ON DECEMBER 6, 2002 WHEN LARRY J. SHAPIRO, MD, formally accepted the positions of dean of the School of Medicine and executive vice chancellor for medical affairs, his remarks included a favorite quote from former U.S. President Bill Clinton: “When our memories outweigh our dreams, we become old.”

Shapiro, a graduate of baccalaureate and MD programs at Washington University, returns to the campus with a wealth of memories of the institution. But as his citation makes clear, those memories are eclipsed by the vision that he has for the future; they are more fuel for what can be than reminiscence of what has been.

For example, Shapiro first arrived on the medical campus as a student at about the time the revolution in genetics was beginning. Recalling his time as a medical student, he says, “No one could have predicted then most of the things we now do on a daily basis. Completing the sequence of the human genome wasn’t imaginable,” he says.

After an eminent 30-year career in genetics at UCLA and UCSF (including important contributions to the understanding of X chromosome inactivation and more than 130 journal articles), Shapiro now challenges the School of Medicine to build on its scientific strengths and to lead the way in a second genetic revolution: “At the heart of what we should be doing is the building of translational bridges—taking all of our advances in genetic sequencing, analysis, imaging and other technologies and applying them to human problems.” He calls the goals of the medical school’s BioMED XXI initiative—designed, among other things, to bring progress in genomic science to the bedside — “ambitious and large, but precisely on the mark.”

Larry J. Shapiro, MD, went on to an eminent career in research before coming full circle: Shapiro has assumed the dual positions of vice chancellor for medical affairs and dean of the School of Medicine.

Shapiro also plans close work with community leaders and organizations to effectively transfer developing technology to start-ups and bio-tech firms, an area in which he says Washington University “has not been dormant, but one in which we can be more active.” He calls on the School of Medicine to become “an engine” to drive the fruits of scientific investigation to the people who ultimately will benefit.

William Sly, MD, arguably one of the fathers of human genetics at Washington University, predicts success for Shapiro’s plan. Today chairman of biochemistry and molecular biology at Saint Louis University, Sly remembers Shapiro as “the brightest and most enthusiastic” student among a small group interested in human genetics, then adds, “He’s always been the best—at every stage of his training.”

Shapiro was first inspired toward medical science in a developmental biology class he took from Viktor Hamburger and Nobelist Rita Levi-Montalcini, an experience he recalls as “spectacular. They infused me with the excitement of scientific discovery.” He adds, “In some other places, students may be overwhelmed with rote memorization; at Washington University, people are provoked to think and are prepared for a career of lifelong learning. To promote curiosity and critical thinking —these should be the hallmarks of our programs.

We must continue to build upon our excellence in education,” he says. “We’ll soon begin construction of the Farrell Learning and Teaching Center that will be the centerpiece of our efforts. But we have to rededicate ourselves to assuming a leadership role in medical and scientific instruction. We must utilize new information technology as well as simulation modules. We need to continue the evolution to interactive discussions from large lecture formats.” His concern is with the complete student experience, he says, and he also hopes to address the issue of student indebtedness and its disproportionate influence on career choice.

Apropos of the breadth of his own education here, when Shapiro speaks of his commitment to advancing instruction, he often refers to the university as a whole. And his commitment includes fostering what he calls “community across the park.” He foresees new collaborations with endeavors on the Hilltop campus, including biomedical engineering, chemistry, physics, social work, economics and perhaps others.

“UCSF is a health sciences campus only, with no undergraduate students,” Shapiro says. “Returning to a full university, I’m reminded of how rich and wonderful the Hilltop is. The university is thriving and is a premiere institution, widely known for its quality.” Chancellor Mark Wrighton says of Shapiro: “Being a graduate of the university’s undergraduate program and medical school, he is familiar with us and our traditions. I look forward to our work together in the years to come.”

With regard to the broader community, Shapiro appreciates the enhancements to many St. Louis neighborhoods, particularly downtown and the Central West End, since the days when he was a student. “Anyone who thinks St. Louis hasn’t made progress, doesn’t remember those days,” he says. “St. Louis is a vibrant place, with a great quality of life. We have to enhance the reputation of the school and build a sense of pride for the school within the community. That’s another way for us to attract and retain the best students, faculty and staff.”

On the clinical front, Shapiro is a veteran of building partnerships in the interest of improved care. As UCSF’s pediatrician-in-chief, he worked on the attempt to merge the UCSF and Stanford medical centers. “Ultimately, it was an ill-fated marriage that came unraveled,” Shapiro says, but the joint children’s program was largely successful, and it improved the health of the children of Northern California. So Shapiro’s vision calls for the closest possible collaboration with Barnes-Jewish Hospital and St. Louis Children’s Hospital.

“It is to our mutual benefit to build on our partnership,” he says. “We couldn’t be as great as we are without a strong clinical partner. Although it is a complex association in which we may have different emphases, the success of our partnership with our teaching hospitals is critical to our future. Every top ranked medical school is associated with a great hospital.”

He aims to establish Washington University Physicians as the “very best provider of care in the region. We compete nationally in medical science; we compete nationally for the best students. We have to compete in the delivery of highly specialized, highly competent and compassionate care.”

As for “managing” the School of Medicine, Shapiro will follow the lead of former dean William A. Peck, MD, whom he succeeds, and says simply that he won’t. “It’s a misconception that the dean is in charge. I’ll have 1,400 faculty suggesting the best course of action.”

More seriously, he points out that top-down management may succeed in a corporate or government setting, but that his job is more to “help plan, execute and secure the necessary resources to allow good people to fulfill their dreams. A place so complex requires an extraordinary diversity of skills and talents. One of my key tasks is to foster excellence in all areas, to make sure everyone, not just the obvious stars, feels valued for their contributions.”

The time demands of his new job are likely to make research or clinical endeavors difficult. Although Shapiro says that he will miss his personal involvement in research and patient care, he is looking forward to the challenges of leadership. He says, “As my career has evolved and moved more toward administration, I’ve discovered a new kind of creativity. One way to be creative is to see the connections and to build the cooperation that make quantum advances possible. I find it challenging and interesting to put the people and resources together to make good things happen.”

Of Shapiro’s administrative skills overseeing the 120-member Department of Pediatrics at one of the nation’s top 10 medical schools, UCSF dean of medicine Haile T. Debas, MD, says, “His uncompromising standards and advocacy for academic excellence, his national standing as a leader . . . brought recognition to UCSF. He was not just a department chairman, he was also one of the most committed and valued campus leaders.”

Shapiro foresees a few hurdles to fulfilling his vision. “Ours is a strongly departmental system,” he says, “with financial responsibility and authority residing in the departments. It’s a good system for many reasons, but it requires activation energy to achieve interaction between departments. To create interdisciplinary programs of the size and complexity of the Siteman Cancer Center will take commitment on the part of the school’s leadership.”

A second challenge will be to continue to secure the resources required as expectations inexorably rise. “We simply have to be successful at continuing to obtain support from both granting agencies and our many friends in the community,” he says.

But overall, Shapiro concentrates on the positive over the negative, the dreams over the memories. He possesses confidence in the people of the School
of Medicine.

“What makes this institution superb is the quality of the people. They are stunning. Because of them, no other place has the same ability to bridge medicine and science. Both disciplines have become more challenging. Science is much harder and more complex. Delivering care is also more difficult. But here we are ideally positioned to translate scientific advances into clinical reality, to deliver care with scientific rigor while continuing to make groundbreaking discoveries. For me, it’s the opportunity of a lifetime.”