Bill Brody: Physician, Pilot, Engineer, Pianist, Research Scientist, Educator, Academic Leader
Bill Brody at a Glance
Title: President, Salk Institute for Biomedical Research (effective March 2009)
Previous Position: President, The Johns Hopkins University (1996 through 2008)
Education: BS, Electrical Engineering Honors Program, 1965, Massachusetts Institute of Technology; MS, Electrical Engineering, 1966, Massachusetts Institute of Technology; MD, 1970, Stanford University School of Medicine; PhD, Electrical Engineering, 1972, Stanford University School of Engineering
Stanford Roles (1977 through 1986): Professor of Radiology and Electrical Engineering; Director, Advanced Imaging Techniques Laboratory; Associate Professor of Radiology and Electrical Engineering; Director of Research Laboratories, Division of Diagnostic Radiology
Affiliations: Member, Institute of Medicine, National Academy of Engineering. Fellow, Institute of Electrical and Electronic Engineers (IEEE); American Academy of Arts and Sciences; American Institute of Biomedical Engineering; International Society of Magnetic Resonance in Medicine; American Heart Association; American College of Radiology; and American College of Cardiology. Previously served on the President’s Foreign Intelligence Advisory Board.
Other accomplishments: Respected scientist with more than 100 published articles. Co-founder of three medical device companies. Former president and CEO of medical instrument manufacturer Resonex Inc. (1984 through 1987). Advocate for innovation and strengthening the U.S. economy through investments in research and education. Active proponent of discussion of health care reform during the presidential election campaign.
You’ve been at the helm of Johns Hopkins for 12 years. How have the challenges of university leadership changed during that time?
Today the biggest challenge is survival. We’re in an unprecedented period. All revenue streams—endowment, gifts, funds from tuition—are potentially down. State and federal aid will be under pressure. And for the health system, so are Medicare and Medicaid reimbursements. So what’s the good news? I believe in tough times you can move up or you can move down. I think there are things academic medical centers and universities in general can do to seize this crisis: figuring out better cross-collaboration and shared administrative services, outsourcing when necessary, even shedding things that aren’t core, though obviously that’s a gut-wrenching decision.
What is one of the accomplishments you take pride in from your time at Hopkins?
We implemented a groundbreaking patient safety initiative while I was at Hopkins. We knew we were above average in our rate of patients with bloodstream infections from indwelling catheters, and we decided to talk openly about our infection rates, and do something about it. Of course, the lawyers went ballistic. But we insisted. Instead of hiring consultants, we tapped people on the front lines: doctors, nurses, ward clerks, patient transport, information technology, infectious disease. We set a goal that reflected our patients’ expectations: zero percent infection. “That’s impossible!” we were told. But in fact, that’s what we did: We set a goal of zero percent infections, and after several years of hard work we got basically zero infections. We replicated this outside of Hopkins, across the state of Michigan in a project with Blue Cross. Now a number of hospitals around the world are adopting these concepts with similar results.
As a student, a faculty member, and an academic leader, you’ve been on the inside of some of this country’s leading research universities. What qualities do these institutions share? How do they differ?
To outsiders, universities all look the same. Like children, they all go through the same developmental stages. But as you know if you have children, each one is different. For example, in some ways the personality of Hopkins is the personality of Baltimore—a place where people grow up, put down roots, and stay. It has a wonderful sense of stability, collegiality, and friendship. Whereas in California, where I grew up, most people came from outside. Because there’s no historical tie to the past, you’re free to do crazy and inventive things. So in California you find a certain intellectual experimentation and entrepreneurship, which is exciting and creates a very different institution at Stanford than Hopkins.
One of your goals at Hopkins was to create more transparency in medicine. How can other institutions learn from your example?
Rand Corporation did a famous study of 30 common conditions like myocardial infarction and pneumonia, in 12 geographical areas around the United States. They asked, “How often do patients get the right diagnosis and treatment?” They found that the answer was only about half the time—54 percent on average.
We did a similar examination for myocardial infarction at Hopkins and found that, depending on the ward, we were accurate 80 percent to 96 percent of the time—but not 100 percent. And this is for a condition where everybody understands the appropriate treatment regime. Why? It’s not because people don’t know. It’s because the system wasn’t organized to make sure the right treatment got instituted. I always say the biggest disease in America today is variability. We want to reduce variability to make sure everybody gets the right diagnosis in the right time, and the right treatment. But unless you measure, unless you publish your results, and unless you set a goal, you’ll never get there. Transparency is the first step to improving quality in our health care system.
