Wednesday, October 22, 2014

Choosing Dean Johnston

Earlier this year the New York Times sponsored a conference on the future of healthcare hosted by the University of California’s major healing-arts campus, in San Francisco. The questions were asked by the Times’ chief medical correspondent Elisabeth Rosenthal who trained as a physician and on the dais Dr. Rosenthal recounted a Kafkaesque conversation she had with a UCSF trainee. “I was speaking to a young student, a MD-PhD student who was working on research on Lou Gehrig’s Disease,” she told the well-heeled, medically-literate audience, “and I was all excited to hear about his work, and I said to him, so, you’re going to become a neurologist and he said to me—really seriously, you know—‘No, I just want the patent.’” Seated next to Dr. Rosenthal at that moment was Nobel Prize-winning UCSF neurologist Stanley Prusiner who discovered prions that cause Mad Cow. Dr. Prusiner remained diplomatically silent, at UCSF people like to do their talking in the lab, there’s a lot of investigative audacity but the researchers are not really big on speaking out. Right and wrong on this campus can be kind of like a laboratory test, “right” is what gets results.
The chief of UCSF’s translational science office—that’s commercialization of medical discoveries—Dr. Clay Johnston, another neurologist with an interest in patents was just chosen as dean of the newest medical school in the country, in Austin. Two of the other finalists’ names were accidentally made public and were apparently deans in Houston and in New York, both traditional academics, Clay Johnston is more like a business consultant who helps physicians become “medical entrepreneurs,” that’s the UCSF tradition, moneymaking as much as medicine—and within weeks of the new dean’s appointment the long arm of the University of California business office was already reaching out to the Texas capital. Dr. Maninder Kahlon, Dr. Johnston’s principal deputy at UCSF—after the announcement of the new dean’s appointment in Austin—wrote an email to a S.F.-based company called Practice Fusion that provides an electronic medical record system to physicians. The Practice Fusion service is “free” to the MD but includes advertisements for meds on the screen the physician charts on, keyed to the patient condition: perhaps a Zyrtec spot, a commonly cited example, if the patient has seasonal allergies.
“I’ll put my head together with Clay,” Dr. Kahlon wrote to Practice Fusion’s associate vice president for product development, “to get a sense of when might be good to have a conversation around the Austin opportunity. If readily available, would appreciate any info you have on penetration of PF in Travis County.” 
            Dr. Kahlon is now coming to Texas too. Her new post just hired by Dr. Johnston is Dell Medical School’s vice dean of “partnerships,” Clay Johnston’s right hand from S.F. suddenly reattached in Texas so to speak. UCSF’s medical school is 150 years old this semester and has been doing whatever it does for a long time, long before the modern medical industry like Practice Fusion came into being. One of this biggest and baddest players in Big Pharma today was actually born in a laboratory at UCSF and it’s hard to imagine how this school of medicine—which UT Austin’s new medical program is being patterned after—could be any more tied to industry unless the docs put sponsor’s names on their white coats.
Traditionally the history of UCSF is framed by the number of Nobel Prizes won—that’s the way greatness is measured at the University of California—in this case four, the most recent two years ago for an advance in stem cells. 
         But the university’s modern history actually goes back decades earlier to an achievement that changed healthcare fundamentally yet won no Nobel prize—a lot of the monetary kind though—when two researchers, one from UCSF and one from Stanford University discovered an easy way to cut sequences of DNA and reattach them. That was it. For a moment don’t think about the science which was beautiful, consider the money that was obscene, the Stanford researcher went back to the lab while the UCSF guy found a business partner and started Genentech, the first biotech firm during those heady early days of Silicon Valley—Hewlett-Packard et al, don't you know—the same people who financed H-P also gave upfront money for UCSF’s experimental child Genentech during the beginnings of the venture capital age. The result was a company that was sold to Swiss drug-making giant Hoffman-Roche five years ago for $47 billion, half the average annual budget of the State of California, that’s where the University of Texas entered the picture actually, that year, the year of the big sale of Genentech to Roche. When you hear about new UT Dell School of Medicine Dean Clay Johnston you may think that San Francisco is corrupting our bucolic clean-living hilltop community, here in Central Texas, that’s the expected narrative—but what goes around comes around, eventually—included in Dr. Johnston’s bag on his flight from Baghdad on the Bay to our Hill Country home is bad mojo—bad medicine literally from whence it came.
So, five years ago—the recession hit with a thud, tax revenues down, costs up and tuition rising, to preserve the state’s main think tank and business incubator (the ten campuses of the University of California) the regents brought in a new president, from Austin, Mark Yudof. Originally a Philadelphia lawyer, literally—not that there’s anything wrong with that, Philadelpia lawyer can have a good connotation or a bad one—Yudof did what the Regents of the University of California wanted, he got the job done. Specifically the old leader of the S.F. campus Nobel winner Mike Bishop was retiring after a long decade on the job, talking about “a return to the lab,” looking tired and having taken a few hard administrative falls himself, some of it played out in the pages of the Times—that was when Genentech was being sold to Roche. 
