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SMOOT: Dr. Markesbery, last time we were talking, we brought you up to where you had--(Markesbery clears throat)--joined the University of Kentucky at this time as a member of their faculty. I would like for you to tell me a little bit this morning about your impressions, just to get us started, about your impressions, uh, of the faculty and of the institution that you were coming back into and you may carry on, if you would, chronologically up to the present. Tell me about your impressions of the development of this institution, the university institution, Medical Center in particular, of course.

MARKESBERY: Okay. And you want me to discuss quality, or what is it you really--

SMOOT: Yes, sir. I want you to tell me your impressions about the quality of the faculty, the quality of the students, the quality of the physical plant, uh, a variety of factors, anything that you may not have touched upon, and I think I can probably catch in a cover up question.


MARKESBERY: This is when I came back here in 1972, is that correct?

SMOOT: Yes, sir.

MARKESBERY: Okay. Well, number one I was--we have to put it into context of my excitement and enthusiasm of coming back to an institution where I had started, but you also have to put it into context that I was--I had been at two excellent medical centers, one Columbia Presbyterian Medical Center and the University of Rochester in Rochester, New York, both of whom were considered to be, uh, first-class medical centers and first-class college of medicines and very good places to train, uh, staff. So, my--those are my comparison yardsticks. I had looked at job opportunities at other places and had 00:02:00that as a yardstick comparison for judging the quality of those medical centers. So, those are my preliminary background statements, I would have to say. Um, the physical plant was in the process of changing when I came back, they were adding new buildings and adding new, um, it seemed like administrative components. The Medical Center as a whole had grown in terms of the College of Pharmacy and the College of Nursing, uh, Allied Health, all of those things had grown considerably, but I didn't have a very large understanding of the administrative structure at that point, which I have subsequently gained, uh, through wasting all that time in administrative things. Uh, the plant was 00:03:00growing, and the place was growing. The, um, I thought I detected the same degree of enthusiasm that was present in the faculty. The faculty was much larger when I came back, uh, and there were a lot more students than we used to have. But, the size of the place had grown, uh, considerably. The VA Hospital was about to open, and there was a larger patient base, as well. So, my view was that I thought I detected the same amount of enthusiasm in the, in the faculty, but as time went on over the next three to five years, I could see that the, uh, enthusiasm on the part of the faculty for the routine things like teaching and clinical care was not quite the way it was when we 00:04:00first started. And, I suppose that's part of the maturation process, you, uh--I guess it's like having your first child--you, your first child. Your, you watch every move they make. Uh, you watch over them so closely that they're probably smothered, and I think that's probably what happened the first three classes here, and I don't think a faculty could be expected to replicate that, but the individual attention that we got as one of the early--as the early class, uh, didn't seem to be present, although there was the same striving for excellence here that, uh, I had found before. Then as time went on, it seemed that more faculty members were, were leaving, perhaps was a--that is good faculty members seemed to come and go, uh, go onto perhaps better institutions or to, um, to better jobs up the academic 00:05:00ladder, that is chairmanships, uh, associate deanships, uh, perhaps to better institutions in some instances. So in that regard, there has been a drain on the University of Kentucky Medical Center, um, good people going to other places, and in that way, we've, we've sort of served as a--Kay Clawson always said we were sort of a farm system for some other medical centers and they came and took our good people after we developed them here. I'm not sure that's necessarily true. If you're a baseball fan, you know about the pharmacist, and it does seem like some of our people have left. The, uh, spirit of the place has changed because it has grown and become larger. Its lack--it lacks 00:06:00a smaller cohesive atmosphere that was here when I was initially here, and I, again, I think that's part of maturation, as well. I suspect that is the same feeling we had at Rochester and the same feeling at Columbia. It was very--both very large places, and therefore, there was, it lacked the individual attention that we had initially in this, in this Medical Center, and I think that has continued to grow into the present where it has become a more impersonal place. I don't say this critically nor negatively, but it's not, uh, it doesn't have the personalized attention for faculty or students that we had, uh, back when, uh, the Medical Center first opened. Um, the plant has grown considerably, and, uh, I suppose that's good, as well. We have a lot 00:07:00more buildings, and although there are chronic space problems, there, as there are in every medical center, um, it seems to me we have spread out and grown a lot more. There is a, there is a certain concept in this Medical Center that everyone wants to still be in the medical, in the hospital building or the Medical Science Building, and for them to move out of that mainstream, for instance to come to Sanders-Brown or to go to one of the research buildings, gets them a little further out of the nest, and, uh, if you've been in the other medical center, you know they are scattered over large areas, and this one has remained small enough that conceptually, people want to stay in the cocoon, so to speak, and, uh, I think we have to get over that, and I think we are gradually. There are some people in our building here at Sanders-Brown that sort of still have that feeling, but we are kind of 00:08:00breaking that barrier in a way. I think the growth is good. I think the administration is doing a very good job, uh, in running the place. No one says that, uh, in the lunchroom, that's where everybody--I don't happen to go there very often, but it seems that's where all the gossip is and the continual damning of the administration, but I think if you get on the inside and look at the major task the administration has, you can see I think they are doing a good job, and there are a lot of constraints on this College of Medicine and the Medical Center and university administration, as well, and I think that the constraints are also from within the state and the state political system, uh, and perhaps may interfere with the complete development of excellence. I'm 00:09:00not much of a politician, but th-, these are some of the things I view, there are lots of political constraints on the university, and, uh, they are passed down to the administrators of the Medical Center and the College of Medicine, and I think they do a very good job in running the place, and it's a thankless job because you can't ever win, seems to me. But, bottom line is that I think we've grown. We've become more impersonal. I think the quality of our medical students, um, the quality that I see, and this will sound a little arrogant, isn't quite as good as it was, uh, initially. We're taking more students, and I think our lower--the lower third of our students aren't quite as good as they should be. The upper two-thirds, especially the upper third, are good as they ever were and will compete with students most anywhere else. I think our students don't, uh, strive or not led to be--I'm not sure what, which, uh, to be as scholarly as they are in some larger 00:10:00medical centers. That may be a statement about the times we're living in, but they are not nearly as many people in this, in the College of Medicine that go into academic medicine or scholarly pursuits, and I think that, that's a mistake, and it may be a mistake that we're making to the faculty. It may be the attitude of the students, it may be the background of the students, but we see very few going into to, uh, into academic pursuits. We see very few going to excellent residency, internships and residency, um, an awful lot of mediocre residency programs and internships are the ones that our students seem to choose, and I'm a little, little bit concerned about that. There's not--perhaps there isn't quite as much push for excellence, um, and it may sound like I've been trying to say that was a part of that, but 00:11:00it seemed to me that there was more of a push for excellence in the past than there is now, um, on the part, on the part of the students and perhaps on part of the faculty, as well. There is more room for mistake, and again, this is a way the health care dollar is divided and the way that medicine is developing. There's much more emphasis on, uh, making, uh, clinical dollars so that the system will work rather than on scholarly and, uh, more broad academic pursuits. And, I'll get myself in trouble, so I'd better be quiet--(Smoot laughs)--but these are just, just how I see them.

