Guiding Principles of the Rockefeller University Hospital

From its inception, the Rockefeller model was driven by several organizing principles that remain vibrant today and are central to the newly established Rockefeller University Center for Clinical and Translational Science.

  1. Medical research requires undivided focus and thus all investigators, including physician investigators, should be fully salaried by Rockefeller and physicians should not engage in fee-for-service medicine. This principle remains operative today, protecting virtually all of investigators' time for research.
  2. Physician-scientists should be encouraged to investigate the basic mechanisms underlying their clinical observations and be provided with laboratory space and resources to conduct the studies. Thus, Avery, MacLeod, and McCarty pursued their observations on clinical pneuomococcal pneumonia to the bench, ultimately making their landmark discovery, and perhaps the landmark discovery of the twentieth century, that DNA confers genetic information from their observations on the transfer of virulence from one pneumococcal strain to another. More recently, Dr. Ralph Steinman's interest in immunologic disease led him to discover antigen-processing dendritic cells. The importance of these cells to the immune response has not only changed the paradigm of immunity, but also opened up new translational opportunities in cell therapy using dendritic cell-based vaccines, including the ones under study by Drs. Dhodapkar and Darnell at the Rockefeller University Hospital, as well as a major new vaccine center with support of the Gates Foundation focused on the development of HIV and malaria vaccines that harness dendritic cell biology directly in patients, a collaboration by faculty members from five different laboratories David Ho, Michel Nussenzweig, Jeffrey Ravetch, Charles Rice, and Ralph Steinman.
  3. Basic science investigators should be encouraged to focus on projects of medical significance. Thus, studies conducted at Rockefeller by the Ph.D. chemist Van Slyke truly transformed clinical medicine by his developing assays to measure CO2, oxygen, blood urea nitrogen (BUN), amino acids, and electrolytes in human blood.
  4. Scientists should be free to pursue new directions for their research, unencumbered by the constraints often imposed by a traditional departmental structure. Thus, Dr. Vincent Dole radically changed the focus of his research from the biochemistry of metabolic disorders when he came to appreciate the enormity of the substance abuse problem in New York City, resulting in the development by him and his colleagues Marie Nyswander and Mary Jeanne Kreek of methadone, the first effective drug for managing substance abuse.
  5. Although animal studies are valuable, there is no substitute for rigorous hypothesis-driven studies of disease pathophysiology in humans. Thus, Dr. David Ho and his colleagues profoundly altered the accepted concept of the pathogenesis of HIV infection when his studies conducted in patients at Rockefeller demonstrated that HIV rapidly replicates in infected individuals, and that very large numbers of lymphocytes are destroyed by HIV each day, leading the way to the development of the multi-drug regimens that have revolutionized the care of HIV patients. Similarly, Dr. James Krueger's cellular and molecular analyses of the skin of patients with psoriasis at Rockefeller not only changed the pathophysiologic paradigm of psoriasis from a disease of unchecked proliferation to a disease of autoimmune dysregulation, but also ushered in a new era of effective therapies that built rationally from this new paradigm.
  6. Trainees should be given independence and maximum flexibility in designing their educational programs. From its beginnings, the Rockefeller Institute for Medical Research selected for self-confident and independent trainees who subsequently went on to leadership positions in their disciplines. Thus, it has been estimated that by the late 1930s, nearly one-half of the full-time Chairs of Medicine in the United States were occupied by individuals who had trained at Rockefeller.1 That initial spirit of selecting independent and self-confident learners has remained a hallmark of the Rockefeller University PhD, MD-PhD, and Clinical Scholar Programs. Thus, all of these programs emphasize mentored research experiences, tutorial learning, and flexibility in curriculum design.
  7. Rockefeller should focus on research on illnesses that affect all of humankind, even when studies of diseases primarily affecting the underdeveloped world are not supported by external agencies or not scientifically fashionable. This long-term commitment to global health challenges extends back to Dr. Max Theiler's pivotal studies identifying an attenuated strain of the yellow fever virus that remains the basis of the highly effective vaccine that is still used today. That commitment is equally palpable today in the work of Dr. John McKinney on tuberculosis, Dr. George Cross in parasitology, and most notably, Dr. David Ho and his colleagues who have undertaken the daunting tasks of both developing and testing an HIV vaccine specifically designed to protect recipients from an HIV strain that is endemic in a region of China but not in the U.S.
  8. The decision to maintain focus on scientific productivity by retaining and refining the unique aspects of the Rockefeller structure. The noted University of Wisconsin sociologist, Dr. J. Rogers Hollingworth, has studied in detail the academic structures that have been most successful in fostering the achievement of breakthrough science. He singled out Rockefeller as the institution where, despite the small size of its faculty, "more major discoveries occurred...than at any other research organization during the twentieth century."2 He attributed that success to Rockefeller's structure, emphasizing its relatively compact size, interdisciplinary nature, organization by laboratories, solid financial support, intimate social climate, and excellent leadership as among the most important elements. Thus, Rockefeller has chosen to focus on the challenging, and ever increasingly complex, interface between scientific discovery and clinical potential. This focus permits undivided attention and resource commitment to this goal.
  9. The essential role of Clinical Research Nursing to the success of the research mission of the Rockefeller University Hospital has been recognized since the inception of the Hospital in 1910. As a result, throughout its history and extending to the modern day, Rockefeller University Hospital has placed and continues to place enormous emphasis on training a cadre of nurses with in depth knowledge of the scientific basis of the studies being conducted, unique skills to conduct the studies efficiently, and an absolute commitment to participant safety and the protection of human subjects.
  10. The "home" for clinical investigation and clinical investigators at Rockefeller since 1910 has been, and remains, The Rockefeller Hospital, led by a Physician-in-Chief charged with mentoring junior investigators and developing a coherent, integrated research program. All members of the faculty, both basic and clinical, are encouraged to participate in the research opportunities and to share in governance and strategic planning. Since the inception of GCRC program support at Rockefeller in 1963, and now the Clinical and Translational Science Award, the Physician-in-Chief has had the benefit of sharing governance and mentoring with the CTSA Program Director and Associate Program Director, as well as benefiting from the advice and strategic planning conducted by the Advisory Committee for Clinical and Translational Science (ACCTS).

References

  1. J Hirsch, Rufus Cole and the Clinical Approach, in Creating a Tradition of Biomedical Research; Contribution to the History of the Rockefeller University, Darwin H. Stapleton, editor. Rockefeller University Press, New York, 2004)
  2. J. Rogers Hollingsworth, Institutionalizing Excellence in Biomedical Research: The Case of the Rockefeller University in Creating a Tradition of Biomedical Research; Contribution to the History of the Rockefeller University, Darwin H. Stapleton, editor. Rockefeller University Press, New York, 2004.