          A new head of this healthcare campus to replace Dr. Bishop was needed in the context of a lot less money coming from Sacramento and Yudof turned to industry for a leader, something he learned at the Texas Capitol working for W and then for Rick Perry; at UT Yudof served as enabler in what was one of Gov. Perry's principal episodes of crony capitalism, which is saying a lot. In San Francisco new UC President Mark Yudof reached out to Big Pharma and found an energetic and charismatic cancer specialist—a former UCSF chief resident and all-around wonder woman named Susan Desmond-Hellmann, SDH for short who was, at that moment, we’re still talking five years ago, 2009 or thereabouts, head of product development across the way at, you guessed it, Genentech. 
 A recent authorized history of UCSF published by University of California Press found that conflict at this campus has most often related to allocation of research money and laboratory space. More recently race, gender and conflict of interest have been big players. Both Dr. Bishop’s chancellorship and SDH’s time at the wheel involved Biblical themes, right and wrong in an Old Testament sense, each period of leadership scarred by one or two major areas of wrongdoing—mixed with good science—Dr. Bishop’s issues being gender and money and Dr. Desmond-Hellmann’s focusing on racism and poor ethics, mostly her own. SDH did better on the former than the latter and even on the former she didn’t do particularly well, still she proved to be a talented woman, she came back to UCSF, you might say, and did a job, just like Mark Yudof did at the UC president’s office (UCOP) across the bay in Oakland. The intellectual foundation for SDH’s very practical-minded approach to fixing the university’s money woes by selling research and access to research, as if that wasn’t already happening, by getting more study participants as we’ll see—allowing Big Pharma to contract out drug discovery and development, another win-win for the University of California and industry “partners,” Sacramento’s version of crony capitalism, you could call it, San Francisco-styleUC instead of UT—brought to you by the director of UCSF’s Clinical and Translational Science Institute: Dr. Clay Johnston, the new dean of medicine at UT. 
            That would be the narrative outline here and it would be one of many narratives but it would be a pretty accurate description of what went down recently at the campus on Mt. Parnassus in San Fran. From her start back at UCSF this time as chief administrator of what she called “the enterprise,” consisting of the university and the huge and profitable medical center, SDH complained about the school’s endangered financial resources but Dr. Desmond-Hellmann actually had a list of big money backers to die for. UCSF has been the largest public recipient of federal biomedical research dollars in the country for the last few years not just because the university does good science but because the local member of Congress—bringing home the bacon—is House Minority Leader Nancy Pelosi. The university does good science in part because it gets a lot of money to do it. The other part is because it's UC and the university faculty is just very good.
The real political power at UCSF is indeed a woman but it’s not Representative Pelosi, not even close, Senior U.S. Senator from California and Chairwoman of the Select Committee on Intelligence Dianne Feinstein who is also a former S.F. mayor and supervisor, Harvey Milk and all that, that DiFiDianne Feinstein's father is said to have been the first Jewish surgeon at UCSF; these ties are strong, and being a UCSF booster also usually means boosting Genentech. The Times outed the company for running a program a few years ago that prompted members of Congress to utter favorable Genentech comments in the Congressional Record. 
           At UC not to be incestuous or anything Feinstein’s husband is on the Board of Regents and was chairman of the board and leader of the search that brought in both Mark Yudof and Susan Desmond-Hellmann, not that there’s anything wrong with that. Regent Blum did a job too, you might say. Janet Yellen, new chair of the U.S. Federal Reserve and probably the single most powerful woman in American government was president of the San Francisco Federal Reserve Bank when Dr. Desmond-Hellmann left Genentech and crossed over to UCSF, and SDH was placed on the advisory board to the San Francisco federal bank. If you had a problem with any of this insiderism—if you wanted to sue the university for ignoring open records requests or charge anyone with a crime like conflict of interest which is where we’re going, yes—there might’ve been a problem until very recently because for the last few years the chief judge of the San Francisco Superior Court has been Katherine Mariano, Dianne Feinstein’s daughter by her first marriage, Judge Mariano left the bench recently announcing she’s going to seek higher office, another S.F. girl making good.
What happens next to Dr. Desmond-Hellmann—earlier this year named CEO of the Gates Foundation—remains pretty much wholly a Bay Area question, one or more of a group of very powerful women deciding whether SDH takes a fall or not. That mostly depends on another San Franciscan, California Attorney General Kamala Harris who during the time in question, circa 2010, was D.A. on the streets of San Francisco—the wrongdoing happened on her watch, so to speak, if there was wrongdoing which it kind of appears there was. It’s by no means a done deal, it has by no means been decided that SDH is going down, with or without others, she may or may not have a come-to-Jesus moment like the good Catholic girl she says she is, depending on the University of California’s stroke which should not be underestimated. Kamala Harris’s mom was a professor at UC Berkeley as are Janet Yellen and her husband, everyone promotes his or her own idea of what the University of California represents—usually white, wealthy and well-connected—there’s a lot of talk that UC is bloated too, the Office of the President kind of seen like the Caliphate in old Baghdad, unless you’re powerful or bearing gifts don’t bother to visit. Right is what works at UCOP in Oakland, too.
