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Dr. David A. Brenner joined Columbia as chairman of the Department of Medicine on March 1. Previously, he was at the University of North Carolina at Chapel Hill for 10 years, where he was chief of gastroenterology and director of the Digestive Disease Center. He is also editor-in-chief of the journal Gastroenterology. In addition to his administrative role, he continues to do research on the molecular biology of liver diseases and conditions such as liver fibrosis – a common pathway for liver disorders – and see patients with gastrointestinal diseases.

Why is the Department of Medicine so important to the university?
To a large extent, the Department of Medicine has driven the success of the medical school. The faculty in medicine do the most teaching of any department. Approximately half of all the patients in the hospital come through the Department of Medicine. The other half comes from all the other departments combined. The Department of Medicine usually has the largest research base. In contrast to the past, however, I want medicine to be much more interactive with the other clinical departments and with the basic science departments. I would also like to develop interdisciplinary centers. The department has 18 divisions but I plan to consolidate some of them.

Can you talk about some of your goals for the department and describe some of the actions you've taken since you came on board?
First, I met with as many people as I could, including the division chiefs, to assess their needs. I met with many different groups in research, teaching, and patient care – these areas represent the three missions of the department. It is a challenge to keep all three reinforcing each other, especially since we have 400 full-time faculty members and 900 affiliated faculty.

An early goal is to recruit and provide resources to build up the divisions. We are recruiting leaders for the two divisions – gastroenterology and rheumatology – that lack chiefs. We recently appointed a new director for the residency training program, Dr. Nick Fiebach, who was the associate director of the residency program at Johns Hopkins.

Columbia's internal medicine residency program has been and continues to be one of the premier residency programs in the nation. We have phenomenal patients who come from various areas, including the local community, other parts of New York City, and the surrounding suburbs. The patients usually present in the emergency room without a diagnosis – making them the most challenging, exciting patients in medicine. By comparison, most of the patients at UNC were transferred from an outside doctor, already having received a diagnosis, and required some type of specialized care. Columbia is a great learning environment for residents because they get to observe and participate in diagnoses. The housestaff have more opportunity to learn from their patients.

What are some administrative issues you face?
We are in the process of reorganizing the administration of the department. There are three new vice chairs in the department and Dr. Paul Rothman [Richard J. Stock Professor of Medicine (Immunology) and Microbiology] is vice chair for research. Dr. Katherine Nickerson [associate professor of clinical medicine] is vice chair for operations and education; Dr. Allan Schwartz [Harold Ames Hatch Professor of Medicine] is vice chair for clinical affairs; and Dr. Paul Rothman [Richard J. Stock Professor of Medicine (Immunology) and Microbiology]. Dr. John Loeb will continue as vice chair for academic affairs. By doing that, we'll make the department more responsive to faculty in the critical areas of education, research and clinical care. There had been vice chairs before, but their titles were essentially honorific. I want to empower them to work closely with faculty and the hospital staff to improve the function of the department and quality of patient care.

What should we watch for regarding research in the department?
I see many opportunities for translational research – to take what's learned in basic science and apply it to patient care. The Department of Medicine is uniquely situated to conduct observation and discovery in labs using cellular and animal models. We can ascertain whether lab discoveries are applicable to patient care. We can better incorporate new technology in the areas of genomics and proteomics, to help us assess disease states using smaller amounts of blood or tissue samples. For example, lab observations can be more quickly assessed in clinical trials for new drugs.

Another example is in gastroenterology, where specialists just recently started using antibodies as a type of therapy. Once gastroenterologists get used to using that therapy, we can try to block targets with other antibodies. In the past we would have waited until a new drug was available, which can take years.

What needs to be done to foster interdisciplinary work?
We need to create new research core facilities to handle tasks that are difficult for the individual researcher. We already have a microarray core to help with gene expression analysis, a confocal microscopy core, and a histology core for use with experimental animals. We are considering whether to create a high-throughput genotyping core and one for immunohistochemistry (analyzing the chemical composition of the cells and tissues of the body using antibodies) to examine animal or patient samples.

I would also like to form clinical trial support cores where we can do both patient care and clinical trials. To assist researchers with clinical trials, we would hire a biostatistician as well as people to handle data entry. The goal is to make it easier to do creative research, ask harder questions, and get answers.

There is also room to expand on the multidisciplinary approach to patient care. This approach is already in place here at the Naomi Berrie Diabetes Center and the Herbert Irving Comprehensive Cancer Center. But we can do something more specialized on a smaller scale in areas such as prostate cancer and inflammatory bowel disease. When I was at UNC, we had success with a joint medical and surgical clinic to treat inflammatory bowel disease and esophagus and liver problems. Patients appreciate it because they can see multiple physicians and get several tests done at one time. Physicians can benefit from their colleagues' knowledge as well as conduct clinical research.

How would you sum up your thoughts about the department and its future?
The students, residents and faculty are incredibly talented and enthusiastic; the challenges and opportunities at Columbia are enormous.


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