I'm not sure "easy" is the word I would use. There is one low point, and it is well known. I supported the UCSF-Stanford merger because I thought it was the best response to the disruptions to the health care system caused by managed care. Our goal was to avoid the competition between us that was driving up our individual costs and to drive a better bargain with the insurance companies. With only a few exceptions, it didn't work. Our cultures didn't mesh. Our systems didn't coordinate well. Our costs did not go down. When it became clear that the merger was not going to be a success, that was my lowest point. It was a very tough time for the hospital and the School. I could never have left at that point. I felt a responsibility to stay on as dean until we had recovered.

And now?
The hospital has rebounded under the leadership of Mark Laret. And thanks to the School's wonderful financial office and the fact that we spend conservatively, the School is in excellent health. We are again experiencing robust income from our clinical departments. Fundraising has been very successful: when I first came to UCSF, raising $30 million was considered a good year. Now $150 million to $200 million is routine. We have created close to 100 Distinguished Professorships. Our research funding is increasing. And our students have been very successful in getting scholarships. UCSF is far better known, too. Part of that change has come because the business community understands better what an economic engine UCSF is. Building an entirely new campus at Mission Bay is an example of that. Still, I think we could be even more visible and contribute even more to socially responsible activities that benefit the city and its people.

Have you noticed any changes among the medical students during your tenure?
UCSF has always been fortunate to have some of the smartest students in the country. But one of the nice things about the new medical students is their altruism. It's quite inspiring to watch them become a different type of practitioner. It's amazing how much community service they provide. It's also true that they are not as diverse as they once were; from about 30 percent minority, we're now about 19 percent. The issue is that because you have a diverse patient population, you need a diverse population of doctors. Nationally, there's an anti-affirmative action trend, but I think that will change as the nation itself diversifies and minority groups, particularly the Hispanics, grow in numbers and political importance.

Another characteristic of your leadership style has been your concern for staff. Why has staff morale been important to you?
The faculty and students get a lot of attention and credit at UCSF. I've always thought that the staff should get as much because they contribute just as much. We make sure that the staff is included in every School event and that we recognize their efforts with appreciation awards. We also do not accept mistreatment of staff. A dean is probably not the best person to ask about morale for all the obvious reasons, but I will say that if attendance at appreciation events is any indication, we are doing quite well. There is a tremendous sense of collegiality and comradeship here.

For a critical moment in UCSF's history, you were both chancellor and dean. How do the roles differ?
A dean's job is much better. You are much closer to faculty and to the students, to the action. You have the time to enjoy people's company, even go to lunch with them from time to time. A chancellor's job is very tough. You have to lead, yet you also have to take into account everyone else: the Regents, the Office of the President, the politicians, the faculty, the donors and more. The list is a long one. You also have events several nights per week. You're always on. There are rewards, of course -- one of my happiest memories was accepting from the Catellus Development Corporation the 43 acres that were going to become UCSF Mission Bay -- but generally, the pleasures of being chancellor are more vicarious because of the distance you must keep.

Do you have any advice for your successor?
That would be very presumptuous. I am very hopeful about the next 10 years. We have a tremendous collegiality among staff and faculty, a new campus at Mission Bay, new centers and talented researchers studying stem cells and infectious disease and many other worthy topics. It will be an exciting time.

What are your plans?
I'm going to take a vacation at a destination of my wife's choosing. Then I plan to take a one-year sabbatical in England. I am very interested in global health issues and I think we can make some real progress if we can develop a whole new field of advanced health sciences that fuses clinical science, basic research and population health. I want to work at that interface.

Haile T. Debas. Photo by Fiona McDougall/OneWorld Communications Inc.

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