Still the political lineup supporting the university boasts all power players—all power forwards you might say, some of them maybe not so nimble anymore but somehow still fast—who all get significant ball time and usually score for the school, or for themselves. Lately though they’ve made the same mistake that university leaders always seem to make. You would think politicians and college presidents would learn because as has always been true at UC campuses not just Berkeley but also San Francisco: You never want to ignore the students.

So, there was someone coming from Texas, like President Yudof from Austin, specifically, a graduate student who arrived just before the new leadership and would do battle with UC. The student was a nurse and nurses do have a reputation for speaking out. As SDH transitioned into office an incident occurred in an UCSF-run kids clinic.
So, this RN who happened to be an African-American and a guy, not that that’s important, raised the question of race in the clinic where he was doing practice for his degree. His question was—if the clinic was seeing almost all minority children which it was—why were there no Hispanic or black NPs or physicians for a clinic population of almost exclusively black and Hispanic children? That’s bad medical practice by definition today—especially at a big academic medical center where everyone has read the Sullivan report on minorities in healthcare, which dictates good practice today, you just can’t do that, not run an all-white shop. The patient outcomes are statistically worse, enough said, at UCSF they presumably knew this, that's what the brother figured since that’s what they were teaching him in class. So, a year later—nothing having been done to return him to classes, the Regents refusing to hear an appeal, saying the Board had no power to intervene—the RN got his hands on SDH’s financial disclosure form and the investments included the name “Altria,” which is the Marlboro brand, not that there’s anything wrong with that, and the description “Tobacco” written in a neat scientific hand, a spelling mistake in one column of tens of millions of dollars in investments crossed out with a single line as required in good medical charting and initialed “SDH.” We pick up our story after the shit hit the fan. Luckily for a very embarrassed SDH she got help redefining the issue of conflict of interest in academia, her partner in rewriting the rules once again the versatile Dr. Johnston, new dean at the University of Texas in Austin but at the time chief business guy for UCSF biomedical research.
“Academic institutions have responded to revelations of conflict of interest by setting more explicit policies. These policies include requiring full public disclosure of all financial ties and,” Chancellor Desmond-Hellman and Clay Johnston co-authored in an important opinion piece in Nature written together with Dr. Stephen Hauser, head of UCSF’s Department of Neurology, a researcher who has previously been criticized for catering his research to, yes, Genentech, “setting strict limits on the types of ties and amounts of compensation. However, in the heat of apprehension and sometimes embarrassment, such policies may have unintended negative consequences, driving a wedge between academia and industry. The atmosphere of inquisition has forced distance, with many faculty avoiding contacts with industry in fear of being called out as corrupt.” An atmosphere of “inquisition” these UCSF docs called it, this view echoed by the leader of the national Institute of Medicine’s committee on conflict of interest—a bioethicist who, coincidentally, was also UCSF faculty and who described UCSF’s own standards as exemplary. For his part Dr. Johnston went further out on the proverbial limb defending “business partners,” specifically the biopharmaceutical industry and even upping the ante on what Big Pharma could do.
In a separate article—in a medical review—he argued for even higher drug charges, an uncommon position to take in a country where healthcare accounts for almost a fifth of all spending already and pharmaceutical costs are much of the expense. In the case of someone going to an emergency room with signs of a stroke—according to the pricing scale Dr. Johnston’s advocated in a journal for his medical specialty, neurology—if the patient is given the standard treatment, a med called tPA, and if the medication breaks up the clot and helps the patient achieve, let’s say, 20 additional years of quality life—the med could legitimately be charged for at a rate of $50,000 for each of those additional years, in other words: a million dollars conceivably for a single medicine given in the ER—having your life saved in the hospital and paying for it all your remaining days. That tPA’s sole distributor in the United States is—you guessed it—Genentech was not mentioned directly in the article. (Dr. Johnston's further explanation offered in a written response for this posting: “The paper was meant to encourage investigators to think again about developing better treatments or more effective ways of delivering tPA. Sadly, there are very few treatments that save society money but tPA for stroke is one of them. This opens the door for even better treatments. The paper was derived from a talk meant to encourage more focus on delivering a great drug or creating a better one.”) He didn’t really have to come out and say it, at UCSF you can assume influence by one company or another, it’s part of the university culture—ties to industry are not merely for researchers but the University of California at large which reported $106 million in royalty income last year mostly from medicines and medical devices, UCSF’s contribution beating out Berkeley, UCLA and UC San Diego all of which are also hotbeds of business activity. For UC System the first big money came from defense, weapons and rocket systems and all that, nukes and nuclear technology, prompted in part by the legendary Chester Nimitz who grew up in our own Texas Hill Country, in a German-speaking home in Fredericksburg, and went to the Navy and beat the Japanese and retired to the Bay Area and the Board of Regents—so it’s not like Texans are innocent of what UC has become. A lot of the early defense work was done at Berkeley. UCLA is where they invented the Internet for the Defense Department, literally. Big Medicine has always been on campus. New UC President Janet Napolitano who left the White House to replace Mark Yudof just announced publicly the university’s next wave of research, science for science’s sake but also to earn a buck and pay bills—Big Food, capitalizing on California’s premier role in agriculture.
