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April 28, 1999 .MAY 1 1 1999 Department of Pharmacology Howard Medical Sciences BIdg./318 Reno, Nevada 89557-0046 (702) 784-6956 FAX: (702) 784-1620 The Honorable Shelley Berkley Member of Congress 1505 Longworth House Office Building Washington, DC 20515 Dear Congresswoman Berkley: I write to thank your office staff for their hospitality during my brief visit to the Capital. Although I was unable to speak with you personally, I was able to speak with your legislative assistant in regard to my concern that we follow through with a commitment to double the NIH budget by the year 2003. We must make the fight against heart disease and stroke our highest priority, as these are the diseases that kill us in numbers beyond all others. A staggering number of us, nearly one million Americans, will die of heart and blood vessel diseases or stroke this year. This is unacceptable. In order to diminish these numbers and alleviate the suffering associated with these diseases, we must increase the NIH budget by 15% this year. You will be assailed by many requests and opinions and will struggle to see where the funds can come from to achieve this and other worthy goals. The legislative responsibilities you bear are challenging. Nonetheless, we must make medical research a priority. If there is a more important priority that keeping our loved ones alive, I am unaware of it. Please join your colleague, Congresswoman Capps, in supporting biomedical research by increasing the National Institutes of Health budget by 15%. I also wanted to thank you for your support of our efforts to replace the Dean of the School of Medicine during your tenure as UCCSN Regent. Our Dean search committee has just presented a short list to President Crowley and we anticipate campus visits by these fine candidates over the next few months. While it will take several months to come to an accommodation with the chosen candidate, we are hoping that Daugherty will not remain in place beyond June 30t h of this year. Although Daugherty and his staff assert that he will remain Dean until a new candidate is found, we are hopeful that the wisdom of arranging his retirement will be adhered to. Despite this logical expectation, we understand that President Crowley has indicated that he will retain Daugherty until a new Dean is hired. I hope you will contact the UCCSN board of regents and support them if it is their desire to see Daugherty step down. While this area of management is not now your focus, we sincerely hope that it can be of interest and that your voice will assist us in improving our at risk school of medicine. Finally, let me appraise you of efforts to provide much needed funding for biomedical research collaborations between the School of Medicine and UNLV. David Schapira, the medical school's Senior f Associate Dean in Las Vegas, Stephen Carper, Associate Professor of biochemistry at UNLV and I have prepared a proposal for Governor Guinn that would commit a small portion of Nevada's tobacco-settlement funds on behalf of a Nevada Cancer and Health Research Consortium {please see the enclosed proposal). The goal of the Consortium is to create a cancer center in Las Vegas within five years and to build excellence in the research and treatment of tobacco-related diseases throughout the state. Your knowledge of our plans and aspirations can have a positive impact on our success. If you have occasion to speak with Iain L. O. Buxton Page 2 05/05/99 I believe that full-funding for the Nevada Cancer and Health Research Consortium proposal can be the most significant boost to establishing biomedical research expertise in the state since the medical school was established thirty years ago. It will cement the collaborations with UNLV that some of us have tried to encourage and that can benefit each campus tremendously. We have much to do if we are to reverse the destructive legacy of Robert Daugherty. Supporting research growth and collaborations between school of medicine and UNLV faculty suggests an exciting future. Thank you again for the warm reception I received from your staff and I look forward to an opportunity to meet you in person on another visit. Most Sincerely, Iain L. O. Buxton Professor of Pharmacology NEVADA CANCER & HEALTH RESEARCH CONSORTIUM PROPOSAL A Medical Research Alliance: On behalf of The People of the State of Nevada David V. Schapira, M.D., University of Nevada School of Medicine, Las Vegas Iain L.O. Buxton, Pharm.D. University of Nevada School of Medicine, Reno Stephen W. Carper, Ph.D. University of Nevada Las Vegas April 26, 1999 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM EXECUTIVE SUMMARY The State of Nevada ranks among the top five states with regard to deaths due to smoking related diseases and cancer. Research and service efforts to combat tobacco related diseases in Nevada are fragmented and unconnected. The State of Nevada could invest tobacco-settlement funds in the future health of its citizens by funding the Nevada Cancer & Health Research Consortium (NCHRC). This proposal seeks to unify medical discovery and cutting edge disease treatment through a cancer and health research consortium. The proposal outlines how physicians and scientists will interact and collaborate at the University of Nevada School of Medicine Campus in Reno, the University of Nevada Las Vegas