As a specialist in the treatment of children with cancer and HIV, Philip Pizzo has seen medicine work wonders.
When he served as head of the infectious disease section and chief of pediatrics at the National Cancer Institute, Pizzo often held the hands of critically ill children. He watched many of them regain their strength and grow up to lead full lives -- he notes with fatherly pride that two former patients recently completed graduate studies in radiology and health services technology.
Pizzo says he had "the enormous privilege" of being at the Cancer Institute at a time when children with leukemia and solid tumor malignancies were cured. And that experience profoundly strengthened his commitment to his work: "If you stay focused, are tenacious, try to maintain your optimism and believe that you can make a difference, sometimes it can happen," he says. "Of course, there's a lot of luck involved, as well."
Those insights should serve Pizzo well when he becomes dean of Stanford's School of Medicine on April 2, taking charge as the school begins a major curriculum reform and a five-year, $185 million renovation of its facilities.
Since he was named to the deanship in December, Pizzo has been commuting between Stanford and Boston, where he has been physician-in-chief at Children's Hospital and chair of pediatrics at Harvard Medical School. On frequent visits here, he has asked broad questions and listened for nuances in the answers, taking the academic and human pulse of the campus.
Education. Research. Clinical care. Community service. Pizzo ticks off the issues he has discussed with deans, researchers, teachers and administrators as he develops his blueprint for change. But in a wide-ranging interview in January, he declined to specify his agenda for the Medical School until he's had time to settle in. "I've begun constructing some of the issues that I think are important to my own strategic plan," he says. "But I'm still validating things by doing a lot of listening."
However, the 56-year-old dean has plenty to say about the bigger picture, particularly the "transitional state" in which teaching hospitals and research institutions find themselves today. Medical schools grew and flourished during the 1970s and '80s, he says, but underwent significant turmoil in the '90s, "when managed care tried to convert medicine to a business, rather than a service." As he takes the helm at Stanford, he says this is a good time to be asking 21st-century questions. "What should a medical school that's in a research-intensive environment look like? How should it configure its education focus? Who should it train? For what purpose? What kind of cross-fertilization should be in place?"
With a nod to the pioneering Bio-X project that will promote interdisciplinary research in biological sciences, bioengineering and medicine at Stanford, Pizzo asserts that cross-campus conversations are the building blocks of future research. "As our knowledge has expanded over the last 50 years, it has become clear that some disciplines that seemed so separate and distinct are actually very closely related," he says. "So the possibilities exist for creating interdisciplinary research that not only improves knowledge but also, in the case of a medical school, potentially improves the ability to diagnose or treat or prevent disease -- or simply understand it better."
At a time when many medical students are trying to decide whether to become primary care physicians or specialists, Pizzo thinks Stanford is positioned to train specialists who are committed to doing research.
"I think this is a big country with a lot of needs, and one of the important issues -- and, I think, big mistakes -- is the concept that medical schools should all do the same thing, that everyone should produce an array of clinicians and researchers," he says. "I think there is a need for focus and specialization. While primary care physicians continue to play an important role, we've learned that specialists and highly trained clinical and basic investigators are an essential part of the medical enterprise. Not every place has the resources or ability to train that group of individuals. So I feel that Stanford and a handful of other schools should focus their energies on specialists and researchers."
As he looks at the changes and needs that are propelling discussions about curriculum reform at Stanford, Pizzo says the declining number of specialists nationwide is one of his top concerns. Citing trends in his own field, he notes that during the past 10 years the percentage of new U.S. pediatricians who opted to enter specialty areas, such as pediatric oncology, fell from more than one-third to less than one-fifth. "That represents a crisis, because it means we won't have enough pediatric specialists to do clinical care," he says. "And even more important, we will have fewer who are able to conduct research -- so that at the very time when there is such a vast array of new opportunities, there won't necessarily be a workforce capable of seizing those opportunities."
An internationally known clinician who has designed innovative controlled trials, Pizzo in 1988 published the first article, in the New England Journal of Medicine, on antiviral therapy for hiv in children. He served as acting clinical director of the National Cancer Institute, where he founded Children's Inn, a temporary home for young patients and their families. In 1997, he was elected to the National Academy of Sciences' Institute of Medicine. The first person in his family to go beyond elementary school, Pizzo holds a bachelor's degree from Fordham University and earned his md at the University of Rochester School of Medicine, which he attended on a state regents' scholarship.
Pizzo's delivery is New York rapid-fire without the bite. He appears to have hit the campus running like the veteran marathoner he is. Year-round, in icy New England or "remarkably nicer" Palo Alto, he begins each day with a 4 a.m. run. A self-described history buff, Pizzo pounds out the miles with rented books on tape; currently he is plugged into the first volume of Sir Martin Gilbert's sweeping trilogy, A History of the Twentieth Century.
When he talks about the history of medical education in the United States, Pizzo goes back to the post-Civil War era, when scientific findings first began to guide the training of physicians. He talks about the founding of the first U.S. medical school in the late 19th century and how researchers in basic sciences worked together with those in clinical medicine in the early part of the 20th century. In the post-World War II phase, Pizzo says, federal funding launched the biomedical research enterprises that have become fixtures of today's medical schools.
While placing a high premium on research, Pizzo says he hopes medical students will keep one guiding principle in mind, no matter what specialties they pursue. "It is all too easy in modern medicine to look at the imaging studies and to look at the laboratory studies and to formulate an opinion without actually engaging in a human interaction," he says. "It's very important not to lose sight of the fact that there's a patient at the other end of the discussion, and that the very fundamental part of medicine is sitting down, listening and making human contact.
"It's one of the reasons why I think there has been, to some degree, a loss of public trust for medicine as a discipline. What people often are looking for is someone to listen to their problem and put an arm around them."