People think of UCLA and Berkeley as the first-stringers in the California system of public research universities but the San Francisco campus actually houses the crème of students and faculty and not just because like cream it's mostly white. Gov. Jerry Brown is said to have had surgery there, Facebook founder Mark Zuckerberg’s wife graduated UCSF med school, how cool is that, and finished her pediatric residency there a little while ago too, allegedly at San Francisco General Hospital, or at least a rotation there, so they say, her time on UCSF’s fog-shrouded Mt. Parnassus campus maybe coinciding with the studies of Al Gore’s daughter who was there too. There have long been rumors of preferences in admissions (not to doubt either of these young women’s credentials) but UCSF refuses open records requests about any kind of influence—recent race statistics among faculty and students are also closely guarded and not because they are good. What has been made public seems very connected, very political and very Caucasian in a state that is more than half black and Hispanic—like the healthcare providers in the UCSF peds clinic, where the RN spoke out, a lot of young white females, which is cool too, but not diverse—men are the minority now as trainees and minority men are almost unheard of: UCSF’s student body is officially two-thirds female and at least equally white—instead of the old boy’s network in S.F. these are mostly white women. Not that there's anything wrong with that. 
            It's woman power in action and networking up the yinyang whether intentional or not: Anne Wojcicki—estranged wife of Google leader Sergey Brin and founder of genetic testing startup 23andme was appointed by SDH to the UCSF advisory board even though the FDA restricted sales of her genetic tests. There’s actually been a lot of appointing going on, Dr. Desmond-Hellmann was appointed to the board of Proctor & Gamble shortly after coming back to UCSF and just two or three years later chosen for the Facebook board. Not everything has been high connectivity and good times for patients however: A spokeswoman for the California Department of Public Health told reporters during SDH’s tenure that a high error rate by UCSF providers was worrisome and a UCSF surgical team committed the ultimate sin—a wrong side cut—no timeout prior to procedure as required, the incident reported to everyone at the medical center in an email from the chief of staff, with a warning to follow the guidelines in the future, but the Department of Public Health said nobody told them. Last year the Philadelphia Inquirer described UCSF as an example of a hospital with a great rating and yet a reputation for error: an academic medical research institution can be judged by its treatment of indigent patients and lab animals and here, too, UCSF is exceptional in the wrong way. During SDH's tenure and after she had been there long enough to own the mistake the university made worldwide headlines for the second time in a decade for grossly mistreating a wide variety of laboratory animals, among them mammals, including the failure to provide post-operative pain medication—those kind of standards of right and wrong, one of the few critical UCSF reports by the S.F. Chronicle, which earns a lot of money from UCSF advertising. 
But what should have led to departures from UCSF were the plans to use Oakland Children’s Hospital, across the bay, as part of an effort to get more black kids to be medical research subjects. How it all went down is easy enough to explain. But—regarding the Genentech “master contract” that SDH pushed—the context was more important than the crime.

Earlier this year a UC professor at the Davis campus near Sacramento pled guilty to felony conflict of interest for receiving secret research funding from a private company. According to press reports the argument of the University of California lawyers was that there cannot be criminal conflict of interest in research, but apparently the prosecutor and judge disagreed. Which is kind of the situation that SDH finds herself in now. At the time research agreements were made with Genentech, among other agreements SDH reached with Big Pharma, Chancellor Desmond-Hellmann was serving as a paid member of Genentech’s science advisory board, a position that she only left after the black nurse took another look at her financial disclosures and began asking what was up with that shit.
SDH’s pay from Genentech on the advisory board was said to be fifty large a year—a small amount for a woman who is a millionaire many times over—she allegedly sold $30 million in stock options when she left The Company, and her husband is also said to be independently loaded—but not a miniscule amount under law, according to the California Public Reform Act of 1974 as cited by the University of California Office of Ethics, Compliance and Audit Services in a webinar that is available not on UC’s website but on the University of Texas System’s site, part of UC’s efforts to share California’s ethical standards with backward Texas: “The Act requires UC employees to disqualify themselves,” the UC voiceover and Power Point inform us, “from making or participating in the making of any University decision in which they may have a disqualifying financial interest.” So, bottom line, it seems it’s not so much that Clay Johnston came to Austin as that he left San Francisco. Ditto SDH. SDH was out the door right after the questions about Genentech payments—the problem was actually, you might say, not the questions the student asked but UCSF’s answers. Dr. Johnston was out the gate right after SDH, the announcement that he was leaving came like two or three weeks later, max. 
              Suddenly one day too, around the same time, SDH’s name disappeared from Genentech’s scientific advisory board on the Genentech website—and a little later Clay Johnston’s name got chiseled in marble in River City, not that there’s anything wrong with that, first dean of the new medical school and all. A University of California spokesman said recently that Dr. Johnston was not required while at UCSF to file a financial disclosure form, it’s kind of interesting nonetheless that since arriving on the banks of the mighty Colorado River the new Dean of Medicine has been speaking proudly about his work solidifying UCSF’s ties to industry, Pfizer for example, Quest Diagnostics, whoever, but he won’t answer questions about the big G: Genentech is like the third rail at UCSF, there’s a lot of juice running between the two locations, the campus in S.F. and The Company in South San Francisco and if you touch the connections wrong you get fried.
