To those who might wonder if UCSF's vaunted interdisciplinary culture is mere institutional boilerplate, just ask School of Pharmacy health economist Kathryn Phillips. "Solving today's health care problems requires that researchers from the basic, clinical and social sciences work together." And true to her word, Phillips is often on the road promoting ideas and projects to potential collaborators all over the UCSF campus and beyond.

Her confidence reflects her academic credentials -- she holds degrees from the University of Texas, Harvard and Berkeley -- and a career in the federal government policy world. Her success also reflects a change in attitude about using economic tools to solve health care problems. "It used to be rare to find health economists at health science universities, but now we are not only welcome at the table, we are being invited."

Building partnerships

The list of Phillips' affiliations is testament to just how welcome her expertise has become. In addition to her primary appointment in the School of Pharmacy, Phillips is a core faculty member of the Institute for Health Policy Studies. She also is affiliated with the UCSF Comprehensive Cancer Center, UCSF Center of Excellence on Health Care Markets and Managed Care, UCSF Center for AIDS Prevention Studies, UCSF Center of Excellence to Eliminate Racial/ Ethnic Disparities, and the UCSF Department of Epidemiology and Biostatistics. Moreover, she is a member of the Cancer Center's Population Sciences Committee and Scientific Advisory Council. This is not to mention being a reviewer for 27 journals or serving on several national and international panels and committees: a busy agenda for someone representing what was once disparagingly called "the dismal science."

Phillips dismisses such characterizations as yesterday's news. "Everyone understands now that when you're talking about health care in the US, you're talking about dollars. Health economics is about making effective choices with limited resources. That's not dismal; it's essential and exciting."

That is particularly the case in the medical and pharmaceutical marketplaces still struggling with the managed care model, which casts about for cost-effective strategies that do not compromise health. Finding the way through the thicket -- even knowing which questions to ask, which interdisciplinary partners to court and which data to sort -- is Phillips' forte. "My research is always focused on the real world. But it doesn't make decisions. This is not about advocacy but about measuring costs and patient preferences and sometimes dispelling myths." One example of the latter would be the so-called obstructionist role of gatekeepers in the managed care system. "In some cases, we've found that they actually can ensure a higher and better use of recommended services."

If the tools of the health economics trade seem familiar -- data collection, modeling and forecasting -- their application can still be a surprise. Incorporating genetic information into clinical practice is a case in point. "Pharmacogenomics is a very hot topic right now because it suggests that we'll be able to individualize drug therapies using a patient's own genetics, but the costs of doing this are unknown. I want to know how you translate pharmacogenomics to the real world."

To accomplish that, Phillips and others in the policy and clinical areas need to determine if the time saved, ineffectual treatment avoided or illness prevented -- often caused by adverse reactions to expensive drugs -- offset the costs of developing and administering the new therapy. In doing so, Phillips brings a wealth of insight from other studies in which she leads or collaborates. These include a health disparities project, which is evaluating how race, gender and social class affect health status, and a cost-effectiveness analysis of new HIV tests. "These new tests could tell patients in 20 minutes whether they are negative or positive, instead of making them wait for two weeks. Huge amounts of money are lost now because as many as one-third of the people who take the test never claim the results."

But it is a large -- and characteristically interdisciplinary -- cancer screening project that has captured Phillips' fancy. "We plan to have 20 collaborators at three universities, all working to find out what the barriers are to critical cancer screening." The proposed study will evaluate everything from quantitative data (who gets screened and who does not) and cost-effectiveness to qualitative analyses of why people are making certain choices and how to influence those decisions.

Phillips asks similar questions of students in her health economics course, a new requirement in the School of Pharmacy's revamped curriculum. While the goal is to familiarize students with economic concepts, its larger purpose is to teach them about context. Says Phillips, "The clinical students often are focused entirely on the science, on getting this diagnosed and that prescribed. What they need to learn, though, is that economics drives a lot of what happens in that patient encounter."

As Phillips continues to build large interdisciplinary partnerships across campus, that message is gaining adherents among established faculty as well. "It helps being at an institution such as UCSF where I'm surrounded by so many dedicated experts." Indeed, the struggle, Phillips says, has never been about gender, but rather "getting smart people together to solve today's health care problems." If past is prelude, Phillips seems well on her way.