I arrived in San Francisco in February of 1968. I came here because of a friendship and because I saw an opportunity to be useful. My colleagues on the Dreaded East Coast thought that I had taken leave of my senses. Most purported not to know that there was a medical school in San Francisco, let alone an entire health science campus. Such was our bleak state then.

In the interim, UCSF remade itself, emerging as one of the premier health science enterprises in the world, equally renowned for its pedagogy, research, health care and communal spirit. And I prospered in kind, living the sheltered and untrammeled life of a university professor. But that changed on July 1 of last year, when I woke up as Chancellor of this uncommon place. Why did I let that happen?

My explanation to the local press was that "an inner voice told me this is something I should probably do" - an honest answer, but also spontaneously styled for the "new age" public of San Francisco. But there was more to it than that: the job involves a number of things that I enjoy and that prefigure how I am likely to conduct myself.

First and foremost, the job is about people, and I enjoy people immensely. Like most scientists, I am no monk - although San Francisco Magazine did describe me as a "lab rat", with the clear implication that this lowly species is not normally fit for chancellorial duties. The editors seemed oblivious to the fact that eight of the nine sitting chancellors of UC are either scientists or engineers, and by most accounts, they have yet to manage the institution into the ground.

The job of chancellor is about politics, and I find politics both intriguing and necessary.

The job is about education, and I am an educator at heart.

The job is about research: getting it done and representing it to the general public; both of these are passions of mine.

The job is about health care, an interest that was bred into my bone at Harvard Medical School and the Massachusetts General Hospital.

The job is about a remarkable academic community - not just an institution, but a community; and I believe heart and soul in the importance of community.

All these things were important to my decision. But in the end, I took the job principally because of my great affection for our fundamental purposes:

• Teaching that prepares inspired, skilled, compassionate and diligent professionals and scientists.

• Research that dispels human ignorance, that speaks to human needs, and that both informs and inspires our teaching.

• Health care delivered at the highest standard, but leavened with compassion, and exploited - there can be no other word for it - exploited for our instructional mission.

• And good citizenship within the various communities that we inhabit: our academic family, our neighborhoods, our city, our professional communities and our nation.

I have something particular to say about each of these purposes.

First, TEACHING

We have a distinctive pedagogical charge that is vital to the health and welfare of all Californians: the education of biomedical scientists, dentists, nurses, pharmacists, and physicians (which I have carefully listed in alphabetical order - the chancellorship inspires new skills - alphabetizing among them). If we are to meet that charge effectively, it is imperative that we adapt our instruction to the vicissitudes of the times.

The present upheavals in health care present an immense challenge to instruction:

• economic forces are wreaking havoc with medical institutions;
• our growing technical capabilities have created ethical issues unimaginable a generation ago;
• some of our most treasured tenets of healing have fallen into doubt;
• the pace of scientific discovery threatens to bewilder us all.

The circumstances are equally acute for graduate education. Here again, an entire field of human endeavor is in great flux, with changing aspirations among students, fluctuating and diversifying opportunities for employment, and dizzying progress - the inattentive scientist easily becomes outmoded within the span of a few years.

The message is simple but daunting: it is no longer sufficient to prepare young professionals and scientists who are made in our own image. We need instead to meet the standard once set by T.H. Huxley's description of an educated person:

"[one] whose intellect is ready..., to be turned to any kind of work, and spin the gossamers as well as forge the anchors of the mind; [one] whose mind is stored with a knowledge of the great and fundamental truths of nature and of the laws of her operations; one who, no stunted ascetic, is full of life and fire, but whose passions are trained to come to heel by a vigorous will, the servant of a tender conscience; [one] who has learned to love all beauty, whether of Nature or of art, to hate all vileness, and to respect others as [themself]".

If we are to meet that standard, we must grant to teaching its rightful nobility. Teaching is our most fundamental birthright in the university: an integral part of academic service - a mandatory part, an essential part, an honorable part, a gratifying part of that service.

The desire to teach is visceral: it requires no defense, it permits no explanation, it is a cultural obligation, it is a vocation. It stands alone as a premier academic obligation.

Second, RESEARCH

UCSF is trying to sustain a world-class health science campus with less space and infrastructure than any of the institutions to which we are commonly compared.

We are proscribed from expansion at our principal location here on Parnassus Heights by an agreement that was sanctioned by the Board of Regents while I was still an untenured youth; that is still vigorously scrutinized by the community in which we reside; and that, to my eye, seems justified.

We have been forced into Rube Goldberg solutions that create inefficient and dangerously crowded facilities. We have been unable to pursue visionary new initiatives that would catch the wave of advance in biomedical science and health care. We have seen dreams thwarted.

We have chosen to address these problems by developing a second campus in the Mission Bay neighborhood of San Francisco, a neighborhood created at the turn of this century by filling an inlet of San Francisco Bay with debris from earthquakes - this is, after all, the City That Knows How.