Dr. Johnston himself seems to be a good guy on a personal level just as SDH is a clever and attractive woman. He’s got a boyish smile, smart and charming, Harvard med school don’t-you-know—he and his wife adopted kids from Guatemala, he likes to tell people he’s a proud dad. 
             SDH and her husband did AIDS research in Uganda when they were young, she likes to say, before she went corporate, before she swore allegiance to the other side of the force and kissed Satan’s ring, so to speak. 
          Dr. Johnston is analytical and thoughtful, talking to large groups his favorite subject is the spread of the American railway network during a prior century, that’s a business model not public health but that’s what he mostly does, business, him and SDH both. They went too far, together or separately in S.F., at the campus on Mt. Parnassus or at the new labs out in Mission Bay. Or across the bay at the UC Office of the President because Mark Yudof is gone too, he resigned for reasons of “health” in the middle of an investigation of his handling of the retaliation against the nursing student, Yudof was swimming in it by then and it was mostly of his own making.
          The new UCSF chancellor tried to cover for Clay Johnston et al recently in an interview with the Austin newspaper—spreading it a little thick, yeah, but he gave it the old college try, calling Dr. Johnston “one of our top guys, but I couldn’t be more proud of him . . . He’s looked at other top leadership positions in the past . . .” no hint given that anything was amiss in the Bay Area. Something happened in S.F., two people who know for sure are the former chancellor and Dr. Johnston, they packed and left so quickly one after another a good bet is that whatever it was had something to do with the acquisition of Oakland Children’s Hospital, part of UC’s new strategy to lure colored kids for research studies or something to do with Genentech because everything that happens at UCSF has something to do with Genentech.
      In a way the Gates Foundation makes sense for her—for a women of her talents and abilities—Seattle may be exactly where she needs to be. It’s the foundation’s money after all without much regard to California law. Attorney General Harris not Bill or Melinda Gates holds SDH’s fate in her hands, Harris was the cop on the beat in S.F. when this all went down, whatever went down, when the Genentech “master agreement” as it’s called, got signed, even if SDH didn’t sign it she orchestrated the action, that’s what they even said on the UCSF website, kudos to SDH, something like that when it got done. According to the UCSF's open records coordinator "hundreds" of individual Genentech agreements have actually been executed. That’s presumably what Mark Yudof brought her in for, to do a job, and it’s hard to see former D.A. Harris going after a former member of the first-string girls’ team of which Kamala herself is a big player but it’s not like it’s a difficult case either, except finding out who else was involved, whoever gave the orders. 
            Regent Blum is worth a look but he’s untouchable, he’s a made guy with that wife, with that money he'll never see the inside of a grand jury room—maybe the UC General Counsel or UC “chief of ethics compliance” who was supposed to know better but still approved everything. Like Dashiell Hammett said it in the Maltese Falcon, it's the fundamental question in San Francisco, the same whenever shit goes down, just like in Austin, actually, at the Texas Capitol: Who takes the fall? 
         That is a completely different question from who actually did it. Susan Desmond-Hellmann is suspect—she made too many unforced errors but it's okay because the Regents brought in Janet Napolitano to take her place in the line-up. With or without SDH, Northern California has a pretty strong all-girls team which is very un-Texan and kind of cool. These chicks play hard. In any kind of showdown with any of these ladies a guy is lucky to escape with his gonads intact.
But as was true with SDH—women foul out just like guys.

 UC Regents paid $10 million to a UCLA professor of surgery earlier this year not because the university retaliated against him for speaking out about fellow UC surgeons’ ties to industry but, as a UCLA spokesperson explained, to put the episode behind the great school.
Ditto last year when UC paid $4.6 million to another professor of surgery, an African-American, for discrimination, UC did nothing really wrong but wanted to move on. At UCSF the only subject more sensitive than conflict of interest is race and the San Francisco campus actually engages in an annual exercise to clear its conscience, a “celebrating diversity” conference in which anyone can come and face the leadership and ask a question: at last count the “chancellor’s cabinet” consisting of one black diversity officer, one Hispanic international health expert and eight white men and women who actually run the medicine and medical research and who all looked extraordinarily uncomfortable sitting there in Cole Hall fielding questions from the audience. (New UT dean Clay Johnston said recently, in an email interview, of diversity at his old gig: “I’m certainly not going to defend UCSF and its track record; we both know it needs to be better.”) At this year’s diversity conference in May, much to the discomfort of the university administration, someone in the audience asked why the University of California always claims to want a diverse body of employees yet it’s always the person you knew at the beginning of the process was going to get the job who does in fact get it. That seems to be a good description how Dr. Johnston got the position in Texas, too.
