Giacomini lays out her vision for the UCSF School of Pharmacy

On July 1, Kathy Giacomini, PhD, BSPharm, became dean of the UCSF School of Pharmacy. A long-time faculty member and leader in the UCSF Department of Bioengineering and Therapeutic Sciences, Giacomini is known internationally as a pioneer of pharmacogenomics and membrane transporters, as well as an expert on the regulatory sciences.

As dean, Giacomini will oversee the School of Pharmacy’s endeavors in research and patient care, as well as its renowned doctor of pharmacy (PharmD) degree program. Giacomini spoke with the School’s editorial director, Levi Gadye, PhD, in late June about her vision for the future of the School.

Gadye: Nice to see you, Kathy. Excited for your first week as dean?

Giacomini: I am excited to be the new dean of the School of Pharmacy. I am still learning about the clinical component, so I’m meeting more with Desi [Kotis, PharmD, chief pharmacy executive of UCSF Health]. Once I start, I’ll spend time with Lisa [Kroon, PharmD, chair of the Department of Clinical Pharmacy] and the entire clinical faculty. I’m very clear on what I want to do in other areas, and of course I will listen to others. But I have more to learn about current clinical practice.

I’m also learning about different components of the university as well as the School. Students, faculty, staff… I haven’t had to consider all the corners of our School before, but now it’s time to think about everyone.

Gadye: It’s certainly complicated when you have these different subcultures that can all be part of biomedicine. You’ve got research, you’ve got clinicians, you’ve got clinician researchers.

Giacomini: And you’ve got students, you’ve got people who are operational, finance, human resources, you’ve got police. So those are all important for me to know about. But I’ve got only so many hours a day. They just put four budget meetings on my calendar. I hope that Alesia [Woods, associate dean of administration and finance] will attend with me, give me advice with budget priorities, “let’s find a way to work through it.”

Gadye: What have you seen the School go through in your time at UCSF? And where do you want to see it go?

Giacomini: When I first got here, in my department at least, we were focused on drug delivery and pharmacokinetics. And that’s a traditional focus of schools of pharmacy in general. As a department chair, I took great steps to expand the research portfolio in our School. And we now have, for example, regulatory science, we now have pharmacogenomics. We also have computation at all levels of drug discovery, drug development, clinical use, therapeutic use. That’s been the most exciting thing to see, that a school of pharmacy is embracing the future.

But we now need to harness that. That, to me, is the challenge. We need to create new opportunities for our pharmacy students. There’s also just a lot of change, and more and more burnout, and Lawrence [Lin, executive director of UCSF-Stanford CERSI] and I have been looking at the data on that. My job as a faculty member always was meetings, writing grants, writing papers. The research enterprise has become wonderful, but also more competitive and stressful for our faculty. The NIH dollars have been pretty flat, over time, per grant. So we have to figure out how to help that situation. I want to avoid student burnout, faculty burnout, teaching burnout, research burnout. Those are the changes, the new challenges, we’ve seen in the landscape.

Gadye: A good amount of that must come from conversations you’ve had in your position as a researcher and principal investigator.

Giacomini: Yes. I feel very proud that as chair, I contributed to our expanded research portfolio. I feel that’s very important, because then that provides the substrate for new endeavors, educational programs, clinical activities. But yes, I do have personal conversations. I fear losing that. I want to stay in touch with my faculty. I’ve been in the trenches for so long, my voice reflects that voice. I’m worried as you become Dean, you evolve or devolve, and then you don’t have that empathy anymore. And I want it.

Gadye: Is that something that you felt you had as a faculty member with Joe [Guglielmo] as dean?

Giacomini: Exactly. Joe was absolutely fantastic, very approachable and down to Earth, a kind person, and Tom Kearney is reflecting that. Mary Anne [Koda-Kimble] also was approachable. I’d like to maintain and build that empathetic atmosphere, which Joe established very nicely, that the School cares about you.

Gadye: You studied pharmacy when you were in college, you helped establish pharmacogenomics as a field, and then you had a long arc of leadership of BTS to CERSI. How have these experiences shaped your vision for the School?

Giacomini: My vision is based on the problems at hand for pharmacists, and the future of clinical pharmacy, married and wedded to the sciences that I have directly been involved with in my career. I’m a pharmacist-scientist, trained in pharmacy schools. All my problems have centered on drug discovery, development, and clinical use. Variation in drug response all the way to regulatory sciences. I’ve seen what the needs are out there, in terms of, what does the industry need to develop? Drugs, new therapeutics, diagnostics, the whole gamut, I’ve seen them, I’m interacting with them.

I realized PharmDs would be ideally suited for a wider variety of careers with more training. I see opportunities in computational pharmacology, quantitative pharmacology, regulatory sciences, pharmacogenomics, pharmacogenomic counseling. All of that I feel we could teach. That said, I do need processes and feedback to make sure these are the right things we should focus our energy on. But yes, it is my research that has given me this vision for our students and for the future of pharmacy.

Gadye: What are your other priorities for the School?

Giacomini: I want to add new opportunities in educational programs for our PharmD students. I want to add on master’s degree programs and fellowships. If you could be a PharmD computational biologist or pharmacologist, that’s exciting. I want to create that excitement.

I also want to develop new funding streams for my faculty to help support their salaries. They must support a large component of their own salary, as well as their entire lab and a research portfolio. I’m going to spend time thinking about fundraising for them.

Also, I feel science could be incorporated even more thoroughly throughout the PharmD curriculum. I’d like to think deeply with a group of people to determine the basic sciences that our students should have that will allow them to retool or grow. Let’s thread a theme of pharmacogenomics through cardiovascular, through renal, through all those thematic blocks. Should we thread regulatory science in the curriculum? I want to enhance the normal curriculum so a PharmD, with no additional training, has more science, and more things at their fingertips that might allow them to diversify and move in different directions as they grow in their career.