and University of Nevada School of Medicine Campus in Las Vegas. This statewide and inter-institutional collaboration has extremely important ramifications with regard to: ? Building research collaborations and establishing new research programs in order to advance collective knowledge and improve disease outcomes for Nevadans. ? Establishing core research and testing facilities that will be shared by every institution thereby advancing knowledge while increasing cost effectiveness and utilization. ? Increasing the likelihood of obtaining additional funds from national agencies resulting in significant growth of research and medical care expertise in Nevada. This concerted approach would also result in the application for a National Institutes of Health funded National Cancer Institute Comprehensive Cancer Center planning grant. The proposal describes an organized approach to building infrastructure and important communications between scientists and clinicians at the research institutions within the State. The budget is comprised of two components or phases. The primary component relates to building infrastructure and communications as well as funding research proposals. The secondary component relates to construction of a Cancer Research and Patient Care Center. Both components of funding will be necessary if we are to move ahead with the aim of justifying a national Comprehensive Cancer Center and build centers of excellence in cardiovascular and pulmonary diseases. It is the opinion of the authors, who have collectively significant research expertise and medical research management experience at multiple institutions, including other national Comprehensive Cancer Centers, that there exists a very real opportunity to build on existing resources and expertise within the State so that Nevada can further develop centers of excellence in research and treatment. These strategies that involve tobacco-related disease prevention, early detection and treatment would greatly benefit the people of the State of Nevada. The authors of the NCHRC are mindful of the difficulty in apportioning tobacco-settlement funding to all of the proposals on the table. We respectfully suggest that the requested budget of seven million is comparatively modest and worthy of full funding. If full funding is not possible, the following priorities should be established for partial funding of the proposal. Funding Priorities: ACTION (Budgetary Options) 1. Full funding ensures success 2. Elimination of the capital improvement funding reduces the request to less than four million annually. 3. Removing the laboratory renovation funds from the budget reduces the request to approximately three million annually. 4. An option funded at two million per year would permit some growth and limited training and will reduce the outcomes proposed for the consortium. IMPACT Highly positive; Nevada will have a Cancer Research and Patient Care Center, paving the way for the development of a national Comprehensive Cancer Center in the state. All research program development can go forward; the need for space would be approached through future state and/or private funding. This scenario will impact institutional budgets as funds will still be needed to remodel/renovate to support new research initiatives. This scenario is less desirable, as it removes much of the support thought essential for a successful research/training effort that would benefit institutions north and south. Page 2 of 11 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM INTRODUCTION The legal settlement made between the State of Nevada and the tobacco industry will soon result in a stable source of considerable funding that can have a significant impact on the future of the State and its citizens1. In considering the best way to spend the tobacco settlement funds on behalf of Nevada's citizens, a number of ideas have surfaced in the state and some, such as the Millennium Scholarships, enjoy considerable support2. Clearly, there are many programs that can be seen as productive ways to expend the tobacco settlement funds including public health and education programs designed to reduce the incidence of smoking and patient care efforts designed to reduce the cost burden of caring for patients with tobacco-related illness. Such a comprehensive public health plan surrounding tobacco use was conceived in response to an anticipated settlement and is summarized in considerations for spending the settlement funds described by the Attorney General3. The smoking Program Activity Areas proffered by the public health community and listed in the Attorney General's report are as follows: County Tobacco Prevention Programs ? Statewide & Targeted Community-Based Programs School Programs ? Enforcement Partnership Grants ? Statewide Multimedia Campaign Cessation Programs ? Research and Evaluation Local Incentive Funding Stopping the use of tobacco products by adults and preventing addiction in our children is a widely shared goal and will, we hope, be funded. In formulating decisions as to how the tobacco funds should be expended, however, additional good works beyond smoking cessation and scholarships can be envisioned. Indeed, the language crafted in the consent decree for the tobacco settlement funds indicates that the use of the funds to support medical research is entirely appropriate4. PURPOSE This document is