SMOOT: Well, actually this is not the first time that I have heard that sort of an assessment.

MARKESBERY: It's not a complaint; actually, it's just the way things are evolving. I think if I had my way, about half of our students would go into academic medicine, and we would have too many academicians, uh, half of them go into research and wipe out some of those diseases.

SMOOT: Well, perhaps I--let me ask if, uh, this would be, uh, the right 00:12:00sort of--(Markesbery clears throat)--blip, of the particular thing that you just raised, uh, one of the original ideas of this Medical Center, that is to say one of the original facets of the philosophy, that is to say, uh, one of the things that, that we're striving for was to bring in a number of students who would serve the needs of the people of Kentucky, specifically not necessarily go off on anything else and certainly not leave the state. Uh, do you think that emphasis has been maintained and perhaps that is part of an explanation for the lack of, uh, Kentucky students entering academic medicine?

MARKESBERY: Well, it probably is. Uh, it also represents the background of many of the students that we get here, there--and the fact that maybe some of us aren't playing quite the role model that we should to encourage students to go into academic medicine. Certainly, the school 00:13:00seems to be keeping a good number of their students, of our students within the state, uh, and the great tendency for them to practice in areas that are quite good, uh, i.e., for instance Lexington, seems to be saturated with sub-specialists. We certainly don't need any more sub-specialists in Lexington, but it seems to me that the outlying communities in Central Kentucky, uh, have a good number of doctors, and I'm sure we don't have enough doctors in small communities in Eastern Kentucky and because of the quality of life there and the fact that you have to raise a family there, we will probably never have great numbers of students migrating there, and I don't know that you have, can design a system to make them go there. I think, yeah, the medical school, the College of Medicine plus the College of Dentistry and 00:14:00other areas are certainly, have certainly, has improved the quality of care in the state and given the state lots of, of physicians into smaller communities where they probably wouldn't have had without a medical school here, I think. And that way, it's filling that role, but another role that every College of Medicine has is to make a few more of its own kind, and, uh, we're not doing that as well as we should here. I think again it may not, it may be a combination of the background of the students and perhaps your role models that we're projecting for them. It's not all their fault is what I'm trying to say. It could be our own--much of it may be our own fault.

SMOOT: Let me turn to ask you--(Markesbery clears throat)--a question about the development of this particular institution, the Sanders-Brown 00:15:00Research Center on Aging. Can you tell me a little bit about the origins of this development and what the mission of this particular research center is?