The other thing very important to me is to connect us to the biotech industry here. Why are we here in the backyard of the industry that is so innovative, and not really interacting as a School? I’ve been talking to a lot of people in industry. Often, pharmacist-scientists like myself, who have spent their career in industry, they care about pharmacy, and they know how PharmDs are trained. I will connect our school, through mentoring, through programs, through industrial rotations, to the industry, something that I feel needs to be coming.

It used to be, 30 years ago, that drugs were developed by large companies, but there are all these startups now. Drug discovery and more and more of drug development is spreading into the biotech industry. Even small companies need computational pharmacology, and they need regulatory sciences, because they’re now trying to take on more. It’s an exciting place. Why should pharmacy be a bubble where all they’re doing is clinical work? Clinical work is great, but one size does not fit all. Why can’t they also have other fundamental skill sets that make them attractive, and those industries will also hire them? We are poised to teach these skills that are so needed in industry, like modeling and simulation, all the way to real world data.

And last but not least, I should not forget the staff. What do staff want in their life? A good job, appreciation? I need to get to know what our staff want, so we can support their careers and their lives to the fullest.

I have a lot to think about. I’ve got some good ideas, but we’ll see if we can operationalize it.

Gadye: What do you want to do to build on the School’s existing efforts with diversity, equity, and inclusion (DEI)?

Giacomini: There’s a lot I’m planning or hoping to do. I want to create sister institutions of people, institutions in the Central Valley, maybe Cal State Hayward, institutions that have minorities, that we can approach for students who could be accepted into our program ahead of time. I want to create ways to enhance student diversity and faculty diversity, and even staff diversity. The School of Medicine has a program where they accept people from UC Merced. Igor Mitrovic is very interested in trying to establish something similar for pharmacy, it’s low hanging fruit. If with Igor, I can go over there and talk to them, and get them engaged and make these commitments, that’ll help us to really enhance our community. I also want to support Sharon Youmans’ post-baccalaureate program for PharmDs.

For us faculty, that is a tougher nut to crack. If we pick a [research] area that attracts more minorities, we may be able to enrich the faculty as a whole. The reason I was successful when I was chair in recruiting Esteban Burchard and Ryan Hernandez is that I was advertising in genomics, pharmacogenomics, and many minority scientists gravitate to those areas. I was dipping into a deeper pool than if I just advertised in another area. But we’re still low in faculty diversity, and we will need to continue to work on it.

Gadye: Could you talk about our relationship with UCSF Health?

Giacomini: UCSF Health represents a major and exciting partner for pharmacy. What I liked during the pandemic was that we were finally part of the town halls, the campus Town Hall. Our top pharmacists were there, Desi was there, and Kathy Yang.

But honestly, though we’ve made progress, we haven’t achieved this so-called dream of clinical pharmacy where we are managing the drugs more directly. I’m going to spend time asking Desi how I can help. One idea I’ve had, I want pharmacists to bill. Here’s an example. You get a genetic test, it goes to lab medicine, they get paid, they collect money for the fact that you got a genetic test. But a PharmD might interpret that test. Can we bill for interpretation? Or let’s say they put you on an antibiotic that can harm your ears and your kidney, they do a drug level on you. Lab medicine, again, they bill for that. But somebody interprets the test, and determines you need one quarter of the dose. Can we find those opportunities where we become independent providers?

I also just learned that we are about to have a pharmacogenomics consulting service at UCSF. Bani Tamraz together with Lisa [Kroon] has established it. It’s time. We’re known for some of the research, some that I have been doing, Deanna Kroetz, Akin Oni-Orisan are known for it, we’ve gotten our papers in the highest profile journals. So it’s great to know that we are about to implement pharmacogenetic testing for our patients.

Gadye: I think you’re referring to the big gap that exists between say, in oncology, where there are increasing amounts of genetic testing of tumors, leading to individualized treatments, but there’s a lack of this approach across medicine?

Giacomini: Exactly, we’re a little behind. There’s one thing good about getting to this age, I don’t have the patience to say five more years. I’ve talked to Aleksandar Rajkovic, our chief genome officer for UCSF. He’s an MD. I feel like we should have an associate chief genome officer for pharmacogenetics. If we can get ourselves involved more at those higher levels, that’ll help. And then our pharmacogenomics experts, like Bani Tamraz, Jaekyu Shin, and Akin Oni-Orisan can be involved in some of these exciting programs. We need to be doing more pharmacogenomics at the clinical level, and we need to be at the table. I’ll be working closely with Desi, and I’ll want to know, what can I do with the expertise of the School to make an impact with UCSF Health?

Gadye: What are you most excited to do as dean? And then to wrap, what are you doing for fun lately?

Giacomini: I’m most excited about meeting new people. I’m most excited about meeting even people outside our community that will support our community, alumni. I’m excited about spending time with the clinical faculty. And I’m excited about bringing my network and skill set to really elevate pharmacy the way it needs to be elevated. I can’t say it’s necessarily fun though.

Gadye: I’m sure you’ll find moments to turn off the meetings and the Zoom calls.

Giacomini: Well, I grow veggies. I grow tons of tomatoes. And I now have taken up crocheting. My mom taught me to crochet, but I totally forgot, and now she’s gone, so I went to YouTube and now I’m crocheting so many things. Do you want to see some?

Gadye: This is definitely fun, Kathy.

Giacomini: I’ll show you this. That was my second. And now I’m doing a long scarf. It’s in honor of my mom and then I’m able to think about her when I do it.

Gadye: Well, I know you’ll have something to keep busy when you need a break from running an entire School of Pharmacy.

Giacomini: Yes, and I can also watch zombie shows on TV.