The year before Clay Johnston arrived in Austin another figure from San Francisco landed softly at the University of Texas in Austin: Robert Messing, a UCSF neurologist whose research funding was being phased out in San Francisco was hired by UT President Bill Powers as Vice Provost of Biomedical Sciences. Among Dr. Messing’s first tasks—including getting his funding reinstated—was to lead the search committee for the new medical school dean—a search for that most elusive combination, a “diverse body” of applicants, and still ended up choosing the white guy who had the office down the hall from Dr. Messing at UC San Francisco, Clay Johnston.
Solike SDHDr. Johnston managed a soft landing after leaving S.F., for whatever reason, Susan Desmond-Hellmann's departure from the university may have been soft too but was also sure. She had to go. The new gig is pretty cool running the Gates Foundation and all, maybe she’ll learn compassion working among the good people in Seattle—if not she has some pretty serious explaining to do because at the end of last year while SDH was still UCSF chancellor the Washington Post in a story about Genentech’s pricing strategy for one of its meds highlighted once again Dr. Desmond-Hellmann’s confusion about the difference between right and wrong. The story was actually about two Genentech drugs—Avastin and Lucentis—one that costs $50 and the other $2,000 a dose and both of which do the same job in preventing blindness-causing macular degeneration. So, like, the story was about SDH’s time as Genentech president of product development, 2004-2009, right before she returned to UCSF and the article recalled the extreme efforts she took to push the more expensive drug by misrepresenting the cheaper one.
Not that there’s anything wrong with that.
“When Lucentis did go on sale,” the Post reported, “Genentech’s blockbuster drug already had a competitor [Genentech’s already existing and cheaper cancer drug, Avastin, which worked just as well for macular degeneration.] How could the company convince doctors and hospitals that Lucentis had any major advantage over Avastin? Over and over again [The Company] sought to discourage use of Avastin by raising concerns about its safety. They told doctors that Avastin was not approved by the FDA for use in the eye—Lucentis was. They reminded doctors that if the repackaging firms cutting Avastin into smaller doses were careless, infection could be introduced. And despite the lack of conclusive evidence on the point, they said that Avastin patients might suffer more side effects than Lucentis patients. Sometimes, senior FDA officials said, these warnings stretched the truth.” The named culprit in the misrepresentation in which patients facing blindness were forced to pay $2000 a dose for a med rather than $50 was one Susan Desmond-Hellmann—recently chancellor of the University of California San Francisco and new CEO of the Gates Foundation although the authors of the Post story did not appear to know who she was when they published, in December last year, before Christmas, around when the black RN graduate student was asking about SDH’s continuing paid role at Genentech. Dr. Desmond-Hellmann announced her resignation shortly thereafter, to take effect in a couple of months, the only thing the University of California fears more than budget cuts is bad publicity. Genentech had stopped selling Avastin to repackaging companies that cut the med into smaller doses, the Washington Post reported, in order to force sales of the 4000% more expensive Lucentis. That was on Sue's watch.
“In October 2007,” the Post reported, “the company’s president of product development at that time, Susan Desmond-Hellmann, explained in a letter that Lucentis was already available. Moreover, she said that in a routine FDA inspection of the company’s Avastin manufacturing facility, ‘concerns were raised by inspectors relating to the ongoing ocular use of Avastin because it is not designed, manufactured or approved for this use.’ An FDA ophthalmology official, Wiley A. Chambers, told colleagues that that company had misconstrued the agency’s position. The routine FDA inspection at a Genentech plant, Wiley told his colleagues,” per the newspaper, “was unrelated to the intrinsic safety of Avastin in ophthalmology. Instead, it showed that Avastin had been contaminated by glass particles, a danger that could have harmed cancer patients [for which Avastin was originally created, in another feat of awesome science by a UCSF-trained investigator, working for Genentech] or eye patients. ‘Genentech has found a way to blame FDA for their decision to limit distribution of Avastin,’ Wiley wrote to colleagues.” The result was that Genentech under SDH pushed a med that was 40 times more expensive and no more effective because that math was better for the company, 2,000 dollars a dose versus fifty bucks. During SDH’s time as chancellor an open records request asking if the UCSF medical center itself was using and charging for the more expensive Lucentis instead of Avastin was never answered by her administration. Since then, UC General Counsel Charles Robinson has repeatedly refused to answer the same open records request. In any case, so, like, SDH was toast after that, immediately before or immediately after the Post story ran, before or after the question about the money she was still getting from The Company, from the Big G, UCSF's baby, Genentech. At her new home at Gates, Dr. Desmond-Hellmann has promised to work on reducing drug prices in the Third World, good luck with that, good luck to Africans or whoever ends up working with her, she obviously has the guts to do the job, it’s the heart that’s missing—ultimately the big question is not the money but what to make of Sue? 
She’s Big Pharma, she never denied that or downplayed her willingness to do what needs to be done. That may be why Bill Gates chose her, it takes a thug to cap a thug, that kind of logic, it takes Big Pharma to negotiate with the drug industry, SDH has some pretty big ones God knows—her courage is not in doubt—it’s her judgment, actually, that’s scary. She was made chancellor because the UC Regents wanted to formalize the marriage with Roche, one side or the other becoming the obedient spouse, the only question is which? The problem for SDH and her colleague Dr. Johnson is that her relationship with Genentech is not her biggest sin.
