"It’s what I’ve always wanted to do."

With that one sentence, Mark Cullen, MD (professor, general medical disciplines), summarizes how he feels about his appointment as Director of the new Stanford Center for Population Health Sciences.

We’ll go there in a few paragraphs, but first let’s go back. How did he get here?

At the Helm of the Division of General Medical Disciplines

Six years ago, Cullen was invited to take over the Division of General Medical Disciplines, which had a faculty of 26, four hospitalists, a small primary care group, few research aspirations, and no grants. The Division puttered along for awhile as Cullen recruited academicians and began to make a bit of progress. And then the wind began to change direction.

“The institution decided to turn sharply towards developing a real clinical health care system,” Cullen said recently, “which had not been an ambition previously. To have a real health care system you have to have a robust strategy for aggressively managing patients in the inpatient service. You can’t do that without primary care. You need geriatrics. You need palliative care.”

“And there I was standing in the middle of the highway. I am very proud of how well it was built. I recruited people with tremendous strengths in a lot of areas, such as building a primary care program. Sang-ick Chang, MD (clinical professor, general medical disciplines), who is one of my successors as Chief of the Division, played a huge role in how primary care came about.”

“All of a sudden General Medicine was ranked in US News & World Report. We moved from being almost invisible to being pretty credible and interesting. I think we captured everyone’s imagination and attention.”

When Cullen left the Division this month, it had 166 faculty and a budget of about $40 million. And two new co-Chiefs: Chang and Steven Asch, MD (professor, general medical disciplines), who Cullen described as “one of my most successful recruits.”

Creating the New Center for Population Health Sciences

When Bob Harrington, MD (chair, medicine), was recruited to his current position in 2012, one of his stated responsibilities was directing the development of a Stanford Center for Population Health Sciences. Initial discussions happened coincident with early mention of the Big Data initiative and, as Cullen puts it, “new opportunities created in that space.”

To begin to plan the core elements of the Center, Harrington pulled together a committee of three -- Doug Owens, MD (professor, primary care outcomes research) plus himself plus Cullen. Over the past two years, they were joined by Lorene Nelson, PhD (associate professor, health research and policy), Abby King, PhD (professor, health research and policy), and Jason Wang, MD, PhD (associate professor, pediatrics).

Progress was slow but steady. Cullen describes early efforts: “We had an initial symposium a year ago, which was very well attended. We have had a series of interest group meetings about once a month, in which we solicit interest around the campus in our doing this [creating the Center] yet there was no staff, there was no budget, no defined agenda.“

Not long ago, Cullen continues, “a decision was made at the Dean’s level to pull the trigger and move forward. They asked me if I would take it on as a fulltime responsibility. It’s what I’ve always wanted to do. I’ve been looking forward to this opportunity for a long time, and I wasn’t sure if or when it would ever fall to me.

I’m incredibly excited by the opportunity.

“While it is not clear exactly how it is all going to play out, this is the basic idea: There is about to be a new department at Stanford in biomedical data science, which will include three types of faculty, initially all drawn from existing departments: biostatisticians and informaticians as well as people working on the applied sciences of those two, for example people who are studying the application of the informatics of electronic health records. We are critically relying on that department to establish what we are affectionately calling the Hub, which is going to be a place where data will be managed but also where there will be liaison services so that any investigator who needs a partner in one or more of those disciplines can hook up with them and do work collaboratively.”

Bringing Data In-House

To get the Center up and running, Cullen says, “We have asked faculty across the campus to express their interest in becoming faculty affiliates of the Center, to express their interest in various data assets that we could acquire, and asking if they would be interested in exploiting those assets if we spent the money and did the legwork to get them here. The main thing we are trying to do is broker relationships between the faculty of the seven schools at Stanford and a key role of research opportunities created by access to people, to material (e.g., biobank material), and a lot of secondary data that has been collected on large clinical populations.

“The first things we are buying are Medicare and Medicaid and big commercial insurance databases. Most people have no chance of being able to either afford them or manage them themselves. It appears from our survey that there are 50 faculty on campus interested in working with one or more of those datasets, yet only a few have been able to up until now.”

Working Groups

To corral together the data and groups of faculty, fellows, and residents interested in using them on research projects, Cullen plans to create working groups of like-minded people from literally across the Stanford campus. “I envision finding people who want to work around common themes. For example, one that has emerged out of my own work is the whole question of later work life, workability, retirement, disability, healthy aging. There is huge interest in this area from an amazing array of people coming from biology, social science, and medicine who are very interested in better understanding the transition to later phases in life. Economists are interested, ecologists are interested. Others might include health economists, psychologists, sociologists, biologists of aging, immunologists, and geneticists looking at biological changes that occur to the genome over time. This epitomizes what I imagine one working group would look like.

“One thing that I would really love to be able to do, which depends on my success on the development side, is to be in a position to fuel working groups by helping them set up grant challenges so that they in turn can pick things that they want to achieve in one, three, and five years. I’d also like to develop a prize structure so that I can richly reward groups that succeed in meeting grant challenges.”

Two Possible Projects

Several projects are already in the pipeline: “We are developing a strong relationship with the Danish biobank,” Cullen explains. “This is a national insurance registry with health claims data, access to social and economic data, and -- fabulously -- biologic material on almost every citizen of the country. We are hoping to be able to make that resource available to investigators who have an appropriate kind of question.

“And we are spending a lot of resources working with Santa Clara County in the hope that ultimately it can become like Denmark, so that we can encourage health information exchange, to get all of the six health systems that operate in the County to be able to exchange clinical data in a way that investigators can get access to it. Then they can merge it with environmental data and other health department data to create a population-based laboratory.”

A One-Year Goal

With such a large and far-ranging vision, how will Cullen measure success at the end of one year? “I’d like the Center to be sufficiently well-structured and -resourced so that I don’t have to say to people, ‘Oh, it’s a new center.’ To be at a point where no one would guess that to be the case. I want it to look mature in the sense that we have the administration under control; that we’ve garnered sufficient resources that we can make commitments to allow different departments around the institution to hire new faculty that would be ideal to help me develop the mix of people that I want in the Center. I am hoping to use the first year to get a lot of things off the ground. “

Will It Succeed?

Cullen is confident: “This is Stanford. We are very physically close together and we have a track record of being able to work together. Now all we need to do is fuel it and facilitate it.”

The Chair’s Input

Reflecting on working with Cullen in a couple of capacities over the past three years, Harrington said the following: “Mark did a great job leading and building an outstanding Division of General Medicine with transformative growth across all three missions.  He excelled at recruiting outstanding faculty talent and was clearly a visionary in seeing where general medicine could be at Stanford.  We are deeply appreciative of his leadership, his guidance, his collegiality and collaboration across the entire Department.  

On a more personal level, I am indebted to him for his personal friendship and support since I arrived at Stanford in 2012.  I look forward to him doing equally great things as the inaugural director of Stanford's Population Health Science Center, and I look forward to working with him on that.”