Levi Adams had his capable hands on every block of the medical program’s foundation. Fifty years later, he reflects on those heady times.
In the history of medicine at Brown, one figure looms large. Vice President for Biology and Medicine External Affairs Levi Adams, MS, touched nearly every facet of the fledgling school—from recruiting faculty and establishing clinical rotations, to supporting the first students, to convincing a skeptical university, to garnering support from Rhode Island legislators. He was instrumental in establishing the Early Identification Program with Tougaloo College in 1976, and the Office of Diversity and Multicultural Affairs in 1981. He led the first fundraising campaign in the early ’70s to support medical education, raising $20 million ($140 million in 2023 dollars), and helped create a medical alumni association.
Glenn Mitchell, a member of the first graduating class, sat down with Adams to get the full story of how he helped make it all happen.
Why did you join Brown?
Specifically, to help the University come to a decision about whether or not the University should move from the Master of Medical Science (MMS) program to an MD program. This was not an easy decision. We had opposition from University faculty and opposition from some people in the community, including some in political leadership. But there was opportunity. I guess the real task was to see if we could put an MD program in place that was not going to bankrupt the rest of the University. That was the biggest concern on the part of the non-biomedical faculty.
The second one was that we were going to change the nature of the University. Brown was basically a liberal arts college, and they were concerned that we might bankrupt the programs that were hard to finance because it was going to take so much more money to run a medical school. It was not a slam dunk. The naysayer constituencies off campus were also significant and political. But we—the original Brown medical school leadership—saw this as an opportunity to build something special. I always said, “We will build bridges in order to build trust.”
Who were the rest of the leadership team? The MMS had been around since the first students from my undergraduate class entered Brown in 1963.
Remember that Brown was a very strong institution with roots back to 1764. The recently developed “new curriculum” made the College attractive to applicants, but biology was well short of its potential. We were talking about bringing a campus-based enterprise that would strengthen biology and the biological sciences, making new opportunities to collaborate and to seek grants, new opportunities for faculty to pursue things that needed to be explored. Professor Fred Barnes was a key, and in fact he was our first representative to the group on student affairs at the AAMC [Association of American Medical Colleges].
The people on campus included Fred, but there was a core of people who became part of the biomedical faculty. It was already called, because of the MMS program, the Division of Biology and Medicine. And many were resistant to calling things “medical”; you may recall that we didn’t call it a medical school at first. We called it a Program in Medicine. That was in part related to the University faculty who saw Brown as a liberal arts college only and not a professional school and all that that implied.
I believe Dr. Pierre Galletti was most responsible for building bridges that would make sense to everybody. One of the key bridges—and Pierre was a national leader in this—was biomedical engineering. He and Peter Richardson in the Department of Engineering were the key leaders in this area.
They developed a program that involved PhD students and students who were going to be going to medical school, but who had an interest in biomedical engineering research … well, Pierre used to call it “the spare parts for the body program.” It was very successful, and we had a great reputation at the NIH in this area. Glenn, I believe you were part of that research team.
Yes, during my first year in the program, in 1971, I participated in the laboratory animal studies that developed an early artificial lung machine.
Pierre also had a solid reputation among bioengineering people across the country and around the world, and that evolved even more with him here. So, he was the right person at the right time, a good sense of management and a good sense of trying things that people say, “you can’t try, we can’t do.” We had the right person with the right experience, but there were still other things that needed to be developed to start the medical school.
You may recall when we got the school underway we had community health as an integrated unit with sociology. The sociology faculty had done a lot of things related to medicine, but they were definitely established in the sociology world. Our first community health chair was Dr. Al Wessen. Al had previously spent time at the World Health Organization in Geneva dealing with issues of health care and education. We also had Dr. Lois Monteiro, who was an outstanding community medicine and sociology-oriented, PhD-trained nurse. They taught classes in the medical track as well as regular classes in the University. It was great for all sides. We had all these medical students and all these non-medical students: some were premed, some were pre-engineer, some were other things. And they all felt very much at home with the biomed faculty.