intended to be a comprehensive proposal involving multiple institutions for consideration of a tobacco settlement-funded Nevada Cancer and Health Research Consortium (NCHRC) program that will change the future medical research capability and delivery of health care in Nevada. Smoking cessation is a key and integral component of this plan. This plan will place Nevada on a par with other states whose successful competition for federal research moneys is well known? and whose medical researchers set the standard for medical care in the Nation. Outlined below is a strategy that will enhance and augment existing medical scientific expertise and leadership in order that world-class medical research programs will be developed in our State. Investment in a Cancer and Health Research Consortium will create a lasting benefit for our State. THE NEED FOR THE NEVADA CANCER AND HEALTH RESEARCH CONSORTIUM The incidence of cancer in Nevada is one of the highest in the Nation and the death rate attributable to smoking is the highest6 with twenty-seven thousand Nevada citizens dying each year from smoking-related diseases. It is therefore not surprising that the incidence of smoking related cancers {primarily lung cancer) and other smoking related diseases such as chronic pulmonary diseases and cardiovascular disease and stroke are among the highest in the Nation. Over 8,000 new cases of cancer will be detected and 3,800 Nevadans will die from cancer this year. Furthermore, Nevada is a rapidly growing state and the largest segment of population growth is in those people age 55 and older, the group most at risk for developing pulmonary disease and cancer. Unfortunately, research and service efforts to combat tobacco-related diseases in the State are, to date, fragmented and unconnected. One might reasonably expect research and service efforts directed at cancer, heart and lung disease to be activities of a consortium of state-funded medical and academic research institutions. The University of Nevada School of Medicine (UNSOM) has enjoyed some successes since it was established by an act of the legislature in 1969. There has been 1 Office of the Attorney General: Nevada Tobacco Settlement, Allocation of Settlement Procedures, 1999. 2 State of the State Address, Nevada Gov. K. Guinn, January 18, 1999. 1 Public Health Issues for Consideration Regarding Nevada's Tobacco Settlement Proceeds. A Report to the Governor and the Legislature, Frankie Sue Del Papa, February 1999. 4 National Tobacco Settlement Consent Decree, Section "L" 5 Rankings of NIH Funding of Medical Schools, AAMC Statistical reports, 1998 6 US Dept. HHS, Surveillance for Smoking Attributable to Smoking, MMWR 43:SS1 June 10, 1994. Page 3 of 11 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM modest growth of medical research in the state7, but there has been little focus on research programs involving patients and directed at problems such as lung, breast and other cancers known to be directly or indirectly related to smoking. A number of faculty at UNLV have been dedicated to basic biomedical research into the causes, diagnosis, treatment and prevention of cancer that has attracted external research funding, but, until recently, there has not been an integrated research effort. Plans for a UNLV Cancer Institute emerged from regular research workshops beginning in 1998 within the Colleges of Science and Engineering. Topics under study include mammogram imaging, breast cancer, anticarcinogens, drug delivery, photodynamic therapy, cell migration and brain tumors, with faculty participating from the Departments of Chemistry, Biological Sciences, Electrical Engineering, Health Physics and Mechanical Engineering. Thus, a considerable pool of research expertise has been identified and many collaborative research projects (some involving physicians at UNSOM) are emerging. The UNLV Cancer Institute concept recently received strong institutional support through a $30,000 Planning Initiative Award. At the medical school campus in Reno, a number of cancer and cancer related research projects with national recognition have developed. These projects include everything from nutritional sensitization to chemotherapy to the development of metastasis inhibitory factors. These projects have matured in the departments of pharmacology, microbiology, physiology and cell biology and biochemistry. A National Institutes of Health training grant funds a cancer biology emphasis in the Cell and Molecular Biology graduate program. There are nationally recognized efforts underway in the department of nutrition in the College of Human and Community Sciences at UNR to quantify the impact of environmental tobacco smoke exposure in the workplace and the biological role of nutrients in disease. There are behavioral science programs both at UNR in the psychology department and at the School of Medicine in the behavioral sciences department that are aimed at smoking cessation and addictive behavior reduction. The Biomedical Engineering program, an interdisciplinary program of study involving both the School of Medicine and the UNR College of Engineering, has a number of health related projects underway in the areas of medical imaging, biosensors, drug delivery and biological effects of exposure to electromagnetic fields. A concerted effort to coalesce existing resources in order to provide a unified