Those black kids in the East Bay are the ones we really need to worry about.

Before announcing her departure from San Francisco, SDH was speaking on a radio program together with the leaders of the Food and Drug Administration and the National Institutes of Health, in other words the main federal regulators—the only person missing in this clinical trial nexus would have been Julie Geberding, also from UCSF School of Medicine, who was W’s leader of the Centers for Disease Control and runs Merck’s vaccines division now.
So, during previous public chats, among them TedMed conferences “dedicated to ideas worth spreading,” Dr. Desmond-Hellmann encouraged members of the public to “share your data” with physicians and medical researchers although SDH admitted on the radio program, in answer to a question about blacks, “There’s a bad history of clinical trials about minorities.” It’s not hard to see why. Big Pharma’s wish is that black people, especially, will share data—in other words DNA.
Dr. Neil Risch—one of the country’s foremost geneticists and director of the famed Institute of Human Genetics at, none other, yes, UCSF—said in response to written questions from Ta-Nehisi Coates of The Atlantic magazine last year that the attraction of African-ancestry individuals for medical research is a wider variability in some genes, which may ultimately translate into a greater potential for sequencing diseases and preparing medicines than the genes of whites. 
        The late Henrietta Lacks now famous for her cell line (originally ripped off on the East Coast, back in the day) has been put to work in practically every lab in the country and is still going strong. The California Supreme Court ruled that UCLA stole cell lines from a patient, in Moore vs. Regents, but also ruled there’s not much that patients can do about it. That makes taking cell lines even unfairly a potentially good business proposition. This must have been brought home to some of Risch’s colleagues at UCSF last year when the chief of pediatrics at the then-independent Oakland Children’s Hospital across the bay wrote a proposal to UC San Francisco that was reviewed by Clay Johnston’s Clinical and Translational Sciences Institute to increase the “catchment,” that was the word actually used—all of this is on the CTSI website although maybe not for long—of pediatric patients especially African-Americans for UCSF study purposes. One of Dr. Johnston’s major responsibilities at CTSI was not just commercialization but also to increase the number of study participants because there is, after all, little medical research without the public to test it on. Operations were run out of Dr. Johnston’s “Participant Recruitment and Study Management Services.” 
“Recruitment in San Francisco can be especially challenging,” according to the synopsis of the Oakland Children’s proposal on the website of CTSI, then run by the man who has just been chosen the new dean of the Dell School of Medicine in Austin. “In particular there is simply a limited pool of children living in San Francisco for pediatric studies, as well as a limited pool of African Americans of all ages. Fortunately there is a population of more than 2 million individuals in the East Bay which, for the most part, has not been tapped for UCSF-based clinical trials.” “Tapped,” can’t be much more direct than that, the thinking here is that all those digital-age moms and high-tech dads in San Francisco, many of them hipsters or geeks and who have few children anyway and sometimes don’t even want their kids vaccinated, no way they’re going to be medical study participants—but in the historically poorer and darker East Bay, in heavily-minority Oakland, black parents will trade study participation for healthcare. That’s the deal, in effect, and it’s pretty cynical any way you look at it. This idea to get more African-American kids was only delayed when the same Oakland Children’s physician who shopped the proposal to Clay Johnston—Dr. David Durand, head of pediatrics at Oakland Children’s Hospital—became embroiled in an ugly national patient rights’ struggle involving a 13-year-old black girl, Jahi McMath, who was declared brain dead after going to Dr. Durand’s hospital to have her tonsils out.
Dr. Durand was suddenly on the nightly news, not in a good way either, the white face of the administration of a hospital that takes care of minority kids, a kind of we-bury-our-mistakes arrogance that didn’t play well for many people black and white—parents whatever their color. Undeterred, weeks later the new UCSF chancellor who succeeded SDH, former Dean of Medicine Sam Hawgood, a pediatric researcher from Australia who praised Dr. Johnston in the interview with the Austin newspaper—Dr. Hawgood completed a research agreement with Oakland Children’s which, among its consequences, will bring a higher flow of African-Americans from the East Bay to UCSF. This isn’t science fiction—it’s hard science and big business. It’s Henrietta Lacks, Part Two.
A switch to kids actually fits most of Big Pharma’s new goals. There’s a lot of money to be made, the basic plan of pharmaceutical giants is now, according to a recent New Yorker analysis, to move away from widely-used blockbuster drugs to costly designer-drugs for less common chronic conditions. That’s no secret—market analysts talk about it openly on television. What isn’t talked about is that children fit some of the best profiles for buying medication because they will take the pills for a long time—into adulthood—allowing Big Pharma to get the most from its investment. Meanwhile, the University of California has taken the next step in Oakland, in the East Bay, In an expanded view of what constitutes a “research contract,” UCSF has brokered the takeover of the whole Oakland Children’s Hospital. In a speech before the Public Policy Institute in Sacramento a few weeks ago UC President Janet Napolitano announced the good news, talking about the move as the “acquisition” of Oakland Children’s by UCSF, the university website doesn’t really say much about the transaction because there’s a charm offensive being waged online right now aimed at black families to get them to UCSF healthcare. The UCSF-Oakland Children's agreement was signed by Senior UC Vice President for Health Sciences and Services John Stobo who is actually former leader of the University of Texas Medical Branch under then-UT leader Mark Yudof and who Yudof brought with him from Texas. Not that there's anything wrong with that. Now Stobo runs the eighth largest healthcare system in the country.
