1. “GLOBAL MEDICAL RESEARCH: A WORK IN PROGRESS” Stuart E. Siegel, MD Director, Center for International Health Children’s Hospital Los Angeles Professor of Pediatrics, USC Keck School of Medicine Presented at: 2014 USC Provost – Faculty Senate retreat February 28, 2014

2. WHY GLOBAL MEDICAL RESEARCH? Larger Populations, Especially with Rare Diseases Diverse Populations – Ethnicity, Environment, Cultures, Resources Unique “Experiments of Nature” Complimentary Scientific Expertise and Resources Potential for Bigger, Broader Impact “Bridge Building” Larger Potential Funding Base

3. GLOBAL MEDICAL RESEARCH-KEYS TO SUCCESS INITIATION Relationship Building – Trust Mutual Scientific/Academic Benefits – Partnership Good “Fit” Strong Infrastructure Seed Funding Patience SUSTAINING Relationship Building Understanding Each Other’s Environment Continued Productivity Value to Science, Society Value to Students, Trainees, Program Time Investment Technology Support Long-Term Funding Patience and Persistence

4. CHALLENGES IN GLOBAL MEDICAL RESEARCH 1.Cultural Standards 2.Language Skills 3.Governmental and Institutional Regulations 4.Investigator Training and Discipline 5.Infrastructure Support 6.Patient Access and Compliance 7.Funding

5. LEVELS OF GLOBAL RESEARCH COLLABORATION Multi-National Research Organizations i.e. SIOP, COG Inter-Institutional and Consortia (i.e. TACL) Project-Based (i.e. PLA General Hospital and Post Graduate Medical School)

6. CHILDREN’S ONCOLOGY GROUP (COG) U.S., Canada, plus select sites in Europe, Middle East, Australia Strict Membership Criteria Phase I – III Clinical Trials Electronic Web-Based Database and Communications Teleconference, Electronic and In-Person Meetings Funding

7. CHLA PEDIATRIC ONCOLOGY COLLABORATIONS WITH THE PLA GENERAL HOSPITAL AND POST GRADUATE MEDICAL SCHOOL 1987- 1 ST Delegation of U.S. Pediatric Oncologists (CCG) to PRC (Hangzhou, China) (SES) 1987- Initial Meetings with leadership of the General Hospital/Post Graduate Medical School of the People’s Liberation Army (PLA) (Beijing) 1990-Present- Multiple educational exchange Research Fellowships, visits and Clinical Observerships with PLA General Hospital (and 9 other Chinese Pediatric Hem/Onc Programs) Research collaborations in Neuroblastoma, Retinoblastoma 1997- SES awarded Honorary Professorship by PLA General Hospital/Post Graduate Medical School 1998- Formal collaborative agreement for educational exchange in Pediatric Hem/Onc between PLA General Hospital and CHLA

8. Cont… 1999- Formal overall Institutional Collaborative Agreement between PLA General Hospital/Post Graduate Medical School and CHLA (1st with American institution) 2000- SES awarded 1999 Prize of Friendship from PLA General Hospital/Post Graduate Medical School 2001- Visit of Leadership of PLA General Hospital/Post Graduate Medical Center to CHLA October 2011- CHLA approached to be collaborator in development of U.S.-Chinese Children’s Hospital at the Beijing International Medical City (BIMC), Tongzhou District November 23, 2011 - LOI signed between CHLA and Chinese partners for Children’s Hospital at BIMC