approach to the research, prevention and early detection of these diseases within the State is necessary. Nevada might well follow the example of other states such as Florida where $65 million of tobacco tax was utilized for the construction of the H. Lee Moffitt Cancer Center in Tampa. Such an effort seems reasonable to insure the coordination and fortification of efforts that will lead to meaningful progress in the research, prevention and early detection of these smoking related diseases. The result of this effort would be that the population of the State would not need to seek care for cancer, cardiovascular or pulmonary disease outside Nevada because the very best patient outcomes are to be found in Nevada. A Cancer Center in Nevada will thus properly align the status of research and treatment with other states in the Nation. A state-wide consortium involving researchers from UNSOM, UNLV and UNR would focus expertise and resources on the critical area of cancer research. When these independent efforts are brought together under the proposed Nevada Cancer and Heath Research Consortium, collaborative partnerships will result and will lead to increased national recognition. A Cancer Center developed under NCHRC leadership would also hope to benefit from scholarship and service contributions from both the community college and university nursing programs around the state. The notion of academic partnerships and selfless collaborations across the state for the benefit of patients nurtured by a Cancer and Health Research Consortium funded by tobacco settlement funds offers the most significant opportunity for success any UCCSN institution can envision on their own. BENEFITS OF A CANCER AND HEALTH RESEARCH CONSORTIUM The medical care expectations of an informed public are often influenced by perceptions of the expertise of its medical school physicians. At present, there is a perceived lack of expertise in many medical specialties in the state such that patients leave Nevada for medical care. This phenomenon is particularly evident in relation to cancer care and will continue until considerable expertise and reputation exists within the State. In general, Nevada does not have enough physicians. The national average is 255 physicians/100,000 population, while Nevada has only about 150 physicians/100,000 population. Furthermore, a major access issue faces Nevadans seeking the best, state-of-the-art cancer treatment. The closest Comprehensive Cancer Centers to Nevada are located in: Tucson, AZ, Duarte, CA, Orange, CA, Los Angeles, CA, Seattle, WA and Denver, CO. Therefore, to receive the latest therapies and best technologies in cancer treatments, a patient in the state would have to travel to one of these cities. Since most treatments take several weeks to administer, this places large financial burdens on Nevadans to receive the best cancer therapies. Recently, 7 University of Nevada, Reno Sponsored Projects Report, 1998. Page 4 of 11 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM several high profile Nevadans have left the state to receive cancer treatments confirming the above perception. Establishing a Cancer Center in Nevada will alter perceptions and provide much needed expertise in Nevada for Nevada citizens. The development of a Cancer Center in Nevada will accrue untold benefits. The minimum expectations include direct benefits to patients as well as non-patients and include: ? An increase in the number of highly trained physicians, increased collaboration and involvement with community oncologists and improved access to care ? Improvement in the facilities available for patient care ? Immediate availability of sophisticated testing and experimental therapies ? Improved outcomes for patients undergoing surgical interventions ? Economic benefit from cancer research intellectual property development ? Economic development from increased federal support of research programs established with tobacco settlement funds ? Improved epidemiological prediction and risk assessment ? Increased public health expertise and input to the legislative process ? Increased basic research into the causes, diagnosis, treatment and prevention of cancer While it is reasonable to illustrate our excitement about what effect the tobacco settlement funds can have on patient outcomes in Nevada by discussing a much needed Cancer Center, it is also clear that all areas of medicine, particularly those such as pulmonary disease, cardiovascular disease and stroke that are directly impacted by smoking, can also benefit and influence patient care for the better. When considered together, cancer and cardiovascular/pulmonary diseases account for the majority of deaths in Nevada. We can do something about this. PROPOSED ACTIVITIES OF THE NEVADA CANCER & HEALTH RESEARCH CONSORTIUM The immediate goal of the Consortium will be to formulate two principal broad areas of research prominence in cancer and cardiovascular and pulmonary disease in order to focus funding on tobacco-related illness. These centers will be applied statewide and will focus on excellence rather than geography with the goal of developing a balanced growth of research programs at both ends of the state. In the area of cancer research, it will be the intention of the Consortium to lay groundwork for the development of a nationally recognized Cancer Center to attract significant federal