What was called Oakland Children’s Hospital a few months ago is now officially UCSF Benioff Children’s Hospital at Oakland, something like that, a mouthful, sister to the new UCSF Benioff Children’s Hospital at Mission Bay in what was the old minority part of S.F., before the hipsters and PhDs arrived. So, the new San Francisco kid’s hospital is opening next to the new research labs in an area at Mission Bay that SDH's publicity people liked to call, during her time on campus, "the biggest medical research complex under construction in the world." You could say she built that too. A very capable woman.
             The “Benioff” in Benioff Children’s is Marc Benioff—not that he’s involved, although the coincidences are, like, once again, pretty interesting—he's founder of, a tech company that with SDH’s help—another “strategic partnership” for UC, only to pay the bills of course—is becoming the major IT solution for the university. also gave seed money to found Practice Fusion, the “free” electronic health record that Dean Johnston showed an early interest in for Austin, isn’t that a coincidence, the small world in which we live. 
             Practice Fusion’s other investors include the legendary firm Kleiner, Perkins which also provided up front cash for Genentech, Google and—we’re talking some of the first money guys in Menlo Park, they were there at Creation when God first uttered the words “venture capital”—Kleiner, Perkins did Sun Microsystems too and has been a big part of the history of the digital/medical rich. Now Benioff’s company has just moved across the water to do IT for Janet Napolitano too, in Oakland, the new UC president’s explanation would be it’s all about surviving in an atmosphere of less support from Sacramento—research funding cutbacks from D.C. too, don’t you know? 
           You can’t quite escape the feeling people at UCSF are helping themselves, not that there’s anything wrong with that. The Benioff move appears like a merger—or, that is somehow grafting its business onto the University of California. Whatever the case UCSF has now reached Texas, actually it was already here, not UC System but specifically the San Francisco medical campus which under SDH opened an office in Dallas to do business with the UT med school in the Big D. Soon, UCSF will be holding sway in the Live Music Capital of the World, UT Austin has asked for and received protection from the Texas Attorney General to keep confidential any new Genentech agreements but that’s not the only way to know some potentially unhealthy behavior is going on. There’s one fact about the hiring of Clay Johnston away from S.F. that’s especially pertinent. Make of this what you will. In the recent dispute between a University of Texas regent and UT President Bill Powers, the regent was said to have taken an uncalled for interest in Powers’ wife, an Austin real estate lawyer named Kim Heilbrun. How you feel about what you're going to hear depends entirely on your level of comfort for paranoia.
So, if you’re living in Texas or even in northern California and didn’t see something in the news about the dispute you weren’t breathing, the fight dragged on and on, but a particular detail is crucial that you may not know or may not have heard or cared: It was rumored early on, in this very public argument—that it was somehow “inappropriate” that Heilbrun was Professor Bill Powers’ student at UT School of Law, back in the day, when the couple first hooked up. Like who cares who was sleeping with whom thirty years ago, right? 
            This was three decades ago at UT law school back when Austin was still a small town, when no one was even thinking of a medical school, back when Bill Powers was just a law professor, specializing in business, and Mark Yudof—coincidentally—was the assistant dean of the School of Law, not that there’s anything wrong with that, a fortuitous happenstance nothing more. So, like, it’s hard to see anything wrong with two people falling in love whatever their circumstances—we’re not talking Powers and Yudof, although there may be a man-crush at work there, these guys have always been close, it was Mark Yudof who chose Bill Powers as president of UT Austin after all, not that there's anything wrong with that—but Bill Powers and Kim Heilbrun, husband and wife. Like, who cares right—especially if they have since raised a family together as Powers and Heilbrun have done? But that doesn't mean that the couple’s time together in law school is not of interest in more recent academic history—specifically, the choice of Clay Johnston as first dean of the Dell School of Medicine in Austin.
Genentech already has a presence in Texas, a group of a half-dozen or so lobbyists who represent the company before the legislature. The head guy on this influence team is a lawyer named Randall Erben. “I don’t even know Dean Johnston,” Randy Erben protested recently in a phone call and that may be perfectly true. Again, you have to be conspiracy-minded to appreciate this but it’s actually pretty cool. And really scary.

Randy was in Kim’s class at UT School of Law.

Not that there's anything wrong with that. But that means Bill Powers was one of his professors, right? And Mark Yudof was the assistant dean. That was a while ago, sure, but university records show that much more recently Randy Erben has been invited as a guest to President Powers’ private box at Longhorn games. Like, what do you think?
Is that, like, just a coincidence—or is the public about to get screwed again? 

Edited by Jake Schloss

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