Essay

“. . . For academic medical centers, the 1990s were the best and the worst of times. It was an age of rapid and unsettling change in health care, largely brought about by the advent of for-profit managed care. It was also an age of great hope and excitement and a doubling of the NIH budget -- a most promising era in the history of biomedical research.

"And during that decade, Duke adapted to both of those forces, evolving into a very entrepreneurial, highly innovative new model that developed real-world solutions to health care problems. We revolutionized both our structure and our mindset, turning Duke into an academic engine that created new care-delivery and translational-research models that truly improved the health of society.”

• Academic physician-scientist turned biotech industry pro returns to Duke to take the helm 
• Game plan: Make Duke an innovator in biomedical research 
• Crisis/opportunity: the advent of managed care 
• Drs. Califf and Topol run clinical trials with GUSTO 
• Unprecedented DCRI revitalizes clinical research, permits “unbiased and accurate analysis” 
• The competition within: the battle for revenues amid incredible shrinking clinical margins 
• Inventing the wheel: DUAP enables a “hubs and spokes” model 
• Joint venture adventures 
• Birth of a health system