Many of those folks made the difference. … They made the bridge between the College and the evolving medical school. Still, one of the concerns was that if you start hiring all these high-price investigators, it’s going to change the nature of the institution. Well, it did change the nature of the institution some, but not for the bad. I guess one of our contributions was helping University faculty at large begin to understand there was something called indirect cost associated with grants. All the medical schools at that time had indirect costs of about 52 percent connected to their external funding grants. Thus, for every dollar you got as a researcher, the administration got another $1.16 or something close to that. So, if you wanted to build University facilities, if you wanted to keep great Brown faculty overall and bring new faculty, you had the money to do it. It wasn’t taking the money from the rest of the University. We expected our faculty to apply for grants and get grants so we could build the medical school enterprise. And the better the medical school was affiliated with a strong undergraduate institution, the more likely we were to get funds that were at that bridge level between undergraduate education and basic biomedical research.
And how did the clinical training system come together?
The success of the medical school really depended on having a respected and respectful department of medicine. We had the problem of having five hospital medical departments, including the VA, that were going to be key. What we wound up creating was a rotating chairman in medicine: Paul Calabresi at Roger Williams, Milt Hamolsky at Rhode Island Hospital, Bob Davis at The Miriam, and Mario Baldini at Pawtucket Memorial. We couldn’t just say all chairs of medicine are going to be at Rhode Island Hospital. We deliberately rotated the position so we could avoid conflict and grow. It was challenging because Dr. Calabresi was the most renowned. He was recruited to head the FDA, but he turned them down while he was at Brown, and he went from being at Roger Williams as chairman of medicine to being at Rhode Island Hospital. He had come out of the medical system in Boston, and he was well known as a superb clinician and investigator.
We decided to build the clinical experience around having strong departments of medicine and surgery. Drs. Calabresi, [Henry] Randall, and [Fiorindo] Simeone were the key to that. By the time the first classes were ready to begin clinical work, we had rotations that went to Rhode Island Hospital. As quickly as we could, we expanded to other hospitals. By that time, we were ready to create a family medicine department, which we didn’t have initially. Dr. Dave Greer joined the faculty from private practice and led that effort. We deliberately based him at Memorial Hospital to beef up its profile among our clinical facilities. To keep things coordinated, we formed a group, called the Brown CEOs group, which I chaired, of all the CEOs of all the hospitals. We met every Friday morning. …
That approach thrived for a few years, but there were financial problems at several hospitals. By the time I was leaving, we could have worked through some of those things but we didn’t. So, we lost some good faculty. We didn’t miss the opportunity to appoint new people on the faculty, but we had very stringent requirements for the hospitals. Enough could not be said about the hospitals’ investment. We couldn’t have
built the clinical faculty without the hospitals and money. The hospitals put up almost all the money to hire the people that built the hospital-based faculty.
Residency program growth was good for the hospitals because they got solid residency programs. They also got good research. They embraced income from indirect cost better than the people on campus.
You can imagine trying to keep all these things together was not easy, but we got the CEOs to have, in a sense, a kind of comradeship. We had breakfast on Friday mornings with them—Pierre, Stan Aronson, Bill Hall (our businessperson), and me chairing the meeting. And we met every Friday for maybe nine or 10 years. I think that it was when Dave Greer became dean that they stopped having meetings. But by that time, everything was mostly in place.
As I remember, we were looking back through the things that led up to the MMS, and what they were trying to do was to build a school that would generate graduates who would be academics and scholars. The new medical school would be more humanistic, although still rigorously academic.
How helpful was the state in all this? How did they contribute to the school in the early days?
It was interesting. Before the Corporation decision to extend the program in the winter of 1972, the state budget for the coming year had to be made. Then-Gov. Frank Licht [’38] was persuaded to put money in the state budget. It wasn’t very much—around $600,000. We got funding because we made the case for what medicine was going to do to help the people of Rhode Island. Legislative support was bipartisan because the minority leader, Rep. Fred Lippitt, also served on one of our planning committees.
Then we worked with the Finance Committee chairman in the House to get it through. The House Finance Committee was really the strength. Ultimately, we had support that ran for about 10 years, and we finally recognized Rep. Jack Revens, who helped us. I spent hours with him, getting that initial bill passed and getting the school into the state budget for those subsequent years.
We ultimately had a conflict and then-[Brown] President [Vartan] Gregorian said, “We don’t need them because they want to run the place.” At the time, we were getting about $1 million in the budget annually. By that time, we had what we needed to start the program. And another twist was that we were successful in accomplishing our promise that we would be good for the state’s health. We were, remember, exporting complex patients, mostly to Boston at that time. Eight years later, that had turned around and we had a net number of patients coming to Rhode Island, specifically on the track between Rhode Island and Southeastern Massachusetts and the area between Attleboro and Foxborough. So for the first time, there were more patients being billed from our Rhode Island hospitals that came from Massachusetts than there were being billed by Massachusetts for patients from Rhode Island.