What health challenges concern you most?
Although very few people are discussing it, Medicare is part of the problem we’re in now. It’s an enormous strain on the federal budget. The growth in Medicare expenses alone represents the cost of a new Iraq war every three years. At some point, whether it’s this year or 2018, there’s got to be a dramatic shift in how Medicare services are delivered, and academic health centers have to restructure to be part of a new delivery system. I don’t know what that system is, but I do know that it will be more outpatient-oriented and more chronic disease-oriented and more interdisciplinary. We can’t remain stuck in our silos. There has to be a shift to a system where hospitals have the financial incentive to keep people well vs. being paid every time patients come in for service. The academic medical centers that recognize we’re going in that direction and get on top of it will be much better positioned.
Public health is another challenge. We have to stop the epidemic of obesity. Ask most people to name the last surgeon general they can remember and they’ll tell you C. Everett Koop. Why? Because he took a stand against smoking. So why isn’t the surgeon general on television every day talking about obesity, putting pressure on food companies, or trying to tax sugar, which would go a long way to reducing the epidemic? The same kinds of things we did with tobacco we could do with obesity. Sugar is as bad as nicotine, yet presently the federal government actually subsidizes the production of sugar. Like tobacco, we should tax it. It would have enormous health and economic benefits.
Going back to our economy, if you put additional dollars into the National Institutes for Health budget or the National Science Foundation budget, those dollars will stimulate the economy just as effectively as if you gave them to some other sector, or even built bridges with them. In fact, it will get spent faster—if you’re building a bridge, it can take years to get those projects going. I’m not saying you shouldn’t do infrastructure projects. But it’s critical for our country to get back to basics: investing in science and fixing education are key to our longterm success.
Perhaps the biggest economic stimulus the federal government could provide to the U.S. economy is universal health insurance. Health care is now the largest sector of our domestic economy. And with few exceptions, it is not outsourced; health care has to be delivered locally. In addition, medical device, equipment, and pharmaceutical companies are among the few industries that are net exporters. By providing health care insurance for all, we would not only inject more dollars immediately into our economy—as opposed to building or repairing roads and bridges—we would also make people healthier and therefore more productive.
What are you most looking forward to in your new role at the Salk Institute?
I started my career in research and I’m looking forward to getting back, this time as a voyeur, not as a bench scientist. I think this is a renaissance for biomedical research. In the next decade or two, we’re going to see enormous payback from the investments that have been made—in mapping the human genome, in stem cell technology. This will lead to cures for diseases and better understanding of brain function, for example.
Are there any memories that stay with you from your time at Stanford?
As a medical student, I arrived from MIT. Jerry Wiesner, who at the time was provost of MIT, said I was making a big mistake going to California because it was so conservative politically. Then, the first week I was at Stanford, activist David Harris, who was then student body president, led a huge rally at White Plaza. Not long thereafter, they were firebombing buildings. A few years later, protesters occupied the hospital. I was more of a spectator to what was unfolding. I always wondered if Jerry Wiesner had ever set foot in the Golden State. But for me, Stanford was the right place. It allowed me to construct a curriculum that combined medicine and engineering when such a combination didn’t exist anywhere else. Nobody said, “Rule 126.5 on page 110 says you can’t do this.” So I went and did it. That’s the freedom and creativity of Stanford.
You had looked forward to perfecting your piano playing in retirement. Clearly you won’t have as much time now— but what piece would you most like to play to perfection? I thought my next job would be playing in a piano bar, but after a few auditions, it was clear I lacked that critical ingredient: talent. I’d like to play all the Chopin etudes. I can play about half of them poorly, but I’d like to be able to play the other half poorly, too.
You’re also a pilot. Do any of your piloting skills come in handy in university leadership?
A pilot, like a surgeon, has to do multiple things at once. You may have to focus on one thing but keep 10 in your peripheral vision. To get anything done at a university or in life you have to focus. So I tell young people: “Just do one thing. Do it really well. Build a foundation. And after you’ve done that, do the next thing.” At any given time I have two to three things on my plate that I have to focus on, but I have to keep 20 other things in mind, in case they become emergencies or high priorities. I would say that’s similar to piloting an airplane.
Editor’s note: The Board of Trustees of Stanford University elected Bill Brody to a five-year term on the board, beginning June 10, 2009.