Residents, interns and medical students study an X-ray
in pediatric radiology at Duke University Medical Center

A Medical Mecca
Durham boasts an impressive healthcare sector 
that employs more than one of every four residents

Most every city worth its salt has a nickname. Some are apt — the Queen City, after all, was named after King George's bride — while others have seemingly lost their meaning over the years (consider The Big Apple). But Greater Durham leaders were right on the money when they started using the moniker "City of Medicine" to describe their home.

Fueled by the growth and development of Duke University Medical Center over the past 70 years, Greater Durham indeed lays claim to an impressive health care sector that includes research, clinical and manufacturing applications. The numbers tell the story:

27.5 percent of Durham County's population is employed in healthcare;

Direct annual healthcare-related industry payroll in Durham exceeds $1.5 billion (36 percent of Durham’s workplace earnings);

Durham County is the United States home of Glaxo Wellcome, soon to be the world's second largest pharmaceutical company;

Durham is home to Quintiles Transnational, the world's largest contract research organization;

More than 50 percent of North Carolina's biotech firms are located in Durham County;

Three Nobel Laureates did their prize-winning research in Durham;

The physician-to-population ratio is four times the national average, and the county has 1,824 physicians;

The registered nurse-to-population ratio is more than three times the national average, and the county has 4,800 RNs;

Since 1981, the Durham Chamber Economic development has tracked no fewer than 110 announcements of new and expanding health-care institutions and businesses.

Durham County boasts four hospitals — DUMC, Durham Regional Hospital (now owned by Duke), North Carolina Eye and Ear Hospital and the VA Medical Center — and several nationally known weight-loss clinics, including the Rice Diet;

DUMC is ranked the sixth-best medical center in the country (U.S. News & Word Report), with several of its specialties in the top five or 10, including geriatrics, which ranks first in the nation;

Greater Durham is home to an influential non-profit organization whose primary mission is to promote the City of Medicine concept and to champion public health. That organization, Durham Health Partners Inc., is an umbrella group for City of Medicine USA, Durham Healthy Carolinians, and the Foundation for Better Health of Durham.

Although the businesses and providers that make Durham a medical mecca could succeed on their own in any community, it's clear that the concentration of such enterprises in Durham creates a powerful synergy. And it's obvious that synergy would not be possible without DUMC. The City of Medicine without DUMC would be like Rome without the Vatican.

Between Duke Hospital and the Academic Medical Center — which includes the School of Medicine — DUMC employs 12,000 people. Overall, the larger Duke University Health System, which includes Durham Regional Hospital and Raleigh Community Hospital, has a workforce of 20,000. In addition to its value as a major employer and considerable economic engine, DUMC center also benefits its neighbors because of the traffic it generates. Each year, thousands of patients come from around the state, region, country and even the world to receive medical care at DUMC, bringing with them family members who spend money on transportation, hotels, meals and gifts.

That same level of care — from specialists whose departments rank consistently in the top of their fields in the country — is available to those who pass by Duke's facilities each day on their way to work. Ensuring such access is one of the best things DUMC can do for the community, notes Dr. Ralph Snyderman, chancellor for health affairs for DUMC, executive dean of Duke University School of Medicine and president and CEO of Duke University Health System. "I've been on a lot of recruiting visits,” he says, “and the ability to attract business to RTP is enhanced by the prospect of good healthcare for their employees."

As a teaching hospital, DUMC has a commitment to care for all citizens, not just the insured, says Snyderman. "We provide $20 million in charity care a year, in addition to millions more in unreimbursed care," he says. One of its charity efforts is an initiative called Promising Partners, a collaboration between care providers and health agencies that DUMC helped launch. Promising Partners sends physicians and other clinicians into low-income areas to provide primary care for patients with conditions that are disproportionately represented in poor communities, such as diabetes, high blood pressure and asthma.

In addition to its clinical mission, DUMC continues to focus on research activities that will help pioneer new approaches to and new treatments for diseases and conditions. One of its most recent initiatives is the creation of the Genomics Institute, a university-wide effort that will help build on medical breakthroughs that may be possible as a result of scientists' successful sequencing of the human genome, including prospective health care for people whose genes indicate that they are susceptible to certain problems.

"We're here to do good," says Snyderman. "Over the next five to 10 years, we are hopeful we will increase our trajectory for developing rational models for health care delivery."

For many pharmaceutical companies, contract research firms and biomedical companies, the confluence of DUMC and its medical school and allied health programs, Research Triangle Park and RTP tenants like Glaxo Wellcome, has been too tempting to ignore. Another incentive is the Health Technologies program at Durham Technical Community College, which offers associate degrees in nursing, clinical trials research associate, dental laboratory technology, occupational therapy assistant, opticianry, pharmacy technology, phlebotomy, practical nursing, respiratory care technology, and surgical technology.

When executives of Tokyo-based Eisai Co. Ltd. were shopping for places in the United States to locate a new pharmaceutical research and manufacturing facility, they chose RTP for its people and activities. The company's pharmaceutical production and pharmaceutical and analytical research and development facility opened in 1997. As part of a rapidly growing international research-based drug company, Eisai Inc. is the U.S. pharmaceutical operating arm of its Japanese parent. U.S. headquarters for Eisai Inc. are in Teaneck, N.J. The RTP facility makes and packages two Eisai products: Aricept, a treatment for Alzheimer's disease, and Aciphex, a treatment for erosive gastroesophageal reflux disease. The company focuses its therapies on gastroenterology, neurology, acute care and oncology.

"Our decision to locate here was due to the high-quality employment pool, the existing research and development infrastructure in the area coupled with quality academic institutions," says Dr. Ray Wood, vice president for pharmaceutical and analytical research and development. "We already are expanding our 85,000-square-foot facility by an additional 24,000 square feet, and we now employ more than 130 people with 90 percent coming from the local area."

Another international drug company, EMD, is among the most recent recruits to the City of Medicine. "We came here to be close to the City of Medicine because we're developing drugs for cancer and will ultimately need to run them through clinical trials," says Matthew Emmens, president and CEO of EMD, which is the U.S. drug-development arm of German-based Merck KgaA. "We have the need for clinics that participate in clinical trials, for medical experts, for populations that can support trials and for people who can run them." Emmens and his bosses think they are addressing those needs by being located in Durham.

One of Merck's biggest drugs is the diabetes treatment glucophage, which is licensed to Bristol Myers. The company, including EMD's Durham site, concentrates on drugs that treat diseases of metabolism, such as diabetes, as well as agents that battle cancer. Promising research discoveries will create new kinds of cancer therapies that will target antibodies and proteins rather than kill cells the way standard chemotherapy drugs do, notes Emmens. This means more opportunities for drug companies on the cutting edge of research and development.

The company employs 55 people, mainly scientists involved in new drug development. Half have been local hires, including a few veterans of Glaxo Wellcome who bowed out in the wake of the company's merger with SmithKline Beechum. — Suzanne M. Wood