The magnitude of our undertaking at Mission Bay is Herculean: the first phase of the project, due on line by early 2003, will create the equivalent of Rockefeller University in size, and of course, exceed it in talent. By the time the Mission Bay site is completed several decades from now, it will have constituted the largest development project in San Francisco since the building of Golden Gate Park. The cost will be prodigious, and we shall have to meet that cost largely by our own wits. We are nothing if not bold.

Our efforts at Mission Bay will have an exhilarating dimension beyond the confines of academia.

• We will be seizing a rare opportunity for the university to take the lead in urban redevelopment.
• We will be transforming a dreary postindustrial landscape into a glorious place for discovery, instruction and public service.
• We will be setting the tone for a new cityscape and an entire neighborhood.

We simply must do this well.

Third, HEALTH CARE

Charles Vest once said that he agreed to become President of MIT because it had neither a football team nor a hospital. I have already spoken of football and been self-righteous. Now I must speak of hospitals and be humbled. We own two hospitals. They are central to our purposes and a treasured part of our academic community. But to our immense dismay, circumstances have conspired to place them in harm's way.

Writing in last Thursday's New York Times, Bob Herbert described the jeopardy in stark terms: "A deep financial crisis is spreading like a virus through the nation's teaching hospitals. It is undermining their honorable and historic mission." "The bottom line has been an explosion of red ink that threatens not just the mission but the very existence of some of the finest teaching institutions". Herbert justified this gloom with a roll call of financially endangered institutions whose excellence is the envy of the modern world.

Almost two years ago, in the face of mounting jeopardy, the leadership of UCSF and Stanford University joined in a daring and controversial experiment by merging the management of their respective hospitals. The hypothetical underpinning of the experiment was that the merged entity could generate better revenues and, thus, secure our future as an academic health center.

I was not present at either the conception or birth of the experiment - I was in fact on sabbatical leave. When I returned to questions about the merger, I remarked that so far as I was concerned, it might as well have occurred on Mars.

Suddenly, I find myself on Mars. And at the same time, the experiment has taken a perverse form: it has succeeded in sustaining the original hypothesis - revenues have improved; but the experiment is nevertheless threatened with failure by a perilous rise in costs.

This is not the moment to explore the genesis of our predicament. But these things must be said: I brought a fresh eye to this experiment; I quickly became convinced that it was well conceived; it must be given a fair chance to succeed. We will move heaven and earth to preserve the academic mission of our hospitals; but above all else, we must first SAVE those hospitals.

I leave this subject with a vivid recollection. In early discussions about whether I might be willing to accept the chancellorship of UCSF, President Atkinson addressed one of my greatest anxieties by assuring me that, because of the UCSF-Stanford merger, I would not have to worry about the hospitals. Dick, I need to explore with you the definition of "worry".

Fourth, CITIZENSHIP

UCSF is part and parcel of San Francisco - part of the history, part of the warp and woof of daily life in this great city. We originated in North Beach in 1864 as Toland Medical College, then moved to Mount Sutro in time to escape the dubious influence of Carol Doda. (Allow me a personal confession: my first evening in San Francisco included a viewing of Ms. Doda's show. It was a stunning revelation for an immigrant from Harvard and the Repressive East Coast.)

UCSF has grown to be the second largest employer in San Francisco, outdone only by the city government itself. More than half of our 15,000 employees live in San Francisco proper. The remainder live in a state of continual cultural deprivation. I am nothing if not chauvinistic.

We have employees and facilities in virtually every neighborhood of the city - too many neighborhoods, in the minds of some. We operate a bus and shuttle system that carries a million riders around the city every year, with far fewer complaints than Muni.

We gave birth to the biotechnology industry and to several of its giants, such as Genentech and Chiron. Our faculty and its discoveries have since sired more than 40 new companies.

In short, we have the potential to change neighborhoods and lives. This potential sometimes frightens people, and that fear can punish us severely. To the extent that the fears are justified, we must address them. To the extent that they are misguided, we must mitigate them. We need to understand the fear and how it arises; the fearful need to understand us.

As a modest mitigating factor and on behalf of civic pride, we do produce an occasional Nobel Laureate - three in the past decade, to be exact. And I must say that this city is not particularly kind to Nobel Laureates.

Consider my own experience. On the October day in 1989 that Harold Varmus and I were summoned to Stockholm, the San Francisco Giants happened to clinch the National League Pennant - thereby relegating Harold and me to secondary headlines in the San Francisco Chronicle and Examiner. Back on the Remote East Coast, The New York Times did as well.

Harold and I must take some responsibility for the slight: we were at Candlestick Park that day, watching the game - having dispensed with the press at 8:00 AM. Will Clark won the game and the National League Pennant with a two-out single up the middle off Mitch Williams, on an 0-2 count. I will remember that piece of trivia long after I have forgotten Avagadro's number.