grant sponsorship. The Cancer Center will become a successful, multi-institutional program in both basic and clinical research aimed at increasing scientific knowledge and improving the outcomes for patients diagnosed with cancer. Federal Cancer Center status and National Cancer Institute funding is a logical outcome of Consortium programs in cancer research. The second area of focus will be development of knowledge and increased expertise in the diagnosis and treatment of cardiovascular and pulmonary diseases through the development of clinical and basic research. Program project grants from the National Institutes of Health will be the logical measure of success in these areas of research. In both areas of research prominence, emphasis will be placed on research programs that offer the promise of translation of results to the clinic in order to directly benefit patients. The Consortium concept is ideal in this regard since its funding opportunities will attract both basic and clinical scientist groups to come together to share funding, equipment and ideas. BUILDING A SUCCESSFUL RESEARCH AND PATIENT CARE ENTERPRISE The mechanism envisioned for the growth and development of a Cancer Center and areas of excellence in cardiovascular and pulmonary medicine and research is a proven one. Funds are requested in the Consortium's budget that will be awarded to meritorious research proposals prepared by investigators from all disciplines across the state (Research Development Grants). Only excellent grant proposals will be considered for Consortium funding. Equipment grants will provide state-of-the-art instruments to groups of investigators and remodeling funds will be used to provide adequate and appropriate space for funded research activities and new equipment. System institutions whose faculty and students benefit from Consortium funding will be expected to cooperate to provide needed space and protected time for faculty in order to assure success. Institutional overhead may be provided when essential to support meritorious projects impacts institutional goals. Training funds will be used to assure a cadre of MD, PhD physician scientist trainees that will be admitted to medical school (tuition paid) with medical research as a chosen emphasis (MP/PhD training program). Funding will also be used to support doctoral fellowships to allow them to pursue research in biomedical sciences and bioengineering. These students will conduct their thesis research in successful Consortium funded laboratories working on tobacco-related medical and biomedical cancer research. Fellowships to train physicians and PhD scientists attracted to Nevada from other Page 5 of 11 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM states in specific areas of Consortium funded research will provide the kind of critical mass and research productivity that is needed for true growth of programs. Addition of these scholars will create significant interactions among funded laboratories that will be expected to collaborate and share information. Consortium funded seminars and regional meetings will be held in Nevada to intensify collaborations and showcase Consortium funded activities. In addition, collaborative academic programs (e.g. Oncology) will be developed within the Consortium. This increase in scientific interchange will lead to the enhancement of existing and planned projects as well as the emergence of new projects. Sharing equipment and core facilities funded through the Consortium will reduce operating expenses and may well lead to increased utilization and new discovery. It is essential to ensure the development of strategic core facilities of equipment and service that will permit the growth of information and new ideas and accomplish more that any one laboratory group can on its own. Strategic cross training of faculty and technicians will lead to increased institutional scope. Funding core facilities in medical imaging, molecular biology, molecular modeling, cytometry, medical genetics, diagnostic cell biology and biochemistry, proteomics and informatics, telemedicine and other instrumentation-based cores will provide unparalleled scientific capability to multiple groups of scientists. The coalescence provided by collaboration and shared core facilities will ensure improved quality and production of existing research projects into coordinated, focused program projects and centers of excellence. Such program projects and centers of excellence will be given faculty monies (Cancer Center Physicians and Scientists) so that they, together with their departments, colleges and institutions can make strategic hires of new physician and scientist faculty that will ensure success and eventual national prominence. NEVADA CANCER & HEALTH RESEARCH CONSORTIUM: ORGANIZATION An executive committee will manage the Nevada Cancer & Health Research Consortium (NCHRC). The consortium director will be a successful medical researcher appointed from UNSOM joined by two associate faculty directors (one each from UNR and UNLV) and the vice president for research from UNR and the associate provost for research from UNLV. This governing body can add representation from other UCCSN institutions as deemed necessary. The goal is to be inclusive. The executive committee will be responsible for: ? Through UCCSN, providing expert advice to the State regarding tobacco