MARKESBERY: Well, it got its start when the John Y. and Eleanor Brown Foundation gave a million dollars for the purpose of building a building for basic biological research on aging. The state legislature, matched that and gave up, I think, a little bit more than a million dollars, and the University poured more money into it, so this all culminated. I think their gift was in '72 or '73. This culminated in the building being finished in 1979. Now there had been, uh, some efforts in developing an aging program in the seventies, mainly through the administration wanting to do so, but, uh, primarily through the efforts of David Wekstein, uh, associate director here. 00:16:00He kept aging alive here during the seventies. And then the building opened in, uh, the late fall of '79, had the dedication, and, uh, I took the job as director, and so, rather long, tangential story which I won't bother you with, but I was about to go to the University of California in San Francisco on another job, and because my family didn't want to move, they offered me this job, and then I, for some dumb reason, said okay, I'll take it, and, uh, the charge was at that point, and this has a political ring to it. John Y. Brown was going to be the governor, it was clear, and uh, the administration, primarily being Clawson, charged me with get the building opened, get good people into it, get the equipment into it and get something going, but the overall big picture charge was to develop the research into, 00:17:00uh, the biologic aspects into aging, not as opposed to the social and behavioral science side of things, uh, or to the clinical geriatric part of it, we were primarily trying to develop aging research, that's what the whole building was about, what it was given for and where it was conceptually aimed at. So with that in mind, with starter money from the dean, we bought, uh, a fair amount of equipment and hired the first faculty members. And, you have to understand this is not a department, to have an appointment here in the Sanders-Brown building, you have to also be primarily appointed in a department in physiology or anatomy [beeper goes off] or, uh, chemistry or something like that. I have to r-. give them about two or three minutes, and then I'll run over. Anyway, um, we hired, uh, faculty members, started, uh, 00:18:00filling the laboratory, buying equipment and trying to develop program, but the program development had to be wider than what we could just have for the building here. There were a number of people interested in studying aging in other departments, and then on places as far away as the Lexington campus, that is to say in the Department of Chemistry, the Department of Psychology. There were people interested in aging. There were people interested in physiology and anatomy that weren't physically located in this building, so what we tried to do early on was to tie together a group of people interested in studying the biologic aspects of aging, and because I'm a neurologist and neuropathologist, we developed it along the lines of the neurosciences. Now, that was, uh, a bit of freedom I had--develop the program the 00:19:00way we wanted, and it seemed most logical because that was all I knew, number one, uh, and number two, the neurosciences were and are in the process of exploding in their research, uh, in this country. If you look around in most, most medical centers, you find that they are placing a great emphasis on the neurosciences because that's where we are learning much of our basic science information now and applying it to diseases. So, we got together a group of people and put in a training grant to train pre and postdoctoral fellows, and we had, I guess, uh, twelve, twelve or thirteen trainers from a variety of different disciplines which were multidisciplinary, reaching across the Lexington campus in multiple departments within the College of Medicine and, uh, we applied to National Institute of Aging and lo and 00:20:00behold, we got funded. Surprised as could be. Uh, we got a training grant to train people which wasn't easy to do in those days. I guess this was in '81, '81 or '82--I can't remember right now--'81, I guess. It was a five year grant, and it gave us a little credibility in the Medical Center, we were just starting, and no one knew whether this was going to develop or not. The next thing we tried to--then we put in individual, obviously we had individual grants from here to NIH to study a variety of different areas of aging, and we got a few of those, so we made a little headway, and then we got together a group of people interested in Alzheimer's disease, and we put in what's called a program project grant, a group of grants working, uh, around a central theme, and, uh, we were site-visited by, uh, National Institute of Aging which is part of the National Institute of Health, and when they 00:21:00come here, they see we have our own separate building, we have our own separate animal facility, we have very elegant laboratories, they're well equipped, and our science is okay, and you have to understand the NIH scoring system, uh, a five hundred is, uh, disapproval, and one hundred is something, uh, tantamount to a Nobel Prize potential peak, so the scoring goes from one hundred to five hundred, and we got a one hundred and twenty-eight. Now, this is self-serving and boasting, but we were very, very excited to get a score of one hundred and twenty-eight. We said, gee, you guys are doing okay, your science is okay, and it gave us a lot more credibility in the Medical Center because here was a center that had developed relatively quickly and had the ultimate peer approval of NIH of saying, gee, they are doing good work, uh, got a score of one hundred and twenty-eight. So, it 00:22:00was really very, very helpful to us to get that conception. So then we started developing a lot more programs in Alzheimer's disease. We have, uh, the, uh, support groups, and we developed a network of support groups, uh, in the state and subsequently developed a daycare center for Alzheimer's disease patients. Uh, we speak all over the state and the country about Alzheimer's disease, and then there was a request for center grants, that is to say, they wanted to establish ten Alzheimer's disease research centers in the country, and we applied, we worked our heads off and put in an application for that, and, uh, lo and behold, we got to be one of the ten centers, and they came and site-visited us, looked right into our souls and try to find out whether we knew anything or not, and each of these grants, one is about 1.3, and the other is about 1.6 million dollars, put together with our training grant, we had over three million dollars in grants to study 00:23:00Alzheimer's disease and the aging nervous system which, in this day and age, and for a new place that's structured the way this is, we've been very lucky and very fortunate, and we've, we have good people. So, this is sort of a chronology of how at least one aspect of the program developed, and there are other aspects, but I'd better go. I better tell you about in a minute. Do you mind waiting?

SMOOT: No, this is fine.

MARKESBERY: I will have to go.

[End of Interview.]