We asked the [state]director of health, Dr. Joe Cannon, if we could get the medical school support appropriation put in his budget. We didn’t want something that was direct to Brown. It was going to go to an established department within the state structure. And it had to be defended by the director of health rather than depending on the representatives from the East Side. We then had a number of Brown-affiliated people hired by the health department. They became faculty members working out of the Department of Health and working for Brown, mostly in community health. … That was a strategy that really gave us some strength. We were able to say to the Corporation, look, the state is already putting money in the budget and Brown hasn’t made a decision yet. With state support, the other part—getting federal money—was easy. We got an appropriation from the feds, under the Pell Amendment to the Manpower Act of 1971. I spent time in Washington. I had a little side office to myself, and we lobbied the other medical schools to support us. The bill was fairly strong, and we also had [US Sen.] John Pastore, who was the chairman of the Senate Finance Committee.
Thus, we had two powerful politicians in Washington with Sen. Pell on what was then the Health, Education, and Welfare Committee, now Health and Human Services. Pell was a powerful Democrat at the time. So, we were literally on the phone writing the text of the Pell Amendment. Pierre and I, with Kevin McKenna from Pell’s staff, were all working on it. The result was that a little over $3 million got into the budget for the new medical school. The bill specifically benefited schools that were going from a two-year program to an MD program, because there was a great push to increase the number of doctors graduating from medical schools in America at that time. We took advantage of that because there were six schools that had two-year programs, including Rutgers, Dartmouth, North and South Dakota, and Hawaii. Dartmouth had already made a decision to increase the size of its school, but they had a lot of students who were being trained there to go elsewhere to finish their medical education because they didn’t have enough clinical facilities in New Hampshire. And I was in touch with all those schools all the time.
How confident do you think senior leaders were that we would be successful as a medical school? Was it sleepless nights or was it easier than that?
I think we were cocky. Pierre and I and Professor Merton Stoltz, who was provost, were optimists. In fact, Merton was the most influential person in University Hall who pushed the medical school idea along before the final decision to have a full MD program. The year before the decision, Brown didn’t have a president, and we had a national search. Fortunately, new President Donald Honig turned out to be a solid supporter of the medical school. Overall, we had good support from University Hall, primarily through Merton Stoltz, and some key people on the faculty who—once we persuaded people that we weren’t going to take money away from English and philosophy and the rest—were on board. And the MMS students helped because they wanted to develop undergraduate electives and concentrations that had medicine or health care topics as a focus.
Those kinds of links we made throughout the University, and we supported other programs that wanted to develop innovative programs. Don’t forget that a university is a very diverse place, and there are resources you wouldn’t imagine that you had. We had many students who were not already selected as medical students, who went on to medical school, but who benefited from having all these medical people around during their undergraduate experience.
What else could you tell me about the early days of the medical school that I haven’t asked you?
Understand that our mission, as Pierre and I saw it, was to build bridges. We haven’t talked very much about the community, but we were involved there. The health centers in Providence were going to go belly up. So I led a group of people, created a new organization called the Providence Ambulatory Healthcare Foundation, and petitioned the federal government to transfer leadership of the centers to our group, which they did. It included Dr. Charles McDonald, me, and ultimately Dave Greer later on.
The health centers never closed, but the feds were about to withdraw support from them until I said, let me take a shot at it. So we were very much a part of the community. I went to the Cathedral of Saints Peter and Paul with a group of people from the community to talk about what we were going to do now that we were solvent, and the feds are not going to take the money away. We asked people throughout the medical school from time to time to make in-kind contributions. …
Brown has benefited greatly from having the medical school available, having medical faculty around, letting some participate in university courses, because there is tremendous student interest, not only in medical ethics, but the whole health economy. There are students in economics who have an interest in doing special studies. Brown is the best place you can be to do that kind of thing.
We have a good reputation nationally in diversity, equity, and inclusion partly because I was involved in creating a group of minority health educators called the National Association of Medical Minority Educators. I served as its president for three years. We encourage our faculty who had research interests to pursue those interests. You do it because you have an interest in building bridges.