The Giants have not done as well, either before or since, during my 31 years in San Francisco. And to make matters worse, though an ardent Giants fan, I now report to a Board of Regents whose membership includes the owner of one of the Giants most formidable rivals.

PERSONAL GOALS

As I reflect on the future of UCSF, one point returns to mind again and again: we are presently highly celebrated, but we could decline in a moment of time: institutions like ours are delicate fabrics, nit together with countless human relationships and talents: the knitting can come unravelled very easily.

Here are some things that I hope to do in order to keep the fabric intact and enhance its texture.

1. I want to be accessible and responsive, following the injunction of E.M. Forster to "only connect". This is instinctive for me. I am not a "top-down" person. Top-down leadership does not nurture genius, does not sire invention. I acknowledge the need for executive authority and responsibility. But my 31 years at UCSF have taught me that most good ideas at this place originate from the ranks.

   Henry Rosovsky, the former Dean of Arts and Sciences at Harvard University, once wrote that "Not everything is improved by making it more democratic". Alas, he was referring to academic governance. He would not have fared well at the University of California, certainly not at UCSF.

   Connecting with an institution of this size and complexity is not easy. When my appointment as chancellor was announced, a colleague was perplexed by what that might mean. So a call was made to an acquaintance on the tenured faculty at another campus of UC. The first question: "What does a chancellor do?" The answer: "I haven't the slightest idea, but I will look it up in the dictionary". The second question: "Who is your chancellor?" The answer: "I haven't the slightest idea, but I will look it up in the phone book."

2. I want to be chancellor for all the campus: all the schools, all our hospitals, all our faculty, students and staff. I am determined to be catholic and equitable in my stewardship.

3. I want to sustain and build bridges: between teaching and research, between research and clinical practice, between research and industry, between academicians and management, between all of us and the general public.
4. I want to sustain excellence where we have achieved it and foster excellence where we have so far fallen short.

5. I want to nurture diversity on our campus. Diversity had a great deal to do with my coming to UCSF. During my first visit to San Francisco in 1966, I rode a Muni bus - a reasonably pleasant experience in those days. By the time I got off, I had heard six languages. I knew then that this was a place where I would want to live.

   UCSF has a strong history of seeking diversity among our students, faculty and staff. We have had some great successes and some deeply disappointing failures. I believe that we have the will to do better. I will countenance no other attitude.

6. I will do my best to make UCSF a place where people of all assignments believe that whatever they are doing is serving a higher purpose and is appreciated. I regret to say that this is not now the case - one of the most deeply disappointing revelations from my first nine months as chancellor.

   None of us can be truly effective if we have disaffected colleagues. As an institution of healing, this place above all others should foster dignified and respectful personal relationships.

7. I am concerned about housing for our students, postdoctoral fellows, staff and faculty. Affordable and accessible housing are oxymorons in San Francisco. I am doing my best to encourage imaginative new solutions to the problem. We have made some promising steps, by obtaining access to housing in the Presidio, and by committing ourselves to the construction of student housing on our Mission Bay campus. But we need to do much more.

8. With very few exceptions, - the library comes first to mind - our facilities could hardly be styled as elegant - look around you. (In preparing for this event, I proposed that we use the scoreboard to time the speakers, but more sober heads prevailed. I probably benefited as much as anyone from that...)

   I would like to change the ambiance of our place to one that nourishes souls rather than assaults them. As a beginning, I have asked that 1% of all construction costs be reserved for the procurement of fine art to grace our various premises. Consider that the capital budget for Mission Bay will eventually exceed two billion dollars, and you will understand why I hope and expect to become the darling of the art community.

9. I will dun every conceivable pocket book to augment our resources. The need is apparent at every turn. The portion of our budget that derives from the State of California has now diminished to 15%; we forage for the rest wherever it can be found. Every other campus of the University of California can report a similar circumstance.

   Let me dramatize this point in another way. US News and World Report recently published its annual rankings of US educational institutions. However dubious those rankings may be, UCSF was pleased to fare well, finding itself listed among the top ten in virtually every pertinent category.

   With few exceptions, the institutions above us were private universities blessed with ample endowments. I hasten to add that all of those exceptions were some of our sister campuses within the University of California. No other public institution of higher learning made the cut. We are equally proud of that.

"California in its heyday managed to make genius public property. By contrast, Massachusetts, the other great American academic enclave, has always kept genius locked away behind ivied walls.... The hard question for California is whether these achievements will continue... [T]hirty years from now,...it is less clear to what extent...genius will still belong to the people of California."

UCSF represents genius of many sorts: genius of the mind, genius of the eye and hand, genius of the heart and soul. It is our mutual responsibility to assure that genius of every sort remains public property in California. I embrace that responsibility with enthusiasm, and I look to all my colleagues here for help.

From the poetry of Adrienne Rich:

"My heart is moved by all I cannot save:
So much has been destroyed
I have to cast my lot with those
Who age after age, perversely,
With no extraordinary power,
Reconstitute the world."

Thank you, and wish me well.

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