Will Brown’s BIRCH Collaboration Bring Better Health Care to Providence?

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Unsplash/Niah Moua

Earlier this year, Brown University heralded the establishment of BIRCH, the Brown Innovation Research Collaborative on Health.  When the university on College Hill announces a grand new health care initiative, it commands our attention. The partners in BIRCH are The Warren Alpert Medical School, The Brown School of Public Health, Lifespan and Care New England as well as the Veterans Administration Hospital. In its first announcement in 2022, the focus was squarely on these various institutions: “We selected this name based on input from leaders at all levels of the research enterprise, across our institutions. We believe it comprehensively reflects our vision.”

To date, however, there has been scant information to expand on the announcement or to explain exactly how the lives of the citizens of Providence will be affected. In fact, few people are even aware of these ambitious plans.

To see what this new initiative has in store for the residents of our city, The Providence Eye reached out to Mukesh K. Jain, MD. Jain is Dean of Medicine and Biological Sciences at Brown and head of the Warren Alpert Medical School. In office since March 2022, he is the eighth person in fifty-one years to fill the dean’s position.

Dr. Muskesh K. Jain, Dean of Medicine and Biological Sciences, Brown University    
Photo: Nick Dentamaro/Brown University

Jain went on to explain that last year, spring of 2022, just prior to the BIRCH announcement, Rhode Island Attorney General Peter Neronha and the Federal Trade Commission (FTC) had denied the request by Lifespan and Care New England to merge. Brown had strongly supported the merger.

Holly Vedova, director of the FTC’s Bureau of Competition, explained that the merger would have created a health care conglomerate and been detrimental to the competitive marketplace. “The merger as proposed by the companies would see the joined entity control at least 70% of Rhode Island’s market for inpatient general acute care hospital services as well as at least 70% of the market for inpatient behavioral health services,” the FTC stated.

The parties were therefore left without a clear path forward. Jain observed, however, that they still shared a keen interest in working together. Research remained an area of focus and thus, BIRCH was born. “The BIRCH effort will allow us to streamline the administration of research thereby making it easier for investigators to initiate and carry out large collaborative research projects…. BIRCH will also lead to increased recruitment of the best and brightest faculty and trainees to our community, enhance access [to] cutting-edge lifesaving clinical trials, and stimulate biotech/biopharma to locate in Rhode Island.”

As part of the effort, Brown has committed to an investment of $20-25 million over five years. Neither the City of Providence nor the State of Rhode Island are expected to invest funds; however, laboratory properties are tax exempt thereby giving a tax advantage to the university.

Brown also intends to build an Integrated Life Sciences Building at 70 Ship Street in close proximity to the Alpert Medical School and facilities of both Care New England and Lifespan.

Jain lauded the fact that scores of new jobs will be created “from research faculty, doctoral level scientists and physician-scientists, research administrators and research personnel.” Obviously, beyond these core employment opportunities additional jobs will be created to support staff. Small business growth would be expected to expand to serve the growing population.

Dean Jain believes BIRCH has the “potential to build a thriving life science economy and establish itself as a destination for the biotech industry. BIRCH also gives us a distinctive advantage by aligning clinical and basic science research more closely. The School of Public Health is also a critical part of BIRCH, so we are able to complete the full research continuum of what we call “pipette to patient to population” – researchers making discoveries in the lab; testing and refining their therapies and technologies with patients; bringing these life-changing therapies to people who need them; and then studying the societal impact.”

Retired surgeon Steven I. Cohen, who also served on the clinical faculty of Alpert Medical School for forty years, hailed Brown’s growing investment in research: “The three elements essential to delivering optimal medical care are education, research and patient care. A strong research component will attract funds as well as talent. The result is better medical care. Discoveries made in research create an environment in all aspects of health care delivery that is of direct benefit to the patient.”

Brown has already recruited outstanding faculty in cancer, brain science, immunology, and RNA biology.  Some are physician-scientists who see and treat patients in Rhode Island but also do research. They are on the frontlines testing and implementing the newest therapies through clinical trials.

Jain makes it clear that the impact of BIRCH will extend far beyond research advances. Brown has recently “recruited one of the nation’s leading researchers in frontotemporal dementia, Ted Huey, to Brown and the Butler Hospital Memory and Aging Program. While he sees patients at Butler, he’s also studying Alzheimer’s and other dementias with investigators in the Carney Institute for Brain Science. Whether you live within the city limits of Providence or in another part of the state, citizens will continue to benefit from having access to top-level medical and scientific expertise right here in Rhode Island.”

The founding of Brown’s medical school only five decades ago – now named the Warren Alpert Medical School – transformed health care in Providence and the State of Rhode Island. The health care industry spawned by that development is now a multibillion-dollar industry known to virtually every citizen of Rhode Island who seeks health care. Jain paints a very optimistic picture of the future of health care in Rhode Island. He sees the Brown medical programs as instrumental in improving the lives of the residents of Providence.

Of course, there are those who greet BIRCH with some skepticism. Michael Fine, a physician who has long been involved in health care policy and served as Director of the Rhode Island Department of Health under Governor Lincoln Chafee is passionate about the lack of access to primary care. He believes that the financial investments in biotechnology and focus on research actually further skews delivery of medical care. Fine observed that, “The cost of health care in the United States is twice what it is in other developed countries in the world largely due to an over emphasis on biotechnology research. Yet, sadly, only 43 percent of the United States population have a primary care physician.”

Fine’s point is well taken but as proponents point out, that is not the focus of BIRCH. On the other hand, the problem of access to primary care is one that Jain has addressed publicly. He has pledged that the Medical School will address this challenge in the future. (The Providence Eye will continue to cover the issue of access to primary care and Brown’s involvement in the future.)

Fine added that: “The public health benefits of biotech are most meaningful when everyone has access to primary care. If we could reach the whole population with the evidence-based prevention we’ve already developed, we’d anticipate huge public health improvements, while too many new therapies help only people who can afford them, with little measurable public health benefits despite substantial costs.”

If BIRCH is successful, it will clearly have a major impact in Providence. Health care is one of the two largest sectors of the Rhode Island economy. It generates six and a half billion dollars of economic activity. The two hospital systems- Lifespan and Care New England – alone employ 24,000 people. Providence’s economy is obviously dependent on this industry and The Warren Alpert Medical School is the driving force in its future expansion and success. Since its humble beginnings in 1972 the Brown Medical School has enjoyed extraordinary growth, particularly in the last two decades. Providence would be a very different place without it.

The story of how BIRCH will affect Providence will unfold over the next several decades and the details are yet to emerge. Whether or not it impacts the equitable distribution of health care across communities is still to be learned. What we do know, however, is that Providence’s future is inextricably linked to what happens to Brown’s medical school and the affiliated institutions. The local economy is profoundly affected by what Brown does. The University’s expansion touches the lives of virtually all the citizens of Providence in one way or another and BIRCH is no exception.

Note: Dean Jain’s responses have been edited for clarity and space.

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Fraser Lang is the retired publisher of The Block Island Times and Manisses Communications Group Inc, a provider of periodicals and reference works for mental health and addiction professionals. He is a trustee emeritus of Brown University and served on the Corporation Committee for Biology and Medicine.