funded programs and the most successful direction for medical research investment in the State of Nevada ? Providing specific justification for ongoing allocation of tobacco settlement funds to the NCHRC ? Allocation of consortium funds to UCCSN projects and programs on a competitive basis ? Promoting successful research interactions among system faculty and students ? Organizing semiannual research meetings and symposia to highlight Nevada research and promote growth of programs and collaboration of faculty. ? Establishing and developing a Cancer Center at the School of Medicine ? Providing yearly progress reports on the success of NCHRC investment in specific research projects ? Developing successful interactions with other local, state and federal agencies with a stake in NCHRC funded projects The consortium executive committee, to assist in developing a strong competitive research program, will establish a scientific advisory board composed of successful medical researchers from other research-intensive schools of medicine. The executive committee will identify individuals with interests in cancer and health research from each campus and have group meetings with these individuals twice a year. Meetings will focus on research progress, consortium planning and promoting knowledge and interest in consortium programs and opportunities among faculty and students. PROPOSED BUDGET The proposed budget represents a significant investment in medical research throughout the State. The State of Nevada, while not having previously made such a large and concentrated effort to fund medical research, has seen the wisdom of research investment as with the Applied Research Initiative. It is the intention of the NCHRC to make a similar effort to return a significant profit on investment by stimulating research into the causes of; and the treatments for Cancer and other tobacco related diseases. Many areas of research will likely prove profitable. Advances in basic knowledge in areas such as surgical techniques; cancer diagnosis and screening; pharmacological treatments for cancer and heart and pulmonary diseases; nutritional approaches to avoiding risks and increasing good therapeutic outcomes in cancer and cardiovascular disease; antibody therapy for cancer; gene therapy for cardiovascular disease; transplant strategies for treatment of heart and blood vessel diseases; application of advances in genome research and basic biomedical and biochemical research. Page 6 of 11 NEVADA CANCER & HEALTH RESEARCH CONSORTIUM These profitable outcomes, often described as translational research accomplishments, result in both applied and basic research and will be fostered by increasing the interactions of scientists across the State. Our philosophy will be to fund good programs in order to build them and make them more competitive and productive. The result will produce an enormous positive impact on economic development and immeasurable benefits to the citizens of the state. The investment made now can be assured to translate into successful growth as we train additional scientists, particularly with the proposed M.D./Ph.D. program envisioned as a joint program between UNR and UNLV and open to all students without reference to financial resources or campus location. Indeed, the consortium would fund tuition for these students on a competitive basis so that the fledgling cancer and health research programs can attract the very best future physicians from across the State. Addition of medical school training positions for both pre and postdoctoral fellows funded by the NCHRC will solidify these opportunities and can lead to significant growth for specific research programs and for the state research enterprise. Many of these researchers can be expected to remain to practice in the Nevada under the auspices of the Cancer Center or cardiovascular and pulmonary centers of excellence and, wherever they practice, increase the medical research and patient care reputation of Nevada. In formulating the budget options shown below, the Consortium is mindful of the tremendous interest in allocation of the tobacco settlement funds to many deserving special interests. We have prepared this plan with our own significant expertise in the successful management of research and medicine and offer what we believe will be a tremendously successful and partially self-sustaining enterprise. Our full request of approximately $7 million dollars per year will translate into many specific successes but just as importantly, our medical research enterprise in Nevada will be forever changed for the better. In addition to research and infrastructure enhancement, the first four years of the budget will include funding for building a Cancer Research and Patient Care Center at the Las Vegas Technology Center, a developing research park at which both UNSOM and UNLV have land dedicated to research activities. This facility would allow close interactions between UNSOM and UNLV researchers in conducting basic and clinical cancer research. During years 5, 6 and thereafter, more of the funding will be devoted to supporting these research efforts. The funding will allow our researchers to be competitive on a national level and our citizens will want to think of care in state, not in California. Indeed, perhaps we will see some patients come